bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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&lt;0.001), and that brain tumor (three types of glioblastomas and two types of malignant meningioma) was significantly stiffer than normal brain tissue (p&lt;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

Abstract

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&lt;0.01). A sub-analysis of 5 studies involving 164 patients demonstrated a substantial response rate (67%, 95%CI= 47-88%, p-value&lt;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

Abstract

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

Abstract
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

Abstract
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

Abstract

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

Abstract

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 &lt; 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 &lt; 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

Abstract
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

Abstract
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.
SURG-56. TRANSCRIPTION FACTOR CELL LINEAGE DETERMINES AGGRESSIVE BEHAVIOR AMONG NONFUNCTIONAL PITUITARY ADENOMAS
Authors: Himstead Alexander , Fote Gianna , Acharya Nischal , Kuan Edward , Hsu Frank , Mohyeldin Ahmed 
Published: November 2024

Abstract

INTRODUCTION
Pituitary neuroendocrine tumors (PitNETs) are the second most common intracranial neoplasm. Silent or non-functional PitNETs represent a common neuro-oncological challenge due to their size and unpredictable invasion of parasellar structures. This makes their complete surgical resection difficult and puts patients at higher risk for recurrence.

OBJECTIVE
To characterize differences in tumor volume, cavernous sinus invasion, and recurrence in nonfunctional PitNETs.

METHODS
Out of 615 transsphenoidal surgeries from 2012 to 2024, there were 309 overall PitNETs and 181 nonfunctional PitNETs. Based on new WHO criteria for transcription factor profiling (PIT-1, TPIT, and SF-1), there were 98 silent gonadotroph adenomas (SGA), 31 silent corticotroph adenomas (SCA), 10 silent pleurihormonal tumors (PHT), and 2 null cell adenomas. Tumor volume was calculated using (AxBxC/2). Knosp grade was calculated. Cavernous sinus invasion was defined as Knosp ≥ 3. Residual disease at 3 months postoperative was recorded and surgical intervention for growing residual disease was captured.

RESULTS
Average tumor volume of PHT (18.08 cm3) was significantly higher than SGA (8.44 cm3, p=0.007) and similar to SCA (10.33 cm3, p=0.11). Percentage of cavernous sinus invasion was significantly different between SCA (31.82%) and SGA (10.20%, p=0.003), but not PHT (33.33%; p&gt;0.05). There was a significantly higher residual rate in SCA compared to SGA (31.71% vs. 11.22%, p=0.006). There were significantly more reoperations in the SCA group compared to SGA and PHT.

CONCLUSIONS
Despite similar tumor volume between SCA and SGA, there was a significantly higher rate of cavernous sinus invasion and residual disease among SCA. This has important neuro-oncological implications regarding surgical technique, postoperative surveillance, and need for adjuvant therapy to mitigate aggressive recurrent disease.