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- Freyschlag, Christian F, et al.
(författare)
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Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging.
- 2018
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Ingår i: Journal of Neuro-Oncology. - : Springer Science and Business Media LLC. - 0167-594X .- 1573-7373. ; 139:3, s. 699-711
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Imaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers.METHODS: An online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery.RESULTS: A total of 128 fully completed surveys were received and analyzed. Most centers (n = 96, 75%) were academic and half of the centers (n = 64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI.CONCLUSION: A minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of ≤ 3 mm. No common standard could be obtained regarding advanced MRI protocols and PET.IMPORTANCE OF THE STUDY: We believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed "minimal core of imaging" in clinical routine will facilitate future cooperative studies.
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- Mandonnet, Emmanuel, et al.
(författare)
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Survey on current practice within the European Low-Grade Glioma Network : where do we stand and what is the next step?
- 2017
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Ingår i: Neuro-Oncology Practice. - : OXFORD UNIV PRESS. - 2054-2577 .- 2054-2585. ; 4:4, s. 241-247
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Tidskriftsartikel (refereegranskat)abstract
- Diffuse low-grade glioma form a rare entity affecting young people. Despite advances in surgery, chemotherapy, and radiation therapy, diffuse low-grade glioma are still incurable. According to current guidelines, maximum safe resection, when feasible, is the first line of treatment. Apart from surgery, all other treatment modalities (temozolomide, procarbazine-CCNU-vincristine regimen, and radiation therapy) are handled very differently among different teams, and this in spite of recent results of several phase 3 studies. Based on a European survey, this paper aimed to get a picture of this heterogeneity in diffuse low-grade glioma management, to identify clinically relevant questions raised by this heterogeneity of practice, and to propose new methodological frameworks to address these questions.
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- Rofes, Adrià, et al.
(författare)
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Survey on current cognitive practices within the European Low-Grade Glioma Network : towards a European assessment protocol.
- 2017
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Ingår i: Acta Neurochirurgica. - : Springer Science and Business Media LLC. - 0001-6268 .- 0942-0940. ; 159:7, s. 1167-1178
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The European Low-Grade Glioma network indicated a need to better understand common practices regarding the managing of diffuse low-grade gliomas. This area has experienced great advances in recent years.METHOD: A general survey on the managing of diffuse low-grade gliomas was answered by 21 centres in 11 European countries. Here we focused on specific questions regarding perioperative and intraoperative cognitive assessments.RESULTS: More centres referred to the same speech and language therapist and/or neuropsychologist across all assessments; a core of assessment tools was routinely used across centres; fluency tasks were commonly used in the perioperative stages, and object naming during surgery; tasks that tapped on attention, executive functions, visuospatial awareness, calculation and emotions were sparsely administered; preoperative assessments were performed 1 month or 1 week before surgery; timing for postoperative assessments varied; finally, more centres recommended early rehabilitation, whenever needed.CONCLUSIONS: There is an emerging trend towards following similar practices for the management of low-grade gliomas in Europe. Our results are descriptive and formalise current discussions in our group. Also, they contribute towards the development of a European assessment protocol.
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- Smits, Anja, et al.
(författare)
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Seizures and the Natural History of World Health Organization Grade II Gliomas : A Review
- 2011
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Ingår i: Neurosurgery. - 0148-396X .- 1524-4040. ; 68:5, s. 1326-1333
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Forskningsöversikt (refereegranskat)abstract
- OBJECTIVE:The majority of adults with low-grade gliomas have seizures. Despite the frequency of seizures as initial symptoms and symptoms of later disease, seizures in relation to the natural course of low-grade gliomas have received little attention.METHODS:In this review, we provide an update of the literature on the prognostic impact of preoperative seizures and discuss the tumor-and treatment-related factors affecting seizure control at later stages of the disease.RESULTS:Seizures occur most frequently at disease presentation and predict a more favorable outcome. Initial seizures are correlated with tumor location and possibly indirectly to the molecular profile of the tumor. About 50% of all patients with seizures at presentation continue to have seizures before surgery. Maximal tumor resection, including resection of epileptic foci, is a valuable strategy for improving seizure control. In addition, radiotherapy and chemotherapy, as single therapies or in combination with surgery, have shown beneficial effects in terms of seizure reduction. Recurrent seizures after macroscopically complete tumor resection may be a marker for accelerated tumor growth. Recurrent seizures after an initial transient stabilization after radiotherapy and/or chemotherapy may be a marker for anaplastic tumor transformation.CONCLUSION:Preoperative seizures likely reflect, apart from tumor location, intrinsic tumor properties as well. Change in seizure control in individual patients is frequently associated with altered tumor behavior. Including seizures and seizure control as clinical parameters is recommended in future trials of low-grade gliomas to further establish the prognostic value of these symptoms and to identify the factors affecting seizure control.
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- Szalisznyo, Krisztina, et al.
(författare)
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Pathological Neural Attractor Dynamics in Slowly Growing Gliomas Supports an Optimal Time Frame for White Matter Plasticity
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:7, s. e69798-
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Tidskriftsartikel (refereegranskat)abstract
- Neurological function in patients with slowly growing brain tumors can be preserved even after extensive tumor resection. However, the global process of cortical reshaping and cerebral redistribution cannot be understood without taking into account the white matter tracts. The aim of this study was to predict the functional consequences of tumor-induced white matter damage by computer simulation. A computational model was proposed, incorporating two cortical patches and the white matter connections of the uncinate fasciculus. Tumor-induced structural changes were modeled such that different aspects of the connectivity were altered, mimicking the biological heterogeneity of gliomas. The network performance was quantified by comparing memory pattern recall and the plastic compensatory capacity of the network was analyzed. The model predicts an optimal level of synaptic conductance boost that compensates for tumor-induced connectivity loss. Tumor density appears to change the optimal plasticity regime, but tumor size does not. Compensatory conductance values that are too high lead to performance loss in the network and eventually to epileptic activity. Tumors of different configurations show differences in memory recall performance with slightly lower plasticity values for dense tumors compared to more diffuse tumors. Simulation results also suggest an optimal noise level that is capable of increasing the recall performance in tumor-induced white matter damage. In conclusion, the model presented here is able to capture the influence of different tumor-related parameters on memory pattern recall decline and provides a new way to study the functional consequences of white matter invasion by slowly growing brain tumors.
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- Vigren, Patrick, et al.
(författare)
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Awake craniotomy in epilepsy surgery includes previously inoperable patients with preserved efficiency and safety
- 2023
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Ingår i: International Journal of Neuroscience. - : TAYLOR & FRANCIS LTD. - 0020-7454 .- 1563-5279.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Whilst awake craniotomy has been widely used historically in epilepsy surgery, the safety and efficacy of this approach in epilepsy surgery has been sparsely investigated in controlled studies. The objective of this study is to investigate the safety and efficacy of awake resection in epilepsy surgery and focuses on the possibility to widen surgical indications with awake surgery. Methods: Fifteen patients operated with awake epilepsy surgery were compared to 30 matched controls undergoing conventional/asleep epilepsy surgery. The groups were compared with regard to neurological complications, seizure control and location of resection. Results: Regarding seizure control, 86% of patients in the awake group reached Engel grade 1-2 compared to 73% in the control group, operated with conventional/asleep surgery, not a statistically significant difference. Neither was there a statistical significant difference regarding postoperative neurological complications. However, there was a significant difference in location of the resection when comparing the two groups. Of the 15 patients operated with awake intraoperative mapping, four had previously been considered as non-operable by epilepsy surgery centres, due to vicinity to eloquent brain regions and predicted risk of post-operative neurological deficits. Discussion: The results show that awake epilepsy surgery yields similar level of seizure control when compared to conventional asleep surgery, with maintained safety in regard to neurological complications. Furthermore, the results indicate that awake craniotomy in epilepsy surgery is feasible and possible in patients otherwise regarded as inoperable with epileptigenic zone in proximity to eloquent brain structures.
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| 9. |
- Vigren, Patrick, et al.
(författare)
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Experiences of awake surgery in non-tumoural epilepsy in eloquent localizations
- 2020
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Ingår i: Clinical neurology and neurosurgery. - : ELSEVIER. - 0303-8467 .- 1872-6968. ; 199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Whilst modern awake intraoperative mapping has been widely accepted and implemented in the last decades in neuro-oncology, sparse reports have been published on the safety and efficiency of this approach in epilepsy surgery. Method: This article reports four cases with different locations of epileptogenic zones as examples of possible safe and efficient resections. Result: The results of the resections on seizure control were Engel 1 (no disabling seizures) in all cases and no patient experienced significant neurological deficits. Discussion: The discussion focuses on aspects of the future of epilepsy surgery in a hodotopical paradigm.
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| 10. |
- Zanello, Marc, et al.
(författare)
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Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas
- 2019
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-396X .- 1524-4040. ; 85:4, s. E702-E713
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area.OBJECTIVE: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery.METHODS: Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas.RESULTS: A total of 109 patients (66.1% women; mean age 38.4 ± 12.5 yr), were studied. Age >38 yr (odds ratio [OR], 7.33; 95% confidence interval [CI], 1.53-35.19; P = .013) and time to surgery > 12 mo (OR, 18.21; 95% CI, 1.11-296.55; P = .042) are independent predictors of uncontrolled seizures at the time of surgery. Focal deficit (OR, 10.25; 95% CI, 3.16-33.28; P < .001) is an independent predictor of inability to work at the time of surgery. History of epileptic seizures at the time of surgery (OR, 7.61; 95% CI, 1.67-85.42; P = .003) and partial resection of the CA and/or of the hemosiderin rim (OR, 12.02; 95% CI, 3.01-48.13; P < .001) are independent predictors of uncontrolled seizures postoperatively. Inability to work at the time of surgery (OR, 19.54; 95% CI, 1.90-425.48; P = .050), Karnofsky Performance Status ≤ 70 (OR, 51.20; 95% CI, 1.20-2175.37; P = .039), uncontrolled seizures postoperatively (OR, 105.33; 95% CI, 4.32-2566.27; P = .004), and worsening of cognitive functions postoperatively (OR, 13.71; 95% CI, 1.06-176.66; P = .045) are independent predictors of inability to work postoperatively.CONCLUSION: The functional-based resection using intraoperative functional brain mapping allows safe resection of CA and the peripheral hemosiderin rim located within or close to eloquent brain areas.
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