Cheolwon Jang, Byung-Kyu Cho, Sung Hwan Hwang, Hyung Jin Shin, Sang Hoon Yoon
Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. 18F-fluorodeoxy glucose positron emission tomography computed tomography (18F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.
{"title":"Leptomeningeal Spread at the Diagnosis of Glioblastoma Multiforme: A Case Report and Literature Review.","authors":"Cheolwon Jang, Byung-Kyu Cho, Sung Hwan Hwang, Hyung Jin Shin, Sang Hoon Yoon","doi":"10.14791/btrt.2022.0013","DOIUrl":"https://doi.org/10.14791/btrt.2022.0013","url":null,"abstract":"<p><p>Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. <sup>18</sup>F-fluorodeoxy glucose positron emission tomography computed tomography (<sup>18</sup>F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1d/05/btrt-10-183.PMC9353161.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jihwan Yoo, Hun Ho Park, Seok-Gu Kang, Jong Hee Chang
Brain metastasis (BM), classified as a secondary brain tumor, is the most common malignant central nervous system tumor whose median overall survival is approximately 6 months. However, the survival rate of patients with BMs has increased with recent advancements in immunotherapy and targeted therapy. This means that clinicians should take a more active position in the treatment paradigm that passively treats BMs. Because patients with BM are treated in a variety of clinical settings, treatment planning requires a more sophisticated decision-making process than that for other primary malignancies. Therefore, an accurate prognostic prediction is essential, for which a graded prognostic assessment that reflects next-generation sequencing can be helpful. It is also essential to understand the indications for various treatment modalities, such as surgical resection, stereotactic radiosurgery, and whole-brain radiotherapy and consider their advantages and disadvantages when choosing a treatment plan. Surgical resection serves a limited auxiliary function in BM, but it can be an essential therapeutic approach for increasing the survival rate of specific patients; therefore, this must be thoroughly recognized during the treatment process. The ultimate goal of surgical resection is maximal safe resection; to this end, neuronavigation, intraoperative neuro-electrophysiologic assessment including evoked potential, and the use of fluorescent materials could be helpful. In this review, we summarize the considerations for neurosurgical treatment in a rapidly changing treatment environment.
{"title":"Recent Update on Neurosurgical Management of Brain Metastasis.","authors":"Jihwan Yoo, Hun Ho Park, Seok-Gu Kang, Jong Hee Chang","doi":"10.14791/btrt.2022.0023","DOIUrl":"https://doi.org/10.14791/btrt.2022.0023","url":null,"abstract":"<p><p>Brain metastasis (BM), classified as a secondary brain tumor, is the most common malignant central nervous system tumor whose median overall survival is approximately 6 months. However, the survival rate of patients with BMs has increased with recent advancements in immunotherapy and targeted therapy. This means that clinicians should take a more active position in the treatment paradigm that passively treats BMs. Because patients with BM are treated in a variety of clinical settings, treatment planning requires a more sophisticated decision-making process than that for other primary malignancies. Therefore, an accurate prognostic prediction is essential, for which a graded prognostic assessment that reflects next-generation sequencing can be helpful. It is also essential to understand the indications for various treatment modalities, such as surgical resection, stereotactic radiosurgery, and whole-brain radiotherapy and consider their advantages and disadvantages when choosing a treatment plan. Surgical resection serves a limited auxiliary function in BM, but it can be an essential therapeutic approach for increasing the survival rate of specific patients; therefore, this must be thoroughly recognized during the treatment process. The ultimate goal of surgical resection is maximal safe resection; to this end, neuronavigation, intraoperative neuro-electrophysiologic assessment including evoked potential, and the use of fluorescent materials could be helpful. In this review, we summarize the considerations for neurosurgical treatment in a rapidly changing treatment environment.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/81/btrt-10-164.PMC9353165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sang Hwa Lee, Kyung Hwan Kim, Han-Joo Lee, Hyon-Jo Kwon, Seung-Won Choi, Seon-Hwan Kim, Hyeon-Song Koh, Jin-Young Youm
Radiation-induced cavernous hemangiomas (RICHs) have been increasingly reported as a late complication after conventional radiotherapy. RICH after stereotactic radiosurgery (SRS) is extremely rare and the few cases have been reported to demonstrate their properties. A 72-year-old female patient presented with progressive neurologic deficits. She underwent tumor surgery for meningioma 13 years ago and two times of SRS for treating a residual tumor. Newly-developed mass was 4.3 cm-sized heterogeneously enhancing mass with severe cerebral edema. She underwent surgical resection and the histologic examinations revealed organized hematoma. Finally, it was diagnosed as a RICH following SRS based on radiological and histological findings and a history of multiple radiosurgeries. Clinical, radiological, and histological features of a RICH following SRS were discussed in this report.
{"title":"A Huge Radiation-Induced Cavernous Hemangioma Following Stereotactic Radiosurgery for Meningioma: A Case Report.","authors":"Sang Hwa Lee, Kyung Hwan Kim, Han-Joo Lee, Hyon-Jo Kwon, Seung-Won Choi, Seon-Hwan Kim, Hyeon-Song Koh, Jin-Young Youm","doi":"10.14791/btrt.2022.0020","DOIUrl":"https://doi.org/10.14791/btrt.2022.0020","url":null,"abstract":"<p><p>Radiation-induced cavernous hemangiomas (RICHs) have been increasingly reported as a late complication after conventional radiotherapy. RICH after stereotactic radiosurgery (SRS) is extremely rare and the few cases have been reported to demonstrate their properties. A 72-year-old female patient presented with progressive neurologic deficits. She underwent tumor surgery for meningioma 13 years ago and two times of SRS for treating a residual tumor. Newly-developed mass was 4.3 cm-sized heterogeneously enhancing mass with severe cerebral edema. She underwent surgical resection and the histologic examinations revealed organized hematoma. Finally, it was diagnosed as a RICH following SRS based on radiological and histological findings and a history of multiple radiosurgeries. Clinical, radiological, and histological features of a RICH following SRS were discussed in this report.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f9/4d/btrt-10-190.PMC9353168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joonho Byun, Jong Hyun Kim, Moinay Kim, Seungjoo Lee, Young-Hoon Kim, Chang Ki Hong, Jeong Hoon Kim
Background: There are numerous factors to consider in deciding whether to undergo surgical treatment for brain metastasis from lung cancer. Herein, we aimed to analyze the survival outcome and predictors of recurrence of surgically treated brain metastasis from non-small cell lung cancer (NSCLC).
Methods: A total of 197 patients with brain metastasis from NSCLC who underwent microsurgery were included in this study.
Results: A total of 114 (57.9%) male and 83 (42.1%) female patients with a median age of 59 years (range, 27-79) was included in this study. The median follow-up period was 22.7 (range, 1-126) months. The 1-year and 2-year overall survival (OS) rates of patients with brain metastasis secondary to NSCLC were 59% and 43%, respectively. The 6-month and 1-year progression-free survival (PFS) rates of local recurrence were 80% and 73%, respectively, whereas those of distant recurrence were 84% and 63%, respectively. En-bloc resection of tumor resulted in better PFS for local recurrence (1-year PFS: 79% vs. 62%, p=0.02). Ventricular opening and direct contact between the tumor and the subarachnoid space were not associated with distal recurrence and leptomeningeal seeding. The difference in PFS of local recurrence according to adjuvant resection bed irradiation was not significant. Moreover, postoperative whole-brain irradiation did not show a significant difference in PFS of distant recurrence. In multivariate analysis, only en-bloc resection was a favorable prognostic factor for local recurrence. Contrastingly, multiple metastasis was a poor prognostic factor for distant recurrence.
Conclusion: En-bloc resection may reduce local recurrence after surgical resection. Ventricular opening and contact between the tumor and subarachnoid space did not show a statistically significant result for distant recurrence and leptomeningeal seeding. Multiple metastasis was only meaningful factor for distant recurrence.
背景:在决定肺癌脑转移是否接受手术治疗时,有许多因素需要考虑。在此,我们旨在分析非小细胞肺癌(NSCLC)手术治疗脑转移的生存结局和复发的预测因素。方法:197例经显微手术治疗的非小细胞肺癌脑转移患者。结果:本研究共纳入男性114例(57.9%),女性83例(42.1%),中位年龄59岁(27 ~ 79岁)。中位随访时间为22.7个月(范围1-126个月)。NSCLC继发脑转移患者1年和2年总生存率(OS)分别为59%和43%。局部复发的6个月和1年无进展生存(PFS)率分别为80%和73%,远处复发的PFS率分别为84%和63%。整体切除肿瘤导致局部复发的PFS更好(1年PFS: 79% vs. 62%, p=0.02)。脑室开放和肿瘤与蛛网膜下腔的直接接触与远端复发和脑膜轻脑膜播散无关。辅助切除床照射对局部复发的PFS差异无统计学意义。此外,术后全脑照射对远处复发的PFS无显著差异。在多变量分析中,只有整体切除是局部复发的有利预后因素。相反,多发转移是远处复发的不良预后因素。结论:整体切除可减少手术切除后局部复发。脑室开口和肿瘤与蛛网膜下腔的接触对远处复发和脑膜轻脑膜播散没有统计学意义。多发性转移是远处复发的唯一有意义的因素。
{"title":"Survival Outcomes and Predictors for Recurrence of Surgically Treated Brain Metastasis From Non-Small Cell Lung Cancer.","authors":"Joonho Byun, Jong Hyun Kim, Moinay Kim, Seungjoo Lee, Young-Hoon Kim, Chang Ki Hong, Jeong Hoon Kim","doi":"10.14791/btrt.2022.0016","DOIUrl":"https://doi.org/10.14791/btrt.2022.0016","url":null,"abstract":"<p><strong>Background: </strong>There are numerous factors to consider in deciding whether to undergo surgical treatment for brain metastasis from lung cancer. Herein, we aimed to analyze the survival outcome and predictors of recurrence of surgically treated brain metastasis from non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>A total of 197 patients with brain metastasis from NSCLC who underwent microsurgery were included in this study.</p><p><strong>Results: </strong>A total of 114 (57.9%) male and 83 (42.1%) female patients with a median age of 59 years (range, 27-79) was included in this study. The median follow-up period was 22.7 (range, 1-126) months. The 1-year and 2-year overall survival (OS) rates of patients with brain metastasis secondary to NSCLC were 59% and 43%, respectively. The 6-month and 1-year progression-free survival (PFS) rates of local recurrence were 80% and 73%, respectively, whereas those of distant recurrence were 84% and 63%, respectively. <i>En-bloc</i> resection of tumor resulted in better PFS for local recurrence (1-year PFS: 79% vs. 62%, <i>p</i>=0.02). Ventricular opening and direct contact between the tumor and the subarachnoid space were not associated with distal recurrence and leptomeningeal seeding. The difference in PFS of local recurrence according to adjuvant resection bed irradiation was not significant. Moreover, postoperative whole-brain irradiation did not show a significant difference in PFS of distant recurrence. In multivariate analysis, only <i>en-bloc</i> resection was a favorable prognostic factor for local recurrence. Contrastingly, multiple metastasis was a poor prognostic factor for distant recurrence.</p><p><strong>Conclusion: </strong><i>En-bloc</i> resection may reduce local recurrence after surgical resection. Ventricular opening and contact between the tumor and subarachnoid space did not show a statistically significant result for distant recurrence and leptomeningeal seeding. Multiple metastasis was only meaningful factor for distant recurrence.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/54/51/btrt-10-172.PMC9353167.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dysembryoplastic neuroepithelial tumor (DNET) is a distinct type of low-grade glioneuronal tumor. Clinically, DNET is highly associated with intractable epilepsy in young children and adolescents. Therefore, the burden of the tumor comprises oncological concerns (recurrence), seizure control, and quality of life. The pathology of DNET is characterized by glioneuronal elements and floating neurons. Grossly, many DNETs harbor separate nodules on the medial side of the mass. Some of the satellite lesions are bone fide tumor nodules that grow during the follow-up. Therefore, removing all satellite lesions may be important to prevent tumor progression. Seizure control is highly dependent on the complete removal of tumors, and the presence of satellite lesions also exerts a negative impact on seizure outcomes.
{"title":"Dysembryoplastic Neuroepithelial Tumor: A Benign but Complex Tumor of the Cerebral Cortex.","authors":"Ji Hoon Phi, Se Hoon Kim","doi":"10.14791/btrt.2022.0015","DOIUrl":"https://doi.org/10.14791/btrt.2022.0015","url":null,"abstract":"<p><p>Dysembryoplastic neuroepithelial tumor (DNET) is a distinct type of low-grade glioneuronal tumor. Clinically, DNET is highly associated with intractable epilepsy in young children and adolescents. Therefore, the burden of the tumor comprises oncological concerns (recurrence), seizure control, and quality of life. The pathology of DNET is characterized by glioneuronal elements and floating neurons. Grossly, many DNETs harbor separate nodules on the medial side of the mass. Some of the satellite lesions are <i>bone fide</i> tumor nodules that grow during the follow-up. Therefore, removing all satellite lesions may be important to prevent tumor progression. Seizure control is highly dependent on the complete removal of tumors, and the presence of satellite lesions also exerts a negative impact on seizure outcomes.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/4c/btrt-10-144.PMC9353162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cytotoxic chemotherapy has been a mainstay of cancer treatment since the 1940s. In the recent era of emergent targeted therapies and immunotherapies, many cytotoxic chemotherapy agents including temozolomide are still one of main weapons for the treatment of high grade gliomas. However, cytotoxic chemotherapy often causes side effects. Proper management of chemotherapy-induced toxicity can have a significant impact on a patient's quality of life and clinical outcomes. Many supportive care advances have transformed our ability to give full doses of chemotherapy, which is important for achieving their full efficacy. Prevention and treatment strategies have been developed for many chemotherapy-related toxicities. This review focused on managing gastrointestinal toxicity, chemotherapy-induced nausea and vomiting, and hematologic toxicities such as thrombocytopenia during cytotoxic chemotherapy treatment in high-grade brain tumors.
{"title":"Managing Side Effects of Cytotoxic Chemotherapy in Patients With High Grade Gliomas.","authors":"Hyerim Ha, Joo Han Lim","doi":"10.14791/btrt.2022.0018","DOIUrl":"10.14791/btrt.2022.0018","url":null,"abstract":"<p><p>Cytotoxic chemotherapy has been a mainstay of cancer treatment since the 1940s. In the recent era of emergent targeted therapies and immunotherapies, many cytotoxic chemotherapy agents including temozolomide are still one of main weapons for the treatment of high grade gliomas. However, cytotoxic chemotherapy often causes side effects. Proper management of chemotherapy-induced toxicity can have a significant impact on a patient's quality of life and clinical outcomes. Many supportive care advances have transformed our ability to give full doses of chemotherapy, which is important for achieving their full efficacy. Prevention and treatment strategies have been developed for many chemotherapy-related toxicities. This review focused on managing gastrointestinal toxicity, chemotherapy-induced nausea and vomiting, and hematologic toxicities such as thrombocytopenia during cytotoxic chemotherapy treatment in high-grade brain tumors.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/f6/btrt-10-158.PMC9353159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gi Doo Cha, Sonwoo Jung, Seung Hong Choi, Dae-Hyeong Kim
Glioblastoma multiforme (GBM) is a brain tumor notorious for its malignancy. The key reason for the limited efficacy of standard treatment is the high recurrence rate of GBM, even after surgical resection. Hence, intensive postsurgical chemical therapies, such as the systemic delivery of various drugs and/or drug combinations, are typically followed after surgery. However, overcoming the blood-brain barrier by systemic administration to efficiently deliver drugs to the brain tumor remains a daunting goal. Therefore, various local drug delivery methods showing potential for improved therapeutic efficacy have been proposed. In particular, the recent application of electronic devices for the controlled delivery of chemotherapy drugs to GBM tissue has attracted attention. We herein review the recent progress of local drug delivery strategies, including electronics-assisted strategies, at the research and commercial level. We also present a brief discussion of the unsolved challenges and future research direction of localized chemotherapy methods for GBM.
{"title":"Local Drug Delivery Strategies for Glioblastoma Treatment.","authors":"Gi Doo Cha, Sonwoo Jung, Seung Hong Choi, Dae-Hyeong Kim","doi":"10.14791/btrt.2022.0017","DOIUrl":"https://doi.org/10.14791/btrt.2022.0017","url":null,"abstract":"<p><p>Glioblastoma multiforme (GBM) is a brain tumor notorious for its malignancy. The key reason for the limited efficacy of standard treatment is the high recurrence rate of GBM, even after surgical resection. Hence, intensive postsurgical chemical therapies, such as the systemic delivery of various drugs and/or drug combinations, are typically followed after surgery. However, overcoming the blood-brain barrier by systemic administration to efficiently deliver drugs to the brain tumor remains a daunting goal. Therefore, various local drug delivery methods showing potential for improved therapeutic efficacy have been proposed. In particular, the recent application of electronic devices for the controlled delivery of chemotherapy drugs to GBM tissue has attracted attention. We herein review the recent progress of local drug delivery strategies, including electronics-assisted strategies, at the research and commercial level. We also present a brief discussion of the unsolved challenges and future research direction of localized chemotherapy methods for GBM.</p>","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/17/20/btrt-10-151.PMC9353160.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40671364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Rujimethapass, Anant Ananthanandorn, K. Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant
Background Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection. Methods Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis. Results The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001). Conclusion In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.
背景:大前庭神经鞘瘤患者的手术结果各不相同。本研究的目的是评估面神经全切和次全切患者的预后和手术并发症。方法2008年10月至2020年9月,72例患者在Rajavithi医院接受手术治疗。其中48例全部或次全切除。我们将这些参与者分为两组:VS≥3 cm (A组,n=30);VS <3 cm (B组,n=18)。比较两组患者的临床表现、影像学资料、面神经预后和手术并发症。每个病例均采用乙状结肠后入路,所有患者随访至少1年。采用卡方检验和Fisher精确检验进行统计分析。结果A组平均肿瘤大小为3.8 cm, b组为1.5 cm。A组96.7%、66.7%、50%的患者出现听力障碍、步态共济失调、面部感觉异常的临床症状,b组为100%、5.6%、11.1%。40%的大VS患者和94.4%的中小型VS患者面神经预后良好(House-Brackmann [HB]面部评分量表I-III级)。两组仅在步态共济失调(p<0.001)、面部感觉异常(p=0.006)、脑积水影像学征象(p=0.002)、面神经预后1个月(p<0.001)和面神经预后1年(p<0.001)方面存在显著差异。结论在大尺寸VS患者中,显微手术切除的面神经预后较中小尺寸VS差,计划的次全切除配合术后放射手术可能获得更好的面神经预后,并改善大尺寸VS患者的生活质量。
{"title":"Surgical Outcomes After Total or Subtotal Resection of Large Vestibular Schwannoma: A Single-Institution Experience","authors":"S. Rujimethapass, Anant Ananthanandorn, K. Karnchanapandh, Mathee Wongsirisuwan, Ittipon Gunnarat, Noppatee Segkhaphant","doi":"10.14791/btrt.2021.0028","DOIUrl":"https://doi.org/10.14791/btrt.2021.0028","url":null,"abstract":"Background Patients with large vestibular schwannomas have various surgical outcomes. The aim of this study is to evaluate facial nerve outcome and surgical complications in patients who underwent total and subtotal resection. Methods Between October 2008 and September 2020, 72 patients underwent surgery in Rajavithi Hospital. Of these, 48 had total or subtotal resection. We classified these participants into two groups: VS ≥3 cm (Group A, n=30); and VS <3 cm (Group B, n=18). Both groups were compared in terms of clinical presentation, imaging data, facial nerve outcomes, and surgical complications. The retrosigmoid approach was used in each case, and all patients had follow-up for at least 1 year. Chi-square and Fisher’s exact test were used for statistical analysis. Results The mean tumor size in Group A was 3.8 cm compared with 1.5 cm in Group B. In Group A, clinical signs of hearing dysfunction, gait ataxia, and facial paresthesia were present in 96.7%, 66.7%, 50% of patients respectively, compared with 100%, 5.6%, and 11.1% respectively in Group B. Radiographic signs of hydrocephalus were observed in 56.7% of Group A subjects, and 5.6% of those in Group B. At 1 year follow-up, 40% of patients with large VS and 94.4% of patients with small to medium size VS had good facial nerve outcomes (House-Brackmann [HB] facial grading scale grade I-III). Significant differences between the two groups were found only in gait ataxia (p<0.001), facial paresthesia (p=0.006), radiographic signs of hydrocephalus (p=0.002), facial nerve outcome 1 month (p<0.001) and facial nerve outcome 1 year (p<0.001). Conclusion In patients with large size VS, microsurgical resection had poor facial nerve outcomes compared with those of their counterparts with small to medium size VS. Planned subtotal resection with postoperative radiosurgery might attain superior facial nerve outcomes and result in better quality of life in subjects with large VS.","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41679172","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}
The artificial intelligence (AI) techniques, both deep learning end-to-end approaches and radiomics with machine learning, have been developed for various imaging-based tasks in neuro-oncology. In this brief review, use cases of AI in neuro-oncologic imaging are summarized: image quality improvement, metastasis detection, radiogenomics, and treatment response monitoring. We then give a brief overview of generative adversarial network and potential utility of synthetic images for various deep learning algorithms of imaging-based tasks and image translation tasks as becoming new data input. Lastly, we highlight the importance of cohorts and clinical trial as a true validation for clinical utility of AI in neuro-oncologic imaging.
{"title":"Artificial Intelligence in Neuro-Oncologic Imaging: A Brief Review for Clinical Use Cases and Future Perspectives","authors":"Ji Eun Park","doi":"10.14791/btrt.2021.0031","DOIUrl":"https://doi.org/10.14791/btrt.2021.0031","url":null,"abstract":"The artificial intelligence (AI) techniques, both deep learning end-to-end approaches and radiomics with machine learning, have been developed for various imaging-based tasks in neuro-oncology. In this brief review, use cases of AI in neuro-oncologic imaging are summarized: image quality improvement, metastasis detection, radiogenomics, and treatment response monitoring. We then give a brief overview of generative adversarial network and potential utility of synthetic images for various deep learning algorithms of imaging-based tasks and image translation tasks as becoming new data input. Lastly, we highlight the importance of cohorts and clinical trial as a true validation for clinical utility of AI in neuro-oncologic imaging.","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42474724","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}
Seung-Bin Woo, Chang-Young Lee, Chang-Hyun Kim, Young San Ko, El Kim, Y. Shim, Sang Pyo Kim, S. Kwon
Intracranial immature teratoma is an extremely rare disease with poor prognosis and requires complicated treatment. Owing to the deep midline location of the tumor, total surgical resection of the tumor is challenging. We present our experience with a fast-growing pineal gland immature teratoma in a 4-year-old boy, who presented with obstructive hydrocephalus and abducens nerve palsy, which was treated with total surgical resection of the tumor. In addition, we aimed to determine the appropriate treatment modality for intracranial immature teratomas by reviewing the literature and investigating the prognosis.
{"title":"Rapid-Growing Intracranial Immature Teratoma Presenting Obstructive Hydrocephalus and Abducens Nerve Palsy: A Case Report and Literature Review","authors":"Seung-Bin Woo, Chang-Young Lee, Chang-Hyun Kim, Young San Ko, El Kim, Y. Shim, Sang Pyo Kim, S. Kwon","doi":"10.14791/btrt.2022.0005","DOIUrl":"https://doi.org/10.14791/btrt.2022.0005","url":null,"abstract":"Intracranial immature teratoma is an extremely rare disease with poor prognosis and requires complicated treatment. Owing to the deep midline location of the tumor, total surgical resection of the tumor is challenging. We present our experience with a fast-growing pineal gland immature teratoma in a 4-year-old boy, who presented with obstructive hydrocephalus and abducens nerve palsy, which was treated with total surgical resection of the tumor. In addition, we aimed to determine the appropriate treatment modality for intracranial immature teratomas by reviewing the literature and investigating the prognosis.","PeriodicalId":72453,"journal":{"name":"Brain tumor research and treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44989204","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}