Journal of neurosurgery
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Journal of neurosurgery · Dec 2020
The side door and front door to the upper retroclival region: a comparative analysis of the open pretemporal and the endoscopic endonasal transcavernous approaches.
The pretemporal transcavernous approach (PTA) and the endoscopic endonasal transcavernous approach (EETA) are both used to access the retroclival region. A direct quantitative comparison of both approaches has not been made. The authors compared the technical nuances of, and surgical exposure afforded by, each approach and identified the key elements of the approach selection process. ⋯ This study is the first to quantitatively identify the advantages and limitations of the PTA and EETA from an anatomical perspective. Understanding these data may help the skull base surgeon design a maximally effective yet minimally invasive approach to individual lesions.
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Journal of neurosurgery · Dec 2020
Association of decreased levels of lipopolysaccharide-binding protein with OKN-007-induced regression of tumor growth in an F98 rat glioma model.
High-grade gliomas, such as glioblastoma (GBM), are devastating tumors with a very poor prognosis. Previously the authors have found that the nitrone compound OKN-007 (OKlahoma Nitrone 007; or disodium 4-[(tert-butyl-imino) methyl] benzene-1,3-disulfonate N-oxide) is effective against high-grade gliomas in various GBM rodent and human xenograft models. The purpose of the present study was to assess the levels of the lipopolysaccharide-binding protein (LBP) in rodent gliomas treated with OKN-007 as well as determine the expression of LBP in human gliomas. ⋯ LBP could potentially be used as a serum diagnostic marker of treatment response in high-grade gliomas.
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Journal of neurosurgery · Dec 2020
Multimodal cerebral arteriovenous malformation treatment: a 12-year experience and comparison of key outcomes to ARUBA.
Curative treatment of unruptured brain arteriovenous malformations (AVMs) remains controversial after the only randomized controlled trial, A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), was halted prematurely because interim analysis revealed superiority of the medical management group. In contrast, meta-analyses of retrospective cohorts suggest that intervention is much safer than was found in ARUBA. ⋯ This multimodal approach to the selection and treatment of patients with brain AVMs yields good clinical outcomes with key safety endpoints (stroke, death, and mRS score 0-1) better than the ARUBA intervention arm and similar to the ARUBA medical arm at 5 years of follow-up. Results compare favorably to natural history cohorts at longer follow-up times. This suggests that tertiary care centers with integrated programs, expertise in patient selection, and individualized treatment approaches may allow for better clinical outcomes than reported in ARUBA. It supports current registry studies and merits consideration of future randomized controlled trials in patients with brain AVMs.
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Journal of neurosurgery · Dec 2020
Dual BRAF/MEK therapy in BRAF V600E-mutated primary brain tumors: a case series showing dramatic clinical and radiographic responses and a reduction in cutaneous toxicity.
BRAF V600E is a common oncogenic driver in a variety of primary brain tumors. Dual inhibitor therapy using dabrafenib (a selective oral inhibitor of several mutated forms of BRAF kinase) and trametinib (a reversible inhibitor of MEK1 and MEK2) has been used successfully for treatment of metastatic melanoma, anaplastic thyroid cancer, and other tumor types, but has been reported in only a few patients with primary brain tumors and none with pleomorphic xanthoastrocytoma. Here, the authors report on the substantial clinical response and reduction in cutaneous toxicity in a case series of BRAF V600E primary brain cancers treated with dual BRAF/MEK inhibitor therapy. ⋯ Dual BRAF/MEK inhibitor therapy represents an exciting treatment option for patients with BRAF V600E primary brain tumors. In addition to greater efficacy than single-agent dabrafenib, this combination has the potential to mitigate cutaneous toxicity, one of the most common and concerning BRAF inhibitor-related adverse events.
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Journal of neurosurgery · Dec 2020
Cognitive functioning in patients with low-grade glioma: effects of hemispheric tumor location and surgical procedure.
The authors evaluated the cognitive performance of patients with low-grade glioma (LGG) before and after surgery, and specifically investigated 1) the effects of hemispheric tumor location and 2) the type of surgery (either with or without intraoperative stimulation mapping [ISM]). ⋯ Cognitive impairments were found in patients irrespective of hemispheric tumor location, whereby patients who were operated on with ISM performed slightly worse after surgery than patients without ISM. The authors conclude that there is room for improvement of cognitive functioning in surgically treated patients with LGG. The use of specific tests for higher cognitive functions during surgery may potentially improve functional outcome, but that is to be determined in future studies and balanced against oncological outcome. Implementation of neuropsychological assessments into the clinical management of patients with LGG should be encouraged, to inform and alert patients and clinicians on the status of cognitive functioning.