M. Taphoorn, N. Galldiks, M. Preusser, M. Platten, Susan C Short
{"title":"European Association of Neuro-Oncology’s 30th anniversary: A successful and growing relationship with Neuro-Oncology Practice","authors":"M. Taphoorn, N. Galldiks, M. Preusser, M. Platten, Susan C Short","doi":"10.1093/nop/npae061","DOIUrl":"https://doi.org/10.1093/nop/npae061","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jared Sullivan, James P. Chandler, Maciej S. Lesniak, Matthew C. Tate, A. Sonabend, John A Kalapurakal, Craig Horbinski, R. Lukas, Priya Kumthekar, S. Sachdev
Report our institutional experience with pleomorphic xanthoastrocytoma (PXA) to contribute to limited data on optimal management. Patients with pathologically confirmed PXA treated at our institution between 1990 and 2019 were identified. Demographic information, tumor grade, treatment variables, and clinical outcomes were collected from patient charts. Kaplan-Meier estimates were used to summarize two primary outcome measurements: progression-free survival (PFS) and overall survival (OS). Outcomes were stratified by tumor grade and extent of resection. Cox regression and log-rank testing were performed. We identified 17 patients with pathologically confirmed PXA. Two patients were excluded due to incomplete treatment information or <6m of follow-up; 15 patients were analyzed (median follow-up 4.4y). Six patients had grade 2 PXA and 9 had grade 3 anaplastic PXA. The 2-year and 5-year PFS for the cohort was 57% and 33%, respectively; 2-year and 5-year OS was 93% and 75%, respectively. Patients with grade 2 tumors exhibited superior PFS compared to those with grade 3 tumors (2-year PFS: 100% vs. 28%, 5-year PFS: 60% vs. 14%), hazard ratio, 5.09 (95% CI: 1.06-24.50), p = 0.02. Undergoing a GTR was associated with numerical longer survival but this was not of statistical significance (hazard ratio: 0.38, p = 0.15). All but one (89%) of the grade 3 patients underwent RT. The poor survival of the cohort, especially with grade 3 tumors, suggests the need for more aggressive treatment, including maximal resection followed by intensive adjuvant therapy. Better prognostics of tumor recurrence are needed to guide the use of adjuvant therapy.
{"title":"Clinical outcomes for pleomorphic xanthoastrocytoma patients","authors":"Jared Sullivan, James P. Chandler, Maciej S. Lesniak, Matthew C. Tate, A. Sonabend, John A Kalapurakal, Craig Horbinski, R. Lukas, Priya Kumthekar, S. Sachdev","doi":"10.1093/nop/npae074","DOIUrl":"https://doi.org/10.1093/nop/npae074","url":null,"abstract":"\u0000 \u0000 \u0000 Report our institutional experience with pleomorphic xanthoastrocytoma (PXA) to contribute to limited data on optimal management.\u0000 \u0000 \u0000 \u0000 Patients with pathologically confirmed PXA treated at our institution between 1990 and 2019 were identified. Demographic information, tumor grade, treatment variables, and clinical outcomes were collected from patient charts. Kaplan-Meier estimates were used to summarize two primary outcome measurements: progression-free survival (PFS) and overall survival (OS). Outcomes were stratified by tumor grade and extent of resection. Cox regression and log-rank testing were performed.\u0000 \u0000 \u0000 \u0000 We identified 17 patients with pathologically confirmed PXA. Two patients were excluded due to incomplete treatment information or <6m of follow-up; 15 patients were analyzed (median follow-up 4.4y). Six patients had grade 2 PXA and 9 had grade 3 anaplastic PXA. The 2-year and 5-year PFS for the cohort was 57% and 33%, respectively; 2-year and 5-year OS was 93% and 75%, respectively. Patients with grade 2 tumors exhibited superior PFS compared to those with grade 3 tumors (2-year PFS: 100% vs. 28%, 5-year PFS: 60% vs. 14%), hazard ratio, 5.09 (95% CI: 1.06-24.50), p = 0.02. Undergoing a GTR was associated with numerical longer survival but this was not of statistical significance (hazard ratio: 0.38, p = 0.15). All but one (89%) of the grade 3 patients underwent RT.\u0000 \u0000 \u0000 \u0000 The poor survival of the cohort, especially with grade 3 tumors, suggests the need for more aggressive treatment, including maximal resection followed by intensive adjuvant therapy. Better prognostics of tumor recurrence are needed to guide the use of adjuvant therapy.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141920483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Taphoorn, N. Galldiks, M. Preusser, M. Platten, Susan C Short
{"title":"European Association of Neuro-Oncology’s 30th anniversary: A successful and growing relationship with Neuro-Oncology Practice","authors":"M. Taphoorn, N. Galldiks, M. Preusser, M. Platten, Susan C Short","doi":"10.1093/nop/npae061","DOIUrl":"https://doi.org/10.1093/nop/npae061","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mallika P. Patel, M. Affronti, Evan D Buckley, James E. Herndon II, Emma M Mackowsky, Margaret O Johnson, Katherine B Peters
Cancer treatment costs continue to rise with the development of new agents. Financial toxicity is defined as the quantifiable costs associated with cancer and cancer treatment in addition to the patient’s associated distress. This study's rationale is to better understand the financial burden of oral chemotherapies from the perspective of patients with primary brain tumors. After one cycle of oral chemotherapy, we requested patients to complete the Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey and additional questions relevant to insurance and cost. We summarized responses with descriptive statistics within strata defined by on-label or off-label oral therapy. Sixty surveys were completed, with most patients (n = 53, 88%) receiving on-label therapy; only 7 patients (12%) received off-label oral agents. The mean overall financial toxicity score was 23.1 (SD=11.3). When asked if their provider discussed treatment cost before initiation, 21 patients (35%) stated that they did, and 39 patients (65%) said they did not discuss cost or did not recall. However, in the off-label cohort, all seven patients stated that their provider discussed the cost before prescribing. Most patients (70%) had co-pays. Nine (17%) in the on-label group and 3 (43%) in the off-label group had chemotherapy-associated costs that negatively affected their quality of life. A higher percentage of financial distress occurred in the off-label group. Discussing medication costs with patients is an essential part of chemotherapy initiation and may mitigate undue psychosocial and financial distress.
{"title":"Financial Toxicity of Oral Chemotherapy in Patients with Primary Brain Tumors","authors":"Mallika P. Patel, M. Affronti, Evan D Buckley, James E. Herndon II, Emma M Mackowsky, Margaret O Johnson, Katherine B Peters","doi":"10.1093/nop/npae073","DOIUrl":"https://doi.org/10.1093/nop/npae073","url":null,"abstract":"\u0000 \u0000 \u0000 Cancer treatment costs continue to rise with the development of new agents. Financial toxicity is defined as the quantifiable costs associated with cancer and cancer treatment in addition to the patient’s associated distress. This study's rationale is to better understand the financial burden of oral chemotherapies from the perspective of patients with primary brain tumors.\u0000 \u0000 \u0000 \u0000 After one cycle of oral chemotherapy, we requested patients to complete the Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) survey and additional questions relevant to insurance and cost. We summarized responses with descriptive statistics within strata defined by on-label or off-label oral therapy.\u0000 \u0000 \u0000 \u0000 Sixty surveys were completed, with most patients (n = 53, 88%) receiving on-label therapy; only 7 patients (12%) received off-label oral agents. The mean overall financial toxicity score was 23.1 (SD=11.3). When asked if their provider discussed treatment cost before initiation, 21 patients (35%) stated that they did, and 39 patients (65%) said they did not discuss cost or did not recall. However, in the off-label cohort, all seven patients stated that their provider discussed the cost before prescribing. Most patients (70%) had co-pays. Nine (17%) in the on-label group and 3 (43%) in the off-label group had chemotherapy-associated costs that negatively affected their quality of life. A higher percentage of financial distress occurred in the off-label group.\u0000 \u0000 \u0000 \u0000 Discussing medication costs with patients is an essential part of chemotherapy initiation and may mitigate undue psychosocial and financial distress.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141922393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Giovanazzi, Beatrice Ugiliweneza, Elsa Alvarez, Maxwell Boakye, Darryl Kaelin, Megan B Nelson
There is concern regarding the underutilization of rehabilitation services for the malignant primary brain tumor (MPBT) population following hospitalization. Our aim is to assess physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) use after a MPBT diagnosis, evaluate the trend from 2001-2018, and compare to traumatic brain injury (TBI) and stroke. Adult cases of MPBT, TBI, and stroke were extracted from MarketScan database. Inpatient and outpatient data were screened for inpatient rehabilitation use at the time of diagnosis and post-discharge outpatient PT, OT, and SLP over 12 months. Generalized linear regressions were used for analysis. Cohort was composed of 3,381 MPBT, 205,366 stroke, and 24,825 TBI patients. After diagnosis, 1% of MPBTs were discharged to skilled nursing facilities (SNF) and 3% to inpatient rehabilitation facilities (IRF). Rehabilitation use at 12 months was 19% PT, 8% OT, and 6% SLP. These percentages were lower than stroke and TBI; stroke: 8% SNF, 8% IRF, 22% PT, 10% OT, and 8% SLP; TBI: 7% SNF, 7% IRF, 22% PT, 8% OT, and 6% SLP. Outpatient therapies increased from 2001 to 2018, with PT use consistently higher than OT and SLP. MPBT had the greatest increases in OT (7.95 times) and PT (3.89 times) compared to stroke and TBI, while stroke had the greatest increase in SLP (.98 times). MPBT patients had the highest increase of OT and PT utilization when compared to stroke and TBI. However, there remains a utilization gap which demonstrates the need for improvement.
{"title":"Rehabilitation utilization in malignant primary brain tumors compared to stroke and traumatic brain injury: Analysis using a large claim database","authors":"Samantha Giovanazzi, Beatrice Ugiliweneza, Elsa Alvarez, Maxwell Boakye, Darryl Kaelin, Megan B Nelson","doi":"10.1093/nop/npae064","DOIUrl":"https://doi.org/10.1093/nop/npae064","url":null,"abstract":"\u0000 \u0000 \u0000 There is concern regarding the underutilization of rehabilitation services for the malignant primary brain tumor (MPBT) population following hospitalization. Our aim is to assess physical therapy (PT), occupational therapy (OT), and speech-language pathology (SLP) use after a MPBT diagnosis, evaluate the trend from 2001-2018, and compare to traumatic brain injury (TBI) and stroke.\u0000 \u0000 \u0000 \u0000 Adult cases of MPBT, TBI, and stroke were extracted from MarketScan database. Inpatient and outpatient data were screened for inpatient rehabilitation use at the time of diagnosis and post-discharge outpatient PT, OT, and SLP over 12 months. Generalized linear regressions were used for analysis.\u0000 \u0000 \u0000 \u0000 Cohort was composed of 3,381 MPBT, 205,366 stroke, and 24,825 TBI patients. After diagnosis, 1% of MPBTs were discharged to skilled nursing facilities (SNF) and 3% to inpatient rehabilitation facilities (IRF). Rehabilitation use at 12 months was 19% PT, 8% OT, and 6% SLP. These percentages were lower than stroke and TBI; stroke: 8% SNF, 8% IRF, 22% PT, 10% OT, and 8% SLP; TBI: 7% SNF, 7% IRF, 22% PT, 8% OT, and 6% SLP. Outpatient therapies increased from 2001 to 2018, with PT use consistently higher than OT and SLP. MPBT had the greatest increases in OT (7.95 times) and PT (3.89 times) compared to stroke and TBI, while stroke had the greatest increase in SLP (.98 times).\u0000 \u0000 \u0000 \u0000 MPBT patients had the highest increase of OT and PT utilization when compared to stroke and TBI. However, there remains a utilization gap which demonstrates the need for improvement.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Youngdeok Kim, J. Kenyon, Jisu Kim, Kelcie D Willis, Autumn Lanoye, A. Loughan
The sleep diary and wrist-worn actigraphy are widely used to assess sleep disturbances in patients with primary brain tumors (PwPBT) in both clinical and research settings. However, their comparability has not been systematically examined. This study aimed to compare the sleep-wake patterns measured using the subjectively measured Consensus Sleep Diary (CSD) and the objectively measured ActiGraph (AG) actigraphy among PwPBT. Sleep-wake patterns were assessed through CSD and AG over 14 consecutive nights across two occasions among 30 PwPBT. AG data were processed with AG proprietary and open-source GGIR algorithms, both with and without the assistance of CSD. Thirteen sleep parameters covering sleep-wake times, sleep disruptions, sleep durations, and sleep efficiency were compared using equivalency testing, mean absolute percent error (MAPE), and intra-class correlation (ICC). The estimated sleep parameters were correlated with perceived sleep quality and compared across the different sleep measures. Significant between-measure equivalency was claimed for sleep-wake time parameters (Ps≤.05), with acceptable MAPEs (<10%). Sleep disruption parameters such as wake-after-sleep-onset were not statistically equivalent, with a large MAPE (≥10%) between the measures. Sleep efficiency was equivalent, though varied depending on how sleep efficiency was calculated. For most sleep parameters, ICCs were low and unacceptable (<.50) suggesting incomparability between the measures. Lastly, CSD-derived sleep parameters exhibited a stronger correlation with perceived sleep quality compared to actigraphy measures. The findings suggest the incomparability of sleep parameters estimated from different measures. Both subjective and objective measures are recommended to better describe sleep health among PwPBT.
{"title":"Comparison of Subjectively and Objectively Measured Sleep-Wake Patterns Among Patients with Primary Brain Tumors","authors":"Youngdeok Kim, J. Kenyon, Jisu Kim, Kelcie D Willis, Autumn Lanoye, A. Loughan","doi":"10.1093/nop/npae062","DOIUrl":"https://doi.org/10.1093/nop/npae062","url":null,"abstract":"\u0000 \u0000 \u0000 The sleep diary and wrist-worn actigraphy are widely used to assess sleep disturbances in patients with primary brain tumors (PwPBT) in both clinical and research settings. However, their comparability has not been systematically examined. This study aimed to compare the sleep-wake patterns measured using the subjectively measured Consensus Sleep Diary (CSD) and the objectively measured ActiGraph (AG) actigraphy among PwPBT.\u0000 \u0000 \u0000 \u0000 Sleep-wake patterns were assessed through CSD and AG over 14 consecutive nights across two occasions among 30 PwPBT. AG data were processed with AG proprietary and open-source GGIR algorithms, both with and without the assistance of CSD. Thirteen sleep parameters covering sleep-wake times, sleep disruptions, sleep durations, and sleep efficiency were compared using equivalency testing, mean absolute percent error (MAPE), and intra-class correlation (ICC). The estimated sleep parameters were correlated with perceived sleep quality and compared across the different sleep measures.\u0000 \u0000 \u0000 \u0000 Significant between-measure equivalency was claimed for sleep-wake time parameters (Ps≤.05), with acceptable MAPEs (<10%). Sleep disruption parameters such as wake-after-sleep-onset were not statistically equivalent, with a large MAPE (≥10%) between the measures. Sleep efficiency was equivalent, though varied depending on how sleep efficiency was calculated. For most sleep parameters, ICCs were low and unacceptable (<.50) suggesting incomparability between the measures. Lastly, CSD-derived sleep parameters exhibited a stronger correlation with perceived sleep quality compared to actigraphy measures.\u0000 \u0000 \u0000 \u0000 The findings suggest the incomparability of sleep parameters estimated from different measures. Both subjective and objective measures are recommended to better describe sleep health among PwPBT.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mestet Yibeltal Shiferaw, A. S. Baleh, Abel Gizaw, T. Teklemariam, A. Aklilu, A. Awedew, Denekew Tenaw Anley, Bereket Hailu Mekuria, Ermias Fikru Yesuf, Mengistu Ayele Yigzaw, Henock Teshome Molla, Alemu Adise Mildie, Mekides Musie Awano, Abraham Teym
Ischemic cerebrovascular complications following skull base tumor resections remain a significant factor impacting both short-term and long-term patient outcomes. This study aims to improve risk stratification, surgical decision-making and postoperative care protocols. A retrospective cohort study on predictors of ischemic cerebrovascular complications among patients who underwent skull base tumor resection was conducted at two high-volume neurosurgical centers in Ethiopia from 2018 - 2023. Binary logistic analysis was performed to see the association of each predictor variable. The study included 266 patients, with 65.5% being female. The median age and tumor size were 37 (±IQR=17) years and 4.9cm (± IQR 1.5) respectively. Ischemic cerebrovascular complications occurred in 19.9% of patients. Middle cranial fossa tumors and tumors spanning both anterior & middle cranial fossa (AOR = 6.75, 95% CI 1.66-27.54, p < 0.008), grade 3-5 vascular encasement (AOR = 5.04, 95% CI 1.79-14.12, p < 0.002), near-total resection and gross total resection (AOR = 2.89, 95% CI 1.01-8.24, p <0.048), and difficult hemostasis (AOR = 9.37, 95% CI 3.19-27.52, p < 0.000) were significantly associated with iatrogenic vascular injury. Sub-arachnoid hemorrhage had a statistically significant association with vasospasm (AOR = 12.27, 95% CI: 1.99-75.37, p = 0.007). Surgery-related ischemic cerebrovascular complications are common. Thorough perioperative risk stratification and proactive treatment planning are crucial to mitigate vascular insults associated with it. In low-resource settings, neurosurgical services are provided without advanced instruments, leading to more complications. Therefore, it's important to focus on improving neurosurgical setup to enhance patient outcomes.
颅底肿瘤切除术后缺血性脑血管并发症仍是影响患者短期和长期预后的重要因素。本研究旨在改进风险分层、手术决策和术后护理方案。 2018年至2023年，在埃塞俄比亚的两家大容量神经外科中心开展了一项关于颅底肿瘤切除术患者缺血性脑血管并发症预测因素的回顾性队列研究。研究人员进行了二元逻辑分析，以了解各预测变量之间的关联。 研究纳入了266名患者，其中65.5%为女性。中位年龄和肿瘤大小分别为37（±IQR=17）岁和4.9厘米（±IQR 1.5）。19.9%的患者出现缺血性脑血管并发症。中颅窝肿瘤和同时跨越前颅窝和中颅窝的肿瘤（AOR = 6.75，95% CI 1.66-27.54，P < 0.008）、3-5级血管包裹（AOR = 5.04，95% CI 1.79-14.12，P < 0.002）、近乎全切除和粗暴全切除（AOR = 2.89，95% CI 1.01-8.24，P <0.048）以及止血困难（AOR = 9.37，95% CI 3.19-27.52，P <0.000）与先天性血管损伤显著相关。蛛网膜下腔出血与血管痉挛有显著的统计学关联（AOR = 12.27，95% CI：1.99-75.37，p = 0.007）。 与手术相关的缺血性脑血管并发症很常见。彻底的围手术期风险分层和积极的治疗计划对于减轻与之相关的血管损伤至关重要。在资源匮乏的环境中，神经外科服务是在没有先进器械的情况下提供的，这导致了更多的并发症。因此，必须集中精力改善神经外科的设置，以提高患者的治疗效果。
{"title":"Predictors of Operative Ischemic Cerebrovascular Complications in Skull Base Tumor Resections: Experience in Low Resource Setting","authors":"Mestet Yibeltal Shiferaw, A. S. Baleh, Abel Gizaw, T. Teklemariam, A. Aklilu, A. Awedew, Denekew Tenaw Anley, Bereket Hailu Mekuria, Ermias Fikru Yesuf, Mengistu Ayele Yigzaw, Henock Teshome Molla, Alemu Adise Mildie, Mekides Musie Awano, Abraham Teym","doi":"10.1093/nop/npae063","DOIUrl":"https://doi.org/10.1093/nop/npae063","url":null,"abstract":"\u0000 \u0000 \u0000 Ischemic cerebrovascular complications following skull base tumor resections remain a significant factor impacting both short-term and long-term patient outcomes. This study aims to improve risk stratification, surgical decision-making and postoperative care protocols.\u0000 \u0000 \u0000 \u0000 A retrospective cohort study on predictors of ischemic cerebrovascular complications among patients who underwent skull base tumor resection was conducted at two high-volume neurosurgical centers in Ethiopia from 2018 - 2023. Binary logistic analysis was performed to see the association of each predictor variable.\u0000 \u0000 \u0000 \u0000 The study included 266 patients, with 65.5% being female. The median age and tumor size were 37 (±IQR=17) years and 4.9cm (± IQR 1.5) respectively. Ischemic cerebrovascular complications occurred in 19.9% of patients. Middle cranial fossa tumors and tumors spanning both anterior & middle cranial fossa (AOR = 6.75, 95% CI 1.66-27.54, p < 0.008), grade 3-5 vascular encasement (AOR = 5.04, 95% CI 1.79-14.12, p < 0.002), near-total resection and gross total resection (AOR = 2.89, 95% CI 1.01-8.24, p <0.048), and difficult hemostasis (AOR = 9.37, 95% CI 3.19-27.52, p < 0.000) were significantly associated with iatrogenic vascular injury. Sub-arachnoid hemorrhage had a statistically significant association with vasospasm (AOR = 12.27, 95% CI: 1.99-75.37, p = 0.007).\u0000 \u0000 \u0000 \u0000 Surgery-related ischemic cerebrovascular complications are common. Thorough perioperative risk stratification and proactive treatment planning are crucial to mitigate vascular insults associated with it. In low-resource settings, neurosurgical services are provided without advanced instruments, leading to more complications. Therefore, it's important to focus on improving neurosurgical setup to enhance patient outcomes.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141648508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Werner, G. Petrescu, F. Boele, M. Preusser, M. Platten, A. Chalmers, Susan C Short, K. Piil
{"title":"Chairing Scientific Sessions at International Neuro-Oncology Meetings - an EANO guide for early career professionals","authors":"J. Werner, G. Petrescu, F. Boele, M. Preusser, M. Platten, A. Chalmers, Susan C Short, K. Piil","doi":"10.1093/nop/npae060","DOIUrl":"https://doi.org/10.1093/nop/npae060","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141684663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Palliative care in neuro-oncology: The elephant in the room","authors":"Heather Leeper","doi":"10.1093/nop/npae053","DOIUrl":"https://doi.org/10.1093/nop/npae053","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141343923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Methotrexate (MTX) is administered for treatment of central nervous system (CNS) hematologic cancers, prophylaxis of CNS dissemination of certain hematological cancers, and in solid tumor leptomeningeal disease. MTX treatment can be limited by CNS toxicity. Dextromethorphan is used to treat MTX neurotoxicity, with most data derived from pediatric case series. In this report, we profile four adult patients who developed intrathecal (IT) MTX neurotoxicity to better characterize their response to dextromethorphan treatment. A case series of four patients who developed neurologic symptoms attributed to IT MTX neurotoxicity subsequently treated with dextromethorphan was devised. Demographic data, clinical characteristics, electroencephalography results, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) characteristics, and dextromethorphan treatment outcomes were described. Of the four patients developing MTX neurotoxicity, neurologic symptoms developed over a timeframe of two to fourteen days from the precedent MTX exposure. Radiologic phenotypes included subcortical white matter diffusion-restricting lesions, bi-hemispheric subcortical white matter T2-FLAIR hyperintensities, as well other findings described in the report. Time elapsed from initiation of dextromethorphan to neurologic symptom resolution ranged from 1 to 2 days. The profiles of four adult patients developing suspected IT MTX neurotoxicity syndromes with subsequent response to Dextromethorphan add further data to guide management of such patients.
甲氨蝶呤（MTX）可用于治疗中枢神经系统（CNS）血液癌症、预防某些血液癌症在中枢神经系统的扩散以及实体瘤脑膜疾病。MTX 的治疗可能会受到中枢神经系统毒性的限制。右美沙芬用于治疗 MTX 神经毒性，大多数数据来自儿科病例系列。在本报告中，我们介绍了四名出现鞘内 (IT) MTX 神经毒性的成年患者，以更好地描述他们对右美沙芬治疗的反应。 我们设计了一个病例系列，收录了四名因 IT MTX 神经毒性而出现神经系统症状、随后接受右美沙芬治疗的患者。研究描述了患者的人口统计学数据、临床特征、脑电图结果、磁共振成像（MRI）、脑脊液（CSF）特征以及右美沙芬的治疗效果。 在出现MTX神经毒性的四名患者中，神经系统症状的出现时间为首次接触MTX后的2至14天。放射学表型包括皮层下白质弥散限制性病变、双半球皮层下白质T2-FLAIR高密度以及报告中描述的其他结果。从开始使用右美沙芬到神经症状缓解的时间为 1 到 2 天不等。 四名疑似 IT MTX 神经毒性综合征的成年患者对右美沙芬的反应为指导此类患者的治疗提供了更多数据。
{"title":"Intrathecal Methotrexate, Central Nervous System Toxicity, and Response to NMDA Antagonism - An Adult Case Series","authors":"Ryan Donaghy, Lauren Singer, Karan Dixit","doi":"10.1093/nop/npae051","DOIUrl":"https://doi.org/10.1093/nop/npae051","url":null,"abstract":"\u0000 \u0000 \u0000 Methotrexate (MTX) is administered for treatment of central nervous system (CNS) hematologic cancers, prophylaxis of CNS dissemination of certain hematological cancers, and in solid tumor leptomeningeal disease. MTX treatment can be limited by CNS toxicity. Dextromethorphan is used to treat MTX neurotoxicity, with most data derived from pediatric case series. In this report, we profile four adult patients who developed intrathecal (IT) MTX neurotoxicity to better characterize their response to dextromethorphan treatment.\u0000 \u0000 \u0000 \u0000 A case series of four patients who developed neurologic symptoms attributed to IT MTX neurotoxicity subsequently treated with dextromethorphan was devised. Demographic data, clinical characteristics, electroencephalography results, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) characteristics, and dextromethorphan treatment outcomes were described.\u0000 \u0000 \u0000 \u0000 Of the four patients developing MTX neurotoxicity, neurologic symptoms developed over a timeframe of two to fourteen days from the precedent MTX exposure. Radiologic phenotypes included subcortical white matter diffusion-restricting lesions, bi-hemispheric subcortical white matter T2-FLAIR hyperintensities, as well other findings described in the report. Time elapsed from initiation of dextromethorphan to neurologic symptom resolution ranged from 1 to 2 days.\u0000 \u0000 \u0000 \u0000 The profiles of four adult patients developing suspected IT MTX neurotoxicity syndromes with subsequent response to Dextromethorphan add further data to guide management of such patients.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141351100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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