Journal of neuro-oncology
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Journal of neuro-oncology · May 2012
Lexical access speed is significantly correlated with the return to professional activities after awake surgery for low-grade gliomas.
Awake surgery with intraoperative brain mapping is highly recommended for patients with diffuse low-grade gliomas in language areas, to maximise the extent of resection while preserving the integrity of functional networks and thus quality of life. The picture-naming test "DO.80" is the gold standard for language assessment before, during, and after surgery. Cognitive functioning is correlated with quality of life, itself linked with return to work. ⋯ There were no differences between the two groups regarding other measures of cognition. Assessing naming times, and not only naming accuracy, is essential in the management of low-grade glioma patients, before, during, and after surgery, to preserve their quality of life by resuming their previous professional activity. Our results have fundamental implications concerning the comprehension of language processing and its relationship with cognitive functioning.
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Journal of neuro-oncology · May 2012
Significance of target location relative to the depth from the brain surface and high-dose irradiated volume in the development of brain radionecrosis after micromultileaf collimator-based stereotactic radiosurgery for brain metastases.
The objective of this study was to investigate the factors that potentially lead to brain radionecrosis (RN) after micromultileaf collimator-based stereotactic radiosurgery (SRS) for brain metastases. We retrospectively evaluated 131 lesions with a minimum follow-up of 6 months, 43.5% of which received prior whole-brain radiotherapy (WBRT). The three-tiered location grade (LG) was defined, as follows, for each target by considering mainly the depth from the brain surface: grade 1 (superficial), involving the region at a depth of ≤5 mm from the brain surface; grade 2 (deep), located at a depth of >5 mm from the brain surface; and grade 3 (central), located in the brainstem, cerebellar peduncle, diencephalon, or basal ganglion. ⋯ For the WBRT cases, the cutoff values of V15 Gy were 5.61 and 5.20 cm(3) for S-RN and both RN, respectively. In addition to the IIDV data, LG helps predict the risk of RN. High-dose IIDV, V22 Gy, was also significantly correlated with RN, particularly for patients treated with SRS alone.
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Gliosarcoma is a variant of glioblastoma (GBM) with both glial and mesenchymal differentiation. The genetic profile of gliosarcoma is similar to that of primary GBM, except for rare EGFR amplification. However, little is known about O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase (IDH) 1/2 mutations in gliosarcomas. ⋯ Patients who underwent gross total resection (GTR) during first surgery had better survival (mean overall survival 18.1 vs. 9.04 months; P = 0.0543). In multivariate analysis, GTR and/or gamma knife surgery at recurrence was the independent favorable prognostic factor (P = 0.0003). In conclusion, MGMT methylation and IDH1 mutation are rare events in gliosarcomas, and only aggressive and repetitive local control seems to be effective in treatment of gliosarcoma.
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Journal of neuro-oncology · May 2012
Outcomes after discontinuation of antiepileptic drugs after surgery in patients with low grade brain tumors and meningiomas.
Low grade tumors are associated with a high risk of seizures. Prolonged use of antiepileptic drugs (AEDs) is associated with morbidity. Determining which patients can safely discontinue AEDs perioperatively is difficult. ⋯ Predictors of AED continuation included existence of preoperative seizures, temporal tumor location, tumor recurrence, incomplete resection, and male sex. The decision to continue AEDs was predictive for postoperative seizures even after controlling for known risk factors. Although clinicians are able to identify patients at high risk for postoperative seizures, treatment with AEDs is ineffective in many patients.