World Neurosurg
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Review
Challenges in the Treatment of Glioblastoma: Multisystem Mechanisms of Therapeutic Resistance.
Glioblastoma is one of the most lethal human cancers, with poor survival despite surgery, radiation treatment, and chemotherapy. Advances in the treatment of this type of brain tumor are limited because of several resistance mechanisms. Such mechanisms involve limited drug entry into the central nervous system compartment by the blood-brain barrier and by actions of the normal brain to counteract tumor-targeting medications. ⋯ Metabolic cascades in glioblastoma prevent effective treatments through the optimization of glucose use, the use of alternative nutrient precursors for energy production, and the induction of hypoxia to enhance tumor growth. In the era of precision medicine, an assortment of molecular techniques is being developed to target an individual's unique tumor, with the hope that this personalized strategy will bypass therapeutic resistance. Although each resistance mechanism presents an array of challenges to effective treatment of glioblastoma, as the field recognizes and addresses these difficulties, future treatments may have more efficacy and promise for patients with glioblastoma.
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Review Historical Article
Review of Treatment of Gunshot Wounds to Head in Late 19th Century.
During the late 19th century, the seeds of modern neurosurgery were planted to bloom into what it is now known. Wars such as the American Civil War and Crimean War drove the need to find better ways of preventing mortality from gunshot wounds to the head. However, the mortality rate from all major surgical procedures to the head, neck, and face remained staggering. Herein, we describe the surgical treatments for head and neck injuries in order to improve our understanding of neurosurgical procedures performed during the late 19th century. ⋯ Because of improved understanding of infectious processes and technologic advances in surgical equipment, the late 19th century was a major milestone in creating modern day neurosurgery. The methodology behind today's treatments is no different from that of the late 19th century.
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Review Case Reports
Primary Intracranial Rhabdomyosarcoma in the Cerebellopontine Angle Resected After Preoperative Embolization.
Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Owing to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. In pediatric patients, the volume of total blood is less than in adults, and minimal intraoperative hemorrhage is desirable. ⋯ Successfully resection of primary intracranial rhabdomyosarcoma was achieved after preoperative embolization. Tumor vascularity was significantly reduced, and gross total removal was achieved safely with less hemorrhage.
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Glioblastoma is the most common primary malignant brain tumor, with more than10,000 new cases each year in the United States. Significant basic science and clinical research has been devoted to understanding this disease, yet median survival with standard of care treatment remains approximately 15 months. ⋯ These advances have generated both prognostic information as well as a multitude of treatment targets that are just now coming into clinical practice. This article aims to provide a comprehensive update on the recent use of genetic profiling to identify the molecular pathways altered in glioblastoma and to describe ongoing clinical trials to exploit these pathways for treatment.
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Glioblastoma evades conventional therapies through a variety of mechanisms, including suppression of the immune system. This immunosuppressive microenvironment provides a potential target for treatment. ⋯ Although immunotherapy has already demonstrated efficacy for a variety of other malignancies, its efficacy in glioblastoma is still unclear. Identifying predictive biomarkers and improving the management of immune-related adverse effects will help to realize the full potential of these therapies.