Journal of neuro-oncology
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Journal of neuro-oncology · Jun 2014
Clinical management and outcome of histologically verified adult brainstem gliomas in Switzerland: a retrospective analysis of 21 patients.
Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. ⋯ Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.
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Journal of neuro-oncology · Jun 2014
Yield and utility of routine postoperative imaging after resection of brain metastases.
Magnetic resonance imaging (MRI) or computerized tomography (CT) is routinely performed after resection of brain metastases (BrM), regardless of whether there are specific clinical concerns about residual tumor or potential complications. Routine imaging studies contribute a significant amount to the cost of medical care, and their yield and utility are unknown. An IRB-approved retrospective chart review study was performed to analyze all craniotomies for BrM performed at our institution from 2005 to 2012. ⋯ Of these patients, 16 were known to have small residual tumors based on intraoperative findings. Of the remaining 166 patients felt to have had gross total tumor resection, 9 (5.4%) were found to have a small amount of residual tumor on postoperative imaging; no patient had a change in treatment plan as a result. Routine postoperative imaging in patients undergoing craniotomy for BrM has a very low yield and may not be appropriate in the absence of new neurologic deficits, or specific clinical concerns about large amounts of residual tumor or intraoperative complications.
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Journal of neuro-oncology · May 2014
ReviewImaging guidelines and findings of extracranial glioblastoma.
Extracranial manifestations of glioblastoma are uncommon and include a wide spectrum of entities, such as primary spinal cord glioblastoma, spinal leptomeningeal metastasis, seeding into the scalp following intracranial glioblastoma resection, direct extension of an intracranial glioblastoma though a craniotomy defect, dissemination via shunt catheter, and systemic metastasis, including lymphatic and hematogenous spread. Imaging plays an important role in the management of patients with extracranial glioblastomas and guidelines for the imaging evaluation of these lesions are reviewed. ⋯ In particular, advanced imaging techniques such as MR spectroscopy, MR perfusion, diffusion-weighted imaging, and diffusion-tensor imaging can be useful for early detection and characterization of these lesions. CT and (18)FDG-PET are suitable modalities for evaluating systemic and CSF shunt-related metastases.
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Journal of neuro-oncology · May 2014
Efficacy of postoperative seizure prophylaxis in intra-axial brain tumor resections.
The effectiveness of seizure prophylaxis in controlling postoperative seizures following craniotomy for tumor resection is unclear. Most patients are seizure-free before surgery. To prevent seizures, it is common to treat tumor craniotomy patients postoperatively with an antiepileptic drug (AED). ⋯ No difference was found in time-to-seizure between the two groups (hazard ratio 1.38, p = 0.3776). These data show no statistically significant benefit to prophylactic postoperative AED and a nonsignificant trend for increased seizure risk with AEDs. A randomized, placebo-controlled trial is needed to clarify the benefit of postoperative AED use for brain tumor resection.
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Journal of neuro-oncology · May 2014
TP53 and p53 statuses and their clinical impact in diffuse low grade gliomas.
TP53 is a pivotal gene frequently mutated in diffuse gliomas and particularly in astrocytic tumors. The majority of studies dedicated to TP53 in gliomas were focused on mutational hotspots located in exons 5-8. Recent studies have suggested that TP53 is also mutated outside the classic mutational hotspots reported in gliomas. ⋯ In conclusion, we have identified novel TP53 mutations in LGG. TP53 mutations outside exons 4-8 are rare. Although it remains imperfect, p53 expression with a threshold of 10% is a good surrogate marker for missense TP53 mutations and appears helpful in the setting of LGG phenotype diagnosis.