bluuebunny/crossref_metadata_2025 huggingface dataset:
EXTH-81. A RARE CASE OF RELENTLESSLY PROGRESSIVE METASTATIC PINEOCYTOMA MANAGED WITH SEQUENTIAL MULTIMODAL THERAPY
Authors: Valerius Allison , Thomsen Anna , Sener Ugur , Meyer Fredric , Mahajan Anita , Link Michael , LaChance Daniel , Ruff Michael , Burns Timothy , Giannini Caterina
Published: November 2024

BACKGROUND

Pineocytoma is a rare pineal parenchymal WHO grade 1 tumor, typically well-managed with surgical resection alone. With gross total resection (GTR), 91% 1-year and 84% 5-year survival rates have been reported. Recurrent pineocytoma is rare and optimal management in that setting is unknown, in part owing to the rarity of the condition.

METHODS

We report an atypical course of pineocytoma in a 58-year-old male involving metastatic disease.

RESULTS

A pineal mass was identified upon MRI of the brain obtained for vision changes. Patient underwent GTR, pathology was consistent with pineocytoma, WHO grade 1. Ki-67 labeling index was low at 1-2%. Despite low-grade pathology, two years later, surveillance imaging demonstrated recurrence in the pineal region and a second lesion in the right thalamus. The patient underwent gamma knife surgery (GKRS) to both lesions. Three years later, he developed three new lesions in the right cerebellum and again underwent GKRS. Subsequent surveillance imaging identified new lesions in the right cerebellum and along ventricular walls, treated with further GKRS. Nine years after initial diagnosis, focal nodular leptomeningeal metastases were discovered, along with progression at the primary tumor site. Patient was treated with GKRS to the nodular deposits followed by pembrolizumab. Further disease progression as noted despite immunotherapy. Patient was treated with 6 cycles of temozolomide chemotherapy and at further progression 3 cycles of lomustine. Upon additional progression, further radiation therapy was administered with bevacizumab to reduce risk of radiation necrosis. Patient remains on surveillance 13 years after initial diagnosis with visual changes and mild headache representing only clinical issues.

CONCLUSIONS

Although exceedingly rare, pineocytoma is capable of metastasizing to brain parenchyma and the leptomeninges, as demonstrated in our patient. However, our case demonstrates prolonged survival is possible even in the setting of relentlessly progressive metastatic disease with utilization of multimodality treatment.
QLTI-17. COMPARATIVE ANALYSIS OF LUMBAR PUNCTURE UTILITY IN DIAGNOSIS OF PRIMARY VERSUS SECONDARY CNS LYMPHOMA: A RETROSPECTIVE STUDY
Authors: Bardhan Mainak , Namrouti Amina , Sagheer Tiba Al , Linhares Yuliya , Rubens Muni , Odia Yazmin , Ahluwalia Manmeet S , Chen Zhijian
Published: November 2024

OBJECTIVES

Central nervous system lymphoma (CNSL) is a subtype of non-Hodgkin lymphoma, which affects the brain, spinal cord, leptomeninges, or eyes. It includes primary (PCNSL) and secondary CNSL (SCNSL). CNSL diagnosis relies on neuroimaging, cerebrospinal fluid (CSF) analysis (cytology, flow cytometry), and/or tissue biopsy. Lumbar punctures (LP) aid in investigating leptomeningeal involvement. Positive findings confirm CNS involvement and guide treatment decisions. This study seeks to determine the effectiveness of CSF analysis via LP in diagnosing SCNSL compared to PCNSL.

METHODS

This retrospective study comprised patients who received treatment with HD-MTX treated at our center from July 2020 to January 2024. Data was retrospectively collected from electronic medical records (EMR). Pathology reports from tissue biopsy and enhancement of CNS visualized on imaging were utilized to diagnose and differentiate PCNSL and SCNSL. CNS cytology and flow cytometry from LP were analyzed to determine the diagnostic accuracy of LP CSF cytology results in diagnosing CNSL. Descriptive statistical and comparative analysis was conducted to analyze the results.

RESULTS

The sample included 70 patients, 35 each diagnosed with PCNSL and SCNSL. Of these, only 49 patients underwent LP, with a significantly higher proportion of patients in the SCNSL group, 33 (67%), compared to the PCNSL group, 16 (33%) (P<0.001). Among those who underwent LP, CSF cytology and/or flow cytometry were positive in 19 cases, with significantly higher detection rates among the SCNSL cases (16 of 33, 48.5%) compared to the PCNSL cases (3 of 16, 18.8%; p=0.045).

CONCLUSION

Our findings indicate that LPs play a crucial role in diagnosing SCNSL, with a significantly higher CSF detection rate than PCNSL. LP has a limited impact on diagnosing PCNSL, suggesting that tissue biopsy should be prioritized to avoid increased time for PCNSL diagnosis. This study underscores the importance of tailored diagnostic approaches for suspected PCNSL and SCNSL, emphasizing the utility of LP in diagnosing SCNSL and tissue biopsy for PCNSL.
QLTI-20. BRIDGING THE GAP: UNDERSTANDING THE CURRENT TREATMENT RESPONSES TO ENHANCE THE STANDARD OF CARE AND OUTCOMES FOR MALIGNANT PERIPHERAL NERVE SHEATH TUMORS
Authors: Sachdeva Ishita , Luo Chongliang , Yang Kuangying , Zhang Lindy , Makri Stavriani , Pratilas Christine A , Hirbe Angela C
Published: November 2024

Malignant peripheral nerve sheath tumor (MPNST) are a rare and aggressive cancer that make up 5-10% of all sarcomas. There is currently no effective targeted therapy to treat MPNST and surgical resection remains the mainstay of treatment, though often not feasible due to location, size of the tumor, or presence of metastases. Evaluation of MPNST treatment response to palliative chemotherapy regimens could serve as a reference point for target response rates in clinical trials going forward. We performed a retrospective electronic health record analysis of patients with biopsy-proven diagnoses of MPNST at Washington University and Johns Hopkins University. We evaluated tumor characteristics along with treatment response, overall survival (OS), and progression free survival (PFS) rates for different chemotherapeutic regimens. The cohort comprises 140 patients, with ages at diagnosis ranging from 21 to 40 years. Most patients had tumors located in the extremities, with sizes ranging from 5-10 cm at the time of diagnosis. We identified 66 patients who received adjuvant chemotherapy, 44 received neoadjuvant chemotherapy and 28 did not receive any chemotherapy. We will present objective response rate (ORR) and clinical benefit rate (CBR) for neoadjuvant chemotherapy. Among patients with metastatic disease (n=53), 12 chemotherapy regimens were assessed. All regimens other than gemcitabine-docetaxel chemotherapy regimen performed better than the median PFS of 1.77 months which has been observed in clinical trials of targeted agents to date with the most compelling response to vincristine-irinotecan-temozolomide regimen. Despite advancements in our understanding of MPNST pathogenesis, these tumors carry a poor prognosis. Our study has identified several systemic therapies which should be further evaluated prospectively to improve treatment options and outcomes for patients with this aggressive sarcoma. These results can serve as a benchmark for future clinical trials.
QOL-02. SOCIAL NETWORKS CAN BE QUANTITATIVELY MEASURED AND NETWORKS WITH GREATER STRUCTURAL DIVERSITY ARE ASSOCIATED WITH HIGHER HUMAN FLOURISHING
Authors: Rhee John , Mastrangelo Carissa , Youssef Gilbert , Rothfeld-Wehrwein Zachary , Dhongade Vrushali , Nakhate Vihang , Batchelor Tracy , Dhand Amar
Published: November 2024

BACKGROUND

In patients with glioblastoma, the predicted progressive deterioration in physical and cognitive abilities leads to decreased quality of life for patients and their caregivers. Research has shown that one’s social environment is a major contributor to health outcomes. However, in this population, study of the social environment is a gap in the literature.

METHODS

We examined the personal social networks of 25 adult glioblastoma patients at one time between initial diagnosis and first cycle of adjuvant chemotherapy from March to September 2023. We additionally collected demographic, tumor measures, and the European Organization for Research and Treatment of Cancer Quality-of-Life for Patients with Brain Tumors (EORTC QLQ-BN20) and the Harvard Human Flourishing Index (HFI) measures.

RESULTS

The average age was 64.5 years old, 56% were female, and 84% had a Karnofsky Performance Status (KPS) of 70 or higher. Patients had large network sizes (mean of 8.8). Patients reported high levels of flourishing despite the challenging diagnosis. Flourishing was statistically significantly associated with lower network constraint (networks in which alters are less likely to be connected to each other) in a patient’s social network (p=0.046) and less lower extremity weakness (p=0.025), controlling for age, gender, income, tumor at size of diagnosis, and KPS.

CONCLUSION

Our study indicates personal social networks with more contacts who are not connected to each other are associated with greater flourishing. Quantifying the social networks of patients with glioblastoma has implications as an objective measure for supportive care trials. Moreover, standard quality-of-life measures may not adequately capture what it means to meaningfully live and flourish. Therefore, future studies should include how social networks and flourishing change over the course of illness and how this may also impact overall survival.
QOL-10. AN ASSESSMENT TOOL FOR MEASURING CAREGIVERS’ DEATH ANXIETY IN PRIMARY BRAIN TUMOR: A CONFIRMATORY FACTOR ANALYSIS
Authors: Willis Kelcie , Mladen Samantha , Rodin Gary , Loughan Ashlee , Braun Sarah
Published: November 2024

BACKGROUND

Caregivers of patients with primary brain tumor describe significant emotional distress regarding their loved one’s impending trajectory and eventual mortality—a construct known as death anxiety. Our team adapted a pre-existing, validated scale for patients with advanced cancer (the Death and Dying Distress Scale; DADDS) to measure this latent variable in caregivers of patients with primary brain tumors. Our adapted scale (DADDS-CG) demonstrated preliminarily strong internal consistency and construct validity. We now seek to confirm the factor structure, internal consistency, and convergent validity of the DADDS-CG in a second sample of neuro-oncology caregivers in accordance with best practices of measure development.

METHODS

Caregivers of those with primary brain tumors (N=221) completed an online battery of self-report questionnaires, including the 15-item Death and Dying Distress Scale-Caregiving (DADDS-CG), the Generalized Anxiety Disorder (GAD-7), and the Patient Health Questionnaire (PHQ-9). To verify the two-factor structure of the DADDS-CG, we used confirmatory factor analysis. Cronbach’s alpha measured internal consistency, Pearson correlations assessed convergent validity, and descriptive statistics determined the prevalence of death anxiety.

RESULTS

Caregivers (Mage=46.2) were primarily White (85.5%) female (72.4%) spouses (75.6%). The two-factor model demonstrated adequate fit (X2/df=4.24; CFI-.89; NFI=.87; RMSEA=.06), suggesting two correlated subscales of death anxiety: Finitude and Dying (r=.80). The DADDS-CG demonstrated strong internal consistency (a=.95) and was moderately correlated with the GAD-7 (r=.73) and PHQ-9 (r=.68), suggesting adequate convergent validity. Mean scores fell within the moderate range (M=40.5, SD=18.7), with 20.8%, 36.2%, and 43.0% of caregivers reporting low, moderate, and severe death anxiety, respectively.

CONCLUSION

The DADDS-CG is a valid and reliable assessment tool for measuring death anxiety in caregivers of those with primary brain tumors. Given the high prevalence of death anxiety, future investigations are needed to understand caregiver’s death anxiety throughout the disease trajectory and to inform intervention development for neuro-oncology caregivers.
QOL-19. IMPROVING SLEEP IN THOSE WITH PRIMARY BRAIN TUMORS (PBT): A GLIMPSE INTO THE CAREGIVER’S PERSPECTIVE FOLLOWING COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA (CBT-I)
Authors: Loughan Ashlee , Lanoye Autumn , Willis Kelcie , Fox Amber , Zukas Alicia
Published: November 2024

BACKGROUND

Sleep disturbance is commonly endorsed by individuals diagnosed with primary brain tumor (PBT), yet few providers in neuro-oncology assess for sleep disturbance, and even less recommend the gold standard treatment for insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I). In our pilot of a group-based, six-session, telehealth-delivered CBT-I program, PBT patients (N=44) demonstrated clinically significant improvements in self-reported insomnia, fatigue, and sleep quality. The aim of this secondary analysis was to examine informal caregivers’ perspectives of the CBT-I intervention and its impact on patients sleep.

METHODS

Caregivers (N=15, Mage=47.2±14; 53% female; 80% spouses; 93% cohabitating) of patients with PBT and insomnia completed a semi-structured exit interview, following their loved ones’ participation in CBT-I. Descriptive analysis included: perceived improvement in patient and caregiver sleep (rating 1-10; 1=no improvement, 10=great improvement), perceived benefits and drawbacks of CBT-I (open-ended), and caregivers’ recommendation of CBT-I to others with PBT and insomnia (Y/N).

RESULTS

Most caregivers (73%) noticed a moderate-to-great improvement (≥5/10) in the patient’s sleep and 20% endorsed improvements in their own sleep, following CBT-I. Observed patient benefits included: increased sleep, energy, motivation for change, use of a sleep regimen, and support. Caregivers noted minimal drawbacks of CBT-I, though some found the inflexible sleep schedule disrupted family plans and others wished to be more actively involved in the intervention. Nearly all (87%) would recommend CBT-I to others with PBT and insomnia.

CONCLUSIONS

Findings suggest that caregivers observed benefit in the patients’ sleep following a brief behavioral intervention for insomnia, further supporting the acceptability of CBT-I for patients with PBT and insomnia. Future directions include a randomized, two-arm pilot of CBT-I and encouraging caregiver participation in the intervention, both to increase their understanding of CBT-I intervention components for maximum benefit in the patient and to possibly improve their own sleep.
QOL-20. NATIONAL BRAIN TUMOR SOCIETY BRAIN TUMOR QUALITY OF LIFE RESEARCH AGENDA
Authors: Leach Danielle , Kwan Bethany , Salmi Liz , Whaley Morgan , Odom Kristin , Arons David
Published: November 2024

BACKGROUND

QoL is a critical aspect of health care outcomes, particularly in the context of brain tumor treatment and survivorship. There are evidence gaps in optimal strategies for improving QoL among brain tumor patients and care partners. Understanding the multifaceted dimensions of QoL and identifying key areas for brain tumor QoL research can significantly enhance patient care and support. Engaging the brain tumor community in defining QoL outcomes and determining research priorities can help orient research resources to community needs and perspectives.

OBJECTIVE

To summarize the process and outcomes of an NBTS-led collaborative effort to co-design a comprehensive research agenda on QoL for brain tumor patients and care partners, as outlined in the “Brain Tumor QoL Research Agenda.”

METHODS

The agenda was developed through a collaborative effort involving experts in neuro-oncology, patients, care partners, patient advocacy groups, and healthcare professionals over a two-year period. A review of existing literature, patient experiences, and expert opinions informed the identification of key research priorities. A multistakeholder advisory group held monthly meetings where brain tumor QoL was defined. In 2023, we conducted two “Research Roundtables” for adults and pediatric/AYA. The World Cafe method captured data and a survey consensus process to validate findings.

RESULTS

The QoL research agenda delineates a multifaceted framework encompassing domains crucial for understanding and improving QoL in brain tumor patients. Key focus areas include symptom management, psychosocial support, care burden, treatment decision-making, survivorship issues, and health care delivery models. An RFP was released by NBTS with input from stakeholder advisors in April 2024.

CONCLUSION

The Brain Tumor QoL Research Agenda created a roadmap for advancing research efforts aimed at enhancing the QoL of individuals affected by brain tumors. By addressing the identified research priorities, healthcare stakeholders can work towards implementing effective interventions and policies to optimize patient outcomes and well-being. This program was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (EACB-23261).
QOL-30. DIETARY CONSIDERATIONS FOR PEOPLE WITH NF1: A SYSTEMATIC REVIEW OF THE LITERATURE
Authors: Babaria Rajvi , Yogaratnam Arjun , Makri Stavriani , Romo Carlos
Published: November 2024

BACKGROUND

Neurofibromatosis type 1 (NF1) is a neurocutaneous genetic condition. Limited pre-clinical and clinical data suggests that certain metabolic disturbances, body composition differences and nutritional deficiencies may be more prevalent in people with NF1. Data on the role of dietary patterns in people with NF1 and their effects in NF1-related manifestations is scarce.

METHODS

A systematic literature review was conducted; the MeSH database of PubMed was utilized to identify controlled vocabulary and key words associated with NF1, diet, and nutrition. These terms were combined using boolean operators to query PubMed, Embase, PLOS One, and Cochrane. The inclusion criteria consisted of articles in English, full text available, human studies, published between 2000-2024. The results were screened and key details were extracted.

RESULTS

394 published articles were identified, out of which 15 met the inclusion criteria. 379 papers were excluded due to duplication or not meeting all inclusion criteria. Manuscripts included case reports, case series, retrospective and prospective studies, including a phase 2a clinical trial that only included six participants. Topics included vitamin D and bone metabolism, nutritional supplements, glucose metabolism, and nutritional intake.

CONCLUSIONS

Data regarding the effects of diet or nutritional supplements in people with NF1 is limited. Available studies suggest that a diet composed of therapeutic elements, including but not limited to, medium-chain fatty acids, calcium, and vitamin D, aids in bone growth and density, and muscle lipolysis. A single clinical trial suggests that L-carnitine supplementation is safe and feasible and might result in improved functional muscle performance in children with NF1. These conclusions might only be applicable to a small population of people with NF1 and did not result in conclusive significant clinical benefit. Further research is needed to better comprehend the role that nutrition plays in patients’ quality of life.
RBIO-06. STEREOTACTIC RADIOSURGERY ENHANCES T-CELL RECEPTOR REPERTOIRES AND INDUCES IMMUNOGENICITY IN BRAIN METASTASIS
Authors: Fukumura Kazutaka , Reuben Alexandre , Jiang Peixin , Ferguson Sherise D , Yeboa Debra N , Huse Jason T
Published: November 2024

BACKGROUND

Brain metastasis is a frequent and deadly complication of systemic malignancy. The incidence rate is increasing and the prognosis remains poor, in contrast to recent advances in the management of systemic malignancy. Our previous work revealed an immunosuppressive microenvironment in brain metastasis and correlation between T-cell status and patient outcomes, shared across the primary tumor histologies. Therefore, we hypothesize that induction of immunogenicity has potential to improve brain metastasis patient outcome.

METHODS

Pre-operative stereotactic radiosurgery (SRS) (n = 44) and post-operative SRS (n = 47) brain metastasis specimens were collected from an ongoing clinical trial (MDACC protocol 2018-0552) designed to determine optimal timing of SRS for the treatment of brain metastasis. The patient materials were extracted DNA and RNA, and subjected to T-cell receptor (TCR) repertoire sequencing and mRNA-seq to interrogate radiation-induced immunogenicity.

RESULTS

In a preliminary analysis of the first 21 specimens, Gene Set Enrichment Analysis revealed that SRS significantly enhanced multiple immune-related signaling pathways including interferon response, along with apoptotic pathways, in brain metastasis. We also found that TCR signaling and PD-1 signaling was upregulated by radiotherapy. TCR repertoire analysis further identified increased density and diversity of TCRs induced by SRS treatment. Profiling of the remaining sample set is currently ongoing.

CONCLUSIONS

In light of our previous finding regarding the correlation between immune status and outcomes of patients with brain metastases, reversing immunosuppression in brain metastasis could be a key factor on patient prognosis and treatment. Our TCR repertoire and mRNA sequencing analyses with pre-operative and post-operative SRS brain metastasis cohorts support a role for radiation-induced immunogenicity, pointing to a prospective therapeutic approach for brain metastasis management.
SURG-02. ANAPLASTIC PLEOMORPHIC XANTHOASTROCYTOMA WITH LEPTOMENINGEAL DISSEMINATION PRESENTING WITH CRANIAL NEUROPATHY IN AN ADULT PATIENT: ILLUSTRATIVE CASE AND REVIEW OF THE LITERATURE
Authors: Menaker Simon , Boyke Andre , Bannykh Serguei , Ross Lindsey , Eboli Paula
Published: November 2024

INTRODUCTION

Anaplastic pleomorphic xanthoastrocytomas (APXA) are very rare, grade III malignant astrocytic glial neoplasms first described as a distinct entity in the 2016 World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS). They are generally seen in pediatric and young adult patients as supratentorial lesions with both solid and cystic components and have a high propensity for recurrence despite local treatment. APXAs occasionally demonstrate leptomeningeal dissemination (LMD) but extremely seldom at the time of diagnosis. They are typically treated via surgical resection with adjuvant chemoradiation, although there is no standard of care for adjuvant therapy. Case Presentation: The authors describe the case of a 37-year-old male with a history of seizures since age 11 who presented with four months of worsening headache, increasingly frequent seizures, and diplopia with right cranial nerve III palsy. Imaging at the time of diagnosis of his seizure disorder as a child demonstrated a small left temporal lesion, which remained stable on imaging for over 20 years and was never biopsied, however MRI at current presentation showed significant interval enlargement with intralesional hemorrhage and leptomeningeal enhancement involving the left temporal and parietal lobes, left internal auditory canal, and right oculomotor nerve. He underwent surgical resection with gross total resection achieved and pathology revealed WHO Grade III pleomorphic xanthoastrocytoma with ATG7::RAF1 fusion, 9p21 deletion, and TERT promoter mutation on next generation sequencing. This was followed by adjuvant whole brain radiation with boost and treatment with MEK inhibitor cobimetinib. His postoperative course was remarkable for intermittent speech difficulty and improving right third nerve palsy.

CONCLUSION

We describe the unusual presentation of an already exceedingly rare primary CNS tumor, namely APXA in an adult patient with LMD and cranial neuropathy at the time of diagnosis, and detail tailored adjuvant therapy based on genomic profiling.
SURG-03. GENE EXPRESSION CHANGES ASSOCIATED WITH RECURRENCE AFTER GROSS TOTAL RESECTION OF NEWLY DIAGNOSED WHO GRADE 1 MENINGIOMA
Authors: Morshed Ramin , Nguyen Minh , Youngblood Mark , Perlow Haley , Lucas Calixto-Hope , Patel Akash , Palmer Joshua , Chandler James , Theodosopoulos Philip , Magill Stephen , Chen William , Raleigh David
Published: November 2024

Patients who undergo gross total resection (GTR) of Central Nervous System World Health Organization (WHO) grade 1 meningioma constitute a “low risk” group, but some low risk meningiomas can recur despite reassuring clinical and histological features. In this study, gene expression in newly diagnosed WHO grade 1 meningiomas that had undergone GTR were evaluated for their association with recurrence. This was a retrospective, international, multi-center cohort study that included WHO grade 1 meningiomas that underwent GTR as first treatment. Normalized gene expression values from a previously validated 34-gene panel were evaluated for their association with recurrence. Kaplan-Meier, multivariable Cox proportional hazard analyses, and K-means clustering were performed to assess the association of genes of interest with recurrence and identify molecular subgroups among clinically and histologically low risk meningiomas. 442 patients with WHO grade 1 meningiomas that underwent GTR and had available gene expression profiling data were included in the study. Median follow-up was 5.0 years (interquartile range 2.6-7.7 years), local recurrence occurred in 36 patients (8.1%), 5-year local freedom from recurrence (LFFR) was 90.5%, and median time to recurrence of 2.9 years (range 0.5-10.7 years). Eleven genes were associated with local recurrence, including lower expression of ARID1B, ESR1, LINC02593, PGR, and TMEM30B and higher expression of CDK6, CDKN2C, CKS2, KIF20A, PGK1, and TAGLN. K-means clustering based on these 11 genes distinguished 2 molecular groups of clinically and histologically low risk meningiomas with significant differences in LFFR (HR 2.5, 95% CI 1.2-5.1, p=0.016). In conclusion, gene expression profiling may help to identify newly diagnosed WHO grade 1 meningiomas that have an elevated risk of recurrence despite GTR.
SURG-04. DEVELOPMENT OF MICROSURGICAL FORCEPS EQUIPPED WITH HAPTICS TECHNOLOGY FOR IN SITU DIFFERENTIATION OF BRAIN TUMORS DURING MICROSURGERY
Authors: Ezaki Taketo , Kishima Kohki , Shibao Shunsuke , Matsunaga Takuya , Pareira Eriel Sandika , Kitamura Yohei , Nakayama Yuji , Tsuda Noboru , Takahara Kento , Iwama Takashi , Sampetrean Oltea , Ohnishi Kouhei , Shimono Tomoyuki , Sasaki Hikaru
Published: November 2024

BACKGROUND

The stiffness of human cancers is correlated with their pathology, and can be used as a biomarker for diagnosis, malignancy prediction, molecular expression, and postoperative complications. Neurosurgeons perform tumor resection based on tactile sensations. However, it takes years of surgical experience to appropriately distinguish brain tumors from surrounding parenchymal tissue. Haptics is a technology that can amplify, transmit, record, and reproduce real tactile sensation, and the physical properties (e.g., stiffness) of an object can be quantified.

METHODS

glioblastoma (SF126-FmC, U87-FmC, U251-FmC) and malignant meningioma (IOMM-Lee-FmC, HKBMM-FmC) cell lines were transplanted into nude mice, and the stiffness of tumors and normal brain tissues were measured using our newly developed surgical forceps equipped with haptic technology (haptic forceps). Furthermore, pathological examination was performed to explore the correlation between stiffness and histological characteristics.

RESULTS

We found that all five brain tumor tissues were stiffer than normal brain tissue (p<0.001), and that brain tumor (three types of glioblastomas and two types of malignant meningioma) was significantly stiffer than normal brain tissue (p<0.001 for all). The stiffness among glioblastomas was not statistically significant (p=0.468) however, among the 2 malignant meningiomas, IOMM-Lee-FmC was significantly stiffer than HKBMM-FmC (p=0.032). Upon pathological examination, no significant differences were observed in the expression of collagen fibers. However, HKBMM-FmC demonstrated a higher prevalence of necrotic changes compared to IOMM-Lee-FmC.

CONCLUSIONS

Our findings suggest that tissue stiffness could be a marker not only to distinguish brain tumors from surrounding parenchymal tissue but also to distinguish pathology and malignancy of tumors. It is also suggested that the stiffness perceived during actual surgery and the stiffness quantified using haptic forceps may correlate with histological differences. Haptic forceps may help neurosurgeons to sense minute changes in tissue stiffness.
SURG-09. IMPACT OF RESPONSIVE NEUROSTIMULATION IN PATIENTS WITH MESIAL TEMPORAL EPILEPSY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ayesha Ayesha , Raake Mohammed , Łajczak Paweł , Silva Yasmin , Ahmed Aisha Rizwan , Jabbar Rabbia , Sharma Eshita , Majeed Mir Wajid , Fagundes Walter
Published: November 2024

BACKGROUND

Brain-responsive neurostimulation, known as the RNS therapy, proves to be a safe and effective adjuvant therapy in decreasing seizure frequency among medically refractory adults with partial-onset seizures who are either seizure-prone post-surgery or are not eligible candidates for surgery. Nevertheless, previous publications have not presented outcomes specifically on subjects with Mesial temporal lobe epilepsy (MTLE). This meta-analysis aims to evaluate the effectiveness of RNS therapy in patients with medically refractory MTLE.

METHODS

A comprehensive search was conducted across the PubMed, Cochrane, and Scopus databases for studies evaluating the impact of RNS on seizure frequency in patients with mesial temporal epilepsy. Relevant studies published up to March 2024 were included. The statistical analysis assessed the mean seizure reduction, responder rate, and seizure freedom.

RESULTS

We applied a random-effects model to data from 7 cohort studies with 207 patients, which revealed a significant mean reduction in seizures among individuals who received RNS therapy (68.76%, 95%CI=57.16-80.37%, p-value<0.01). A sub-analysis of 5 studies involving 164 patients demonstrated a substantial response rate (67%, 95%CI= 47-88%, p-value<0.01). Furthermore, an analysis of 4 studies comprising 154 patients indicated a considerable proportion of patients achieved seizure freedom after treatment (Proportion=0.29, 95%CI=0.03-0.55, p-value=0.03). Notably, there was moderate to high heterogeneity across the studies.

CONCLUSION

This single-arm meta-analysis demonstrates that responsive neurostimulation could be an effective therapeutic option for patients with MTLE, significantly reducing seizure frequency and a high proportion of patients achieving seizure freedom. Further research, including randomized controlled trials with control groups, larger sample sizes, and longer follow-up periods, is warranted to validate these results and optimize patient outcomes. Keywords: neurostimulation; mesial temporal epilepsy; systematic review; meta-analysis.
SURG-15. THE INCONSISTENT TERMINOLOGY FOR EXTENT OF RESECTION IN GLIOBLASTOMA: A SYSTEMATIC REVIEW ON SIX DECADES OF NEURO-ONCOLOGICAL STUDIES
Authors: Teske Nina C , Jung Leonard B , Teske Nico , Thon Niklas , Tonn Jörg-Christian , Karschnia Philipp
Published: November 2024

BACKGROUND

More extensive resection leads to improved outcomes in patients with newly diagnosed glioblastoma. Insufficient recognition of extent of resection may introduce significant bias in clinical trials. This study aimed to systematically characterize the terminology used to describe resection in neuro-oncological studies.

METHODS

We conducted a comprehensive review of the PubMed database to identify neuro-oncological trials between January 1966 and January 2024. We selected studies providing information on extent of resection for newly diagnosed glioblastoma in adults. A standardized set of semantic and clinical variables was extracted for each study.

RESULTS

We screened a total of 1862 neuro-oncological studies, and 117 studies comprising 44 prospective interventional trials and 73 retrospective studies met our inclusion criteria. While a positive association between outcome and more extensive resection was almost universally reported, a broad range of 15 different semantic terms were used to describe extent of resection (e.g., “complete/incomplete”, “gross-total/subtotal”, or “total/partial” resection). Reflecting this inconsistent terminology, only 60 studies (60/117, 51%) provided explicit definitions for categorizing extent of resection. Of these 60 studies, 17 (17/60, 28%) used subjective measurements including intraoperative estimations for extent of resection, while 43 studies (43/60, 72%) relied on objective measurements of volumetrics on pre- and post-operative imaging. There was no difference in the number of objective definitions between prospective and retrospective studies. However, the number of studies with objective definitions was significantly higher in surgical studies compared to medical neuro-oncological studies and increased over recent years (before 2010: 21%; after 2010: 41%).

CONCLUSION

The terminology used to describe the extent of resection varies greatly across neuro-oncological studies. To minimize imbalances between study arms and enable comparisons across different institutions, adopting a standardized surgical nomenclature appears essential. The recent RANO resect classification for extent of resection might form the basis for such a standardized terminology.
SURG-18. INNOVATIVE DRUG-DEVICE COMBINATION FOR THE PHOTODYNAMIC TREATMENT OF PRIMARY GLIOBLASTOMA (GBM) PATIENTS
Authors: Dupont Clement , Lecomte Fabienne , Bonneterre Marie-Edith , Vermandel Maximilien , Hadjipanayis Constantinos
Published: November 2024

Despite advances in neurosurgical technology and techniques, the survival rate of GBM patients has remained relatively unchanged. The main treatments for GBM are associated with difficulties resulting from incomplete tumor resection and recurrence. In such situations, Photodynamic Therapy (PDT) is increasingly popular as an advanced therapeutic strategy, characterized by fewer side effects, minimal toxicity, and more controlled treatment. 5-aminolevulinic acid hydrochloride, (5-ALA HCl) has been used for years as a photosensitizing drug for the intraoperative visualization of GBM tumor tissue, enabling a more complete tumor resection. We demonstrated that, after such fluorescence-guided surgery, a laser light of specific 635 nm wavelength can additionally induce specific tumor cell death via the production of reactive oxygen species. This 5-ALA HCl–based PDT provides an antitumor effect within the tumor resection margins where recurrences occur in almost all patients. After performing pilot studies in over 20 patients with primary GBM, leading to positive safety and survival signals, we designed a new drug-device combination for this specific PDT procedure. It consists of Pentalafen ®, 5-ALA HCl administered orally to the patient before surgery, combined to Heliance®, a balloon device, inflated intraoperatively into the resection cavity, and connected to a controller (laser system) via an optical fiber to produce the light that illuminates the resection margins. A dedicated algorithm enables the duration of the illumination to be automatically computed from the tumor volume. This procedure adds an average of 30 minutes to the neurosurgery and can thus be fully integrated into the standard of care for primary GBM. This new drug-device combination is currently evaluated in a US phase 1 trial (NCT05736406) evaluating the feasibility of different light regimen treatments with the aim of delaying GBM recurrence and improving overall survival. If data is confirmed, it could be applicable to other CNS and solid tumors.
SURG-23. ESTABLISHMENT OF AN APPROPRIATE GLIOMA SURGERY SYSTEM CONSIDERING MOLECULAR AND FUNCTIONAL BOUNDARIES
Authors: Saito Ryuta , Motomura Kazuya , Ohka Fumiharu , Deguchi Shoichi , Shiba Yoshiki , Yamaguchi Junya , Nishikawa Tomohide , Kibe Yuji , Shimizu Hiroki , Maeda Sachi
Published: November 2024

Gliomas are invasive tumors and cannot be cured by surgery. But surgical removal has also been proven to affect treatment outcomes. Recent advances in molecular diagnostics have identified IDH mutations, especially in lower grade gliomas, allowing the identification of so-called molecular boundaries. It is conceivable that expanded resection to the molecular border may improve treatment outcome. On the other hand, extended resection may be incompatible with functional preservation. In such cases, it is also important to consider that the impact of surgery on treatment outcome has also been proven to vary by glioma genotype. While total resection has a significant prognostic impact on survival in astrocytomas with IDH mutations, the impact on survival in oligodendrogliomas that are sensitive to chemoradiotherapy and, conversely, in high-grade tumors without IDH mutations is lower than in the former. Therefore, it is important to determine the extent of removal after considering the tumor type. In general, various surgical support devices such as surgical navigation systems, fluorescent diagnosis using 5ALA, intraoperative electrophysiological monitoring, awake functional brain mapping, and intraoperative MRI are applied during glioma surgery. In addition to these, we have developed a surgical system that also focuses on tumor subtypes by introducing preoperative tumor type prediction using AI imaging and intraoperative rapid genetic diagnosis. We have further developed intraoperative rapid genetic diagnosis to identify genetic mutations around the tumor, enabling the detection of molecular boundaries. It is now possible to remove as much as possible, considering the molecular boundary, while paying sufficient attention to preservation of brain functions. Gliomas are intractable diseases, but their treatment outcomes have steadily improved over time. We are now in an era of a tailor-made surgery based on a variety of data. Implementing “appropriate surgical procedures” we aim at further improvement of treatment outcomes.
SURG-26. IMPROVEMENT IN PRECISION AND SURGICAL EFFICIENCY USING THE STEALTH AUTOGUIDE™
Authors: Kikuyama Kaoru , Oishi Tomoya , Yamasaki Tomohiro , Maruyama Gakuji , Neki Hiroaki , Koizumi Shinichiro , Kurozumi Kazuhiko
Published: November 2024

INTRODUCTION

The Stealth Autoguide™ (Medtronic) automatically determines the path for guiding instruments based on the created surgical plan. It seamlessly integrates continuous real-time navigation with robotic alignment capabilities, enhancing intraoperative workflow efficiency and supporting precise positioning. Our institution has achieved favorable results with surgeries utilizing the Stealth Autoguide™, and we report these outcomes and our future prospects.

METHODS

We conducted 15 surgeries at our institution using the StealthStation S8 (Medtronic) linked with the Stealth Autoguide™. The average age was 56.2 years, with 10 males and 5 females, all under general anesthesia.

RESULTS

The cases included 11 gliomas, 2 primary central nervous system lymphomas, 1 germ cell tumor, and 1 brain abscess. Applications of the Stealth Autoguide™ included 7 biopsies (6 burr holes, 1 craniotomy), 6 placements of fenestrations, and 2 tubing placements. The biopsies allowed for quick and reliable tissue sampling. In fenestration cases, it was possible to position quickly and precisely at the target, placing it at the planned site with high accuracy. Additionally, by using a 3D endoscopic system, surgeons could view both the surgical field and navigation screens simultaneously without shifting their gaze, enhancing safety during procedures. In the case of an intraventricular germ cell tumor, tubing preceded by ViewSite™ allowed for a safe and clear surgical field.

CONCLUSION

Surgeries using the Stealth Autoguide™ were conducted safely and efficiently, regardless of the surgical technique, achieving high-precision positioning. Continuing to utilize this system is expected to improve the accuracy, safety, and reproducibility of surgeries, thereby reducing the burden on patients.
SURG-28. THE IMPACT OF PERILESIONAL HEATSINK STRUCTURES ON ABLATION VOLUMES AND SYMMETRY IN LASER INTERSTITIAL THERMAL THERAPY FOR THE TREATMENT OF PRIMARY CENTRAL NERVOUS SYSTEM TUMORS
Authors: Berke Chandler , Rivera Cameron , Bhatia Shovan , Levi David , Khalafallah Adham , Lu Victor , Stillman Kate , Delong Chase , Singh Eric , Shah Ashish , Komotar Ricardo , Ivan Michael
Published: November 2024

BACKGROUND

Laser Interstitial Thermal Therapy (LITT) has emerged as a minimally invasive treatment for primary CNS tumors. While LITT offers advantages over traditional approaches, perilesional intracranial heatsinks can lead to asymmetric ablation, impacting patient outcomes. Understanding heatsink effects is crucial for optimizing LITT efficacy.

METHODS

We retrospectively analyzed primary CNS tumors treated with LITT at a single tertiary care center. Ablation outcomes were quantified using the Heatsink Effect Index (HEI) measured on a scale of 0-1 (0=total symmetry; 1=complete asymmetry), and extent of ablation (EOA). Heatsink types evaluated were sulci, meninges, vasculature, and cerebrospinal fluid (CSF) spaces, inclusive of ventricles, surgical resection cavities, and CSF cisterns. Statistical analyses assessed the relationship between heatsink proximity and ablation outcomes.

RESULTS

A total of 99 patients satisfied all selection criteria. The cohort was 53% female, with a mean age of 61 years. Glioblastoma was the most predominant tumor type (78%), followed by low grade gliomas (15%), and meningiomas (4%). Heatsink proximity significantly correlated with ablation asymmetry (HEI) (p < 0.001), particularly at the midpoint of the catheter trajectory. The correlation between closest heatsink distance and HEI varied across the different heatsink types, with distance to vasculature and CSF spaces correlating the strongest with ablation asymmetry. When assessing the relationship between EOA and medial HEI during suboptimal ablations (EOA < 100%), we demonstrated a negative correlation showing improved EOA as HEI was reduced. Optimal cutoff catheter-heatsink distances for predicting ablation asymmetry ranged from 6.6-13.0 mm, emphasizing the impact of heatsink proximity on LITT efficacy.

CONCLUSION

We show that proximity to heatsinks, especially within a threshold distance of 13.0mm from the laser catheter, significantly predicts ablation asymmetry and volume in the setting of primary CNS tumors. Neurosurgeons should consider heatsink effects in pre- and intraoperative planning to optimize LITT outcomes and preserve normal brain tissue.
SURG-32. OPTIMIZING TUMOR TREATING FIELDS THERAPY FOR FIRST RECURRENT GLIOBLASTOMA WITH SKULL REMODELING SURGERY. FINAL RESULTS FROM OPTIMALTTF-2, A MULTI-CENTER, RANDOMIZED, CLINICAL TRIAL
Authors: Mikic Nikola , Skjøth-Rasmussen Jane , Poulsen Frantz Rom , Laursen Rene Johannes , Lukacova Slavka , Møller Søren , Haslund Charlotte Aaquist , Dahlrot Rikke Hedegaard , Solheim Ole Skeidsvoll , Solheim Tora Skeidsvoll , Sørensen Jens Christian Hedemann , Wong Eric T , Korshøj Anders Rosendal
Published: November 2024

Studies indicate that increasing the electric field intensity of Tumor Treating Fields therapy (TTFields) may prolong survival for glioblastoma (GBM) patients. Skull remodeling surgery (SR-surgery) aims to increase electric field intensity by 30-100% by removing the poorly conductive skull, and OptimalTTF-1 (pilot trial) concluded that SR-surgery was safe with a median overall survival (mOS) of 15.5 months for first recurrence GBM (rGBM). OptimalTTF-2 is a 1:1 randomized, comparative, multi-center, investigator-initiated, interventional clinical phase 2 trial investigating the efficacy and safety of TTFields and standard of care with or without SR-surgery for 84 rGBM subjects, with a planned interim analysis after enrollment of the first 52. Randomization is solely for SR-surgery and involves five burr holes of 15mm each in diameter, located in the skull between the tumor and the transducer arrays. The trial was nationwide in Denmark and active from 2020-2024. Major eligibility criteria include age ≥18 years, histopathological confirmed first recurrence of supratentorial GBM, and KPS ≥70. The primary endpoint is OS after 12 months (OS12), while secondary endpoints include PFS, QoL, ORR, QoL, KPS, steroid dose, and toxicity. The trial recruited 58 subjects and 52 had follow-up of 12-months or longer. Randomization was balanced and both arms had a median age of 59 years and no statistical difference in prognostic markers. Intent-to-treat analysis revealed the following for the intervention and control respectively, OS12 55% [95%CI 37-74%] vs. 45% [95%CI 27-64%](p=0.4), mOS 12.2 [7.9-19.1,95%CI] vs. 11 [6.5-17.1, 95%CI] months, and PFS 4.5 [3.4-9.5,95%CI] vs. 3.5 [3-6.4,95%CI] months. All the secondary outcomes were statistically insignificant. The trial was terminated early after interim analysis indicated no survival benefit from SR-surgery and a conditional power calculation that showed a low expected survival benefit for the planned cohort of 84 subjects. Post hoc analysis examining potential negative outcome modifiers is needed.
SURG-55. NOVEL IQ-DOME APPROACH FOR SUPERIOR SEMICIRCULAR CANAL DEHISCENCE REPAIR REDUCES REVISIONAL SURGERY RATE
Authors: Khorasani Laila , Mekonnen Mahlet , Chandla Anubhav , Pandey Aryan , Gopen Quinton , Yang Isaac
Published: November 2024

Superior Semicircular Canal Dehiscence (SSCD) is characterized by a thinning of the bony ceiling of the superior semicircular canal, manifesting in auditory and vestibular deficits. Surgical repair is the standard treatment modality of SSCD, with conventional methods including plugging or recapping the defective canal with bone wax, bone chips, muscle, and others. Previous research has shown multiple complications with these conventional materials, including a high rate of failure of the primary repair and the need for revisional surgeries. To address this challenge, we investigated a novel surgical sealing technique using IQ-Dome, a titanium mesh plate overlying the arcuate eminence. We aim to assess the efficacy of IQ-Dome in the repair of SSCD compared to conventional material while evaluating outcome measures including postoperative symptom resolution, complication, and revisional surgery rates. We performed a retrospective analysis of patients undergoing SSCD repair via the middle cranial fossa approach at UCLA between 2017 and 2021. We compared demographics and post-operative outcomes between the application of IQ-Dome and conventional materials. A total of 160 patients undergoing SSCD repair were included in our study, with 80 patients receiving IQ-Dome and 80 patients receiving non-IQ-Dome approaches. 60% of patients in the IQ-Dome cohort and 66.7% of patients in the non-IQ-Dome cohort were female. The mean ages of patients were 45.7 years (range 13-78) in the IQ-Dome cohort and 48.9 years (range 17-69) in the non-IQ-Dome cohort. The surgical revision rates for the IQ-Dome and non-IQ-Dome cohorts were 5.7% and 8.5%, respectively. There was no significant difference in postoperative complications between groups. Thus, IQ-Dome is a safe approach for the surgical management of SSCD, decreasing failure and revision rate by nearly 3% in our patient population and offering an alternative surgical sealing repair intervention. Future studies with larger sample sizes are warranted to further assess the efficacy of IQ-Dome.