bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURG-11. COMPARATIVE RISK ANALYSIS OF DEVELOPMENT OF ANEMIA IN RADIOTHERAPY-TREATED VS. NON-TREATED MULTIPLE SCLEROSIS PATIENTS: A MULTICENTER RETROSPECTIVE COHORT STUDY
Authors: Hong Jinpyo , Stoltzfus Mason , Hallan David , Rizk Elias 
Published: November 2024

Abstract

INTRODUCTION
The use of RT in patients who are diagnosed with multiple sclerosis (MS) is controversial due to adverse effects such as inflammation. Simultaneously, the relationship between oncologic RT and worsening anemia is well established. However, there is not a clear understanding of the risk associated with undergoing RT due to their oncologic diagnosis in MS patients for developing anemia.

OBJECTIVE
This study aims to analyze the risk of developing anemia for patients with MS who have been treated with RT versus who have not.

METHODS
This retrospective study consists of analysis of the data acquired from TriNetX, a database that houses clinical data from 92 healthcare organizations. Cohort 1 included MS patients with history of RT, while cohort 2 included MS patients without any history of RT. The cohorts were propensity score matched for demographics such as age, sex, race, and ethnicity. All neoplasms were also matched to eliminate cancer as a confounding variable. The analysis included outcomes of interest, ICD-10 code D64 (Other anemia), up to 6 months after the first occurrence of the index event.

RESULTS
4,844 patients were identified for each cohort post-propensity score matching. The mean age was 65.4 and 67.3 years old, and most patients were white at 76.3% and 77.0% for the MS with RT and without RT cohorts, respectively. Cohort 1 had 628 patients who developed anemia, while cohort 2 only had 511 patients. The odds ratio was 1.263 with 95% confidence interval of 1.116 to 1.430 showing the statistically significant difference between the cohorts.

CONCLUSION
This study demonstrates that there is a significant increase in the likelihood of developing broadly categorized anemia for multiple sclerosis patients with or without radiation therapy. Further study is warranted to understand other potential factors leading to an increased risk of developing anemia in the irradiated cohort.
SURG-16. MULTIDISCIPLINARY TREATMENT OF HEMANGIOBLASTOMAS IN CENTRAL NERVOUS SYSTEM AND FUTURE PROSPECTS
Authors: takayanagi shunsaku , Takami Hirokazu , Nomura Masashi , Kitagawa Yosuke , Saito Nobuhito 
Published: November 2024

Abstract

Hemangioblastomas (HB) in central nervous system are originally benign tumors. However, they are extremely vascular and appropriate treatment of the feeders and drainers is important when performing HB resection. Approximately 20% of HB cases are thought to be caused by von Hippel-Lindau (VHL) disease. Patients with VHL disease often develop multiple HBs, and it may be difficult to treat them with excision alone. Recently, belzutifan, a molecular targeted drug indicated for treating HB in VHL disease cases, was approved by FDA. In this presentation, we will provide an overview of the multidisciplinary treatment at our facility.

METHOD
At our facility, we performed 84 cases of excision surgery from 1996 to 2019, and analyzed the results of these treatments. A high-definition 3D fused image was created before surgery to identify the feeders and drainers. Tumor embolization was performed on the feeder, which was thought to be located deep within the surgical field. In addition, gamma knife treatment was performed as appropriate for HBs that did not undergo extirpation.

RESULTS
The breakdown of cases was 46 with VHL disease and 38 with non-VHL disease. Postoperatively, KPS improved in 55% of cases, and some complications occurred in 18%. Gamma Knife treatment has been performed on 58 cases so far, and the 10-year tumor control rate is approximately 80%.

DISCUSSION/SUMMARY
This presentation revealed that multidisciplinary treatment is effective for HBs. In the future it is necessary to consider which HB cases belzutifan is useful for and how it should be combined with other treatments.
SURG-19. THE SYNDROME OF THE SUPPLEMENTARY MOTOR AREA: CLINICAL COURSE AND PREDICTORS OF OUTCOME AFTER RESECTION OF PREMOTOR LESIONS
Authors: Teske Nico , Jung Leonard B , Nöldeke Jan O , Weig Thomas , Blobner Jens , Forbrig Robert , Tonn Joerg-Christian , Kunz Mathias , Thon Niklas , Karschnia Philipp 
Published: November 2024

Abstract

OBJECTIVE
Supplementary motor area (SMA) syndrome frequently occurs after resection of premotor lesions. Interhemispheric connectivity including the contralateral SMA might be crucially involved in its development and recovery. We aimed to identify predictors of outcome by quantifying preoperative structural alterations in the non-affected contralateral hemisphere.

METHODS
We retrospectively searched our database for patients developing SMA syndrome after resection of premotor lesions between 2013 and 2023. Clinical characteristics and imaging data were collected. Structural network analysis was performed using the previously validated morphometric inverse divergence network.

RESULTS
27 patients with a mean age of 39.2 ± 17.7 years developed SMA syndrome, including 13/27 patients (48.1%) with primary brain tumors and 14/27 patients (51.9%) with intractable lesional epilepsy. Postoperative SMA syndrome was commonly characterized by contralateral upper extremity hemiparesis (19/27 patients, 70.4%) and aphasia in case of dominant hemisphere involvement (13/13 patients, 100%). Tumor patients were less likely to fully recover from SMA syndrome after 7 days compared to epilepsy patients (2/13 [15.4%] versus 9/14 [64.3%] patients, p=0.018). Most patients (23/27, 85.2%) experienced full recovery of SMA syndrome after a median follow-up of 5 months (IR 3-16 months), with no difference between patients with tumors or epilepsy (p=0.999). Preoperative contralateral intra-hemispheric connectivity was similar between patients receiving tumor or focal resection (0.183 vs 0.177, p=0.295). However, imaging analyses demonstrated baseline affection of SMA connectivity in patients with brain tumors as characterized by reduced cortical thickness of the contralateral frontal lobe and the cingulate gyrus compared to epilepsy patients.

CONCLUSION
While full recovery from SMA syndrome is common, SMA syndrome is frequently less severe and more transient in patients with epilepsy. This might be due to affection of the contralateral SMA network in tumor patients due to the infiltrative nature of the disease. Imaging analyses might assist in identifying network affections at baseline.
SURG-21. DEVELOPMENT AND VALIDATION OF A CLINICAL RISK SCORE FOR POSTOPERATIVE OUTCOME IN NEWLY DIAGNOSED GLIOBLASTOMA: A REPORT OF THE RANORESECT GROUP
Authors: Karschnia Philipp , Young Jacob S , Youssef Gilbert C , Dono Antonio , Häni Levin , Sciortino Tommaso , Bruno Francesco , Juenger Stephanie T , Teske Nico , Dietrich Jorg , Weller Michael , Vogelbaum Michael A , van den Bent Martin , Beck Juergen , Thon Niklas , Gerritsen Jasper K W , Hervey-Jumper Shawn , Cahill Daniel P , Chang Susan M , Rudà Roberta , Bello Lorenzo , Schnell Oliver , Esquenazi Yoshua , Ruge Maximilian I , Grau Stefan J , Huang Raymond Y , Wen Patrick Y , Berger Mitchel S , Molinaro Annette M , Tonn Joerg-Christian 
Published: November 2024

Abstract

BACKGROUND
Following resection or biopsy, patients with newly diagnosed glioblastoma frequently enter clinical trials. Nuanced risk assessment is warranted to reduce imbalances between study arms. Here, we aim to make use of our RANO classification for extent of resection (I) to analyze the interactive effects of residual tumor with clinical and molecular factors on outcome and (II) to define a postoperative risk assessment tool.

METHODS
The RANO resect group retrospectively compiled an international, seven-center training cohort of patients with newly diagnosed glioblastoma. The combined associations of residual tumor with molecular or clinical factors and survival were analyzed, and recursive partitioning analysis was performed for risk modeling. The resulting model was prognostically verified in a separate external validation cohort.

RESULTS
Our training cohort compromised 1003 patients with newly diagnosed IDH-wildtype glioblastoma, including 744 patients who underwent adjuvant radiochemotherapy (TMZ/RT→TMZ). Residual tumor, MGMT promotor methylation status, age, and KPS were prognostic of overall survival and forwarded into regression tree analysis. By combining eleven terminal nodes and individually weighting the prognostic factors, an additive scale (range, 0-9 points) integrating these four variables distinguished patients with low (0-2 points), intermediate (3-5 points), and high risk (6-9 points) for poor postoperative outcome (median overall survival: 24 vs. 16 vs. 6 months; p&lt;0.01). The presence of the three risk groups was confirmed in the subgroups of patients treated with or without RT/TMZ→TMZ. The prognostic value of the risk score was verified in a external single-center validation cohort of newly diagnosed glioblastoma (n = 258, p&lt;0.01). Compared to previously postulated models, goodness-of-fit measurements were superior for our score.

CONCLUSIONS
The novel RANO risk score serves as an easy-to-use, yet highly prognostic tool for postoperative patient stratification prior to further therapy. The score may serve to guide patient management and reduce imbalances between study arms in prospective trials.
SURG-34. NEURO ENDOSCOPIC VS CRANIOTOMY APPROACH IN SUPRATENTORIAL HYPERTENSIVE INTRACEREBRAL HEMORRHAGE: AN UPDATED META-ANALYSIS
Authors: Haseeb Abdul , Shafique Muhammad Ashir , Mustafa Muhammad Saqlain , Singh Ajeet , Iftikhar Sadaf , Rangwala Burhanuddin Sohail , Waggan Anzah Imtiaz , Ahmad Tagwa Kalool Fadlalla , Wold Brandon Lucke 
Published: November 2024

Abstract

INTRODUCTION
Intracerebral hemorrhage (ICH) is a serious medical condition associated with high mortality and disability rates. Surgical interventions, including neuro-endoscopic surgery (NES) and craniotomy, are employed to manage ICH and improve patient outcomes. This meta-analysis compares the effectiveness of NES versus craniotomy in treating ICH.

METHODS
A systematic literature search was conducted to identify relevant studies comparing NES with craniotomy for ICH. Inclusion criteria encompassed primary or secondary results from randomized controlled trials (RCTs) or observational studies (OSs) with confirmed supratentorial ICH. Data were extracted, and methodological quality was assessed using appropriate tools. Statistical analysis was performed using Comprehensive Meta-Analysis.

RESULTS
Twenty-six studies (n=3237 patients) were included in the analysis. NES was associated with significantly lower mortality compared to craniotomy (OR: 0.45, 95% CI 0.33 to 0.60, p &lt; 0.00001). Hematoma evacuation rates were higher with NES (SDM: 1.505, 95% CI 0.835 to 2.160, p &lt; 0.00001). NES also showed better functional outcomes (OR: 3.31, 95% CI 1.78 to 6.17, p = 0.0002) and reduced blood loss (SDM: -3.06, 95% CI -3.979 to -2.141, p = 0.000). Additionally, NES was associated with shorter hospital and ICU stays, shorter operative times, and fewer complications such as infection and rebleeding.

CONCLUSION
NES emerges as a promising alternative to craniotomy for treating ICH, offering advantages in terms of mortality reduction, improved functional outcomes, and fewer complications. Future studies should explore advancements in neuro-endoscopic techniques to optimize patient outcomes further.
SURG-35. NEURONAVIGATED INTRAOPERATIVE ULTRASSOUND X SODIUM FLUORESCEIN FOR BRAIN METASTASIS: WHICH IS BETTER?
Authors: Campos Paiva Aline Lariessy , Araujo João Luiz Vitorino , Lovato Renan Maximillian , de Oliveira Jean Gonçalves , Veiga José Carlos Esteves 
Published: November 2024

Abstract

BACKGROUND
Improve quality of life with a maximum surgical resection is the main goal of neurosurgeons. Brain metastasis are even more prevalent because of patients are living more. The grade of resection and the maintenance of a good performance are fundamental for these patients perform adjuvant radiotherapy. There are several technologies that may help. Considering two of them that have an easier access and are cheaper, we compared a high definition ultrasound (BK 3000) coupled to neuronavigation system (Brainlab) and sodium fluorescein (SF).

METHODS
Adult patients with main radiological hypothesis of brain metastasis were included in a PhD study previously approved by ethics committee. 3-5mg/kg of SF was administered by intravenous infusion during anesthetic induction. An specific craniotomy transducer was used in all cases with shift correction in real time by neuronavigator. All procedures were guided by the same neurosurgeon.

RESULTS
High definition ultrasound allows an excellent tumor delimitation. SF helped to increase grade of resection however made confusion about what is infiltration and what is tumor and for this ultrasound were superior. Increased fluorescence is easily detected when compared to ultrasound information’s.. For both technologies, when the surgical site had blood, the evaluation about grade of resection is not accurate because in ultrasound appears a posterior shadow and considering SF it seems that there are not further tumor because blood does not have increased fluorescence.

CONCLUSIONS
US and SF are different tools which improve brain metastasis resection. In each moment of surgery one technology was superior or not. We used an specific probe for neurosurgery that has high quality and allowed detailed evaluations. These technologies helps surgeons take quick decision and optimized brain tumor removal. The neurosurgeon should be more familiar to US images because provide a real time evaluation with low cost.
SURG-36. ACCURACY OF THE ROSA ONE BRAIN ROBOTIC PLATFORM FOR THE PLACEMENT OF NEUROBLATE AND VISUALASE LASER INTERSTITIAL THERMAL THERAPY PROBES
Authors: Rademacher Anneliese , Imran Zunaira , Fadel Hassan , Pawloski Jacob , Anzalone Anthony , Latack Katie , Lee Ian 
Published: November 2024

Abstract
Laser interstitial thermal therapy (LITT) is a minimally invasive treatment option for patients with intracranial lesions. The success of LITT is dependent on accurate placement of the laser probe in target tissue. Placement can be facilitated by various stereotactic methods, including the Robotic Surgical Assistant (ROSA) ONE Brain robotic platform. The aim of this study is to examine the accuracy of stereotactic probe placement utilizing the ROSA robot. Primary outcomes were entry distance, target distance, and entry angle error. Accuracy differences between two major LITT platforms, the Neuroblate (Monteris Medical) and Visualase Systems, were compared. A prospective institutional database was used to identify all patients who underwent LITT for intracranial tumors utilizing the ROSA robot between 2013-2023. The sign test was used to compare error values to test their difference from a null value of 0. Spearman correlation was used to assess the relationship between angle of error and trajectory length. Kuskal-Wallis test was used to compare errors and trajectory length between the two companies. Of the 105 patients who underwent LITT during the study period, 337 probes were placed. For Visualase probes, median entry distance (1.1mm, IQR=0.4-2.0), target distance (1.6mm, IQR =0.9-2.4), and entry angle error (1.5°, IQR=0.9-2.5), were significantly different than zero (p=&lt;.0001). For Neuroblate probes, median entry distance (1.5mm, IQR=1.0-2.1), target distance (1.8mm, IQR=1.1-2.4), and entry angle error (1.8°, IQR=1.1-2.5) were significantly different than zero (p=&lt;.0001). When comparing laser systems, there was a significant difference in median entry distance error with Neuroblate having a higher error (1.5mm, IQR=1.0-2.1) than Visualase (1.1mm IQR=0.4-2.0, p=0.0041). Stereotactic placement of LITT probes utilizing the ROSA robotic system was not able to achieve perfect alignment with the planned trajectory. When comparing the systems, Visualase probes were placed more accurately at the entry point than Neuroblate probes.
SURG-43. PATTERNS OF FAILURE FOLLOWING REIRRADIATION WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY FOR RECURRENT HIGH-GRADE GLIOMAS
Authors: Bindal Shivani , Gonzalez Brandon , Esquenazi Yoshua , Dono Antonio , Riascos Roy , Zhu Jay , Hsu Sigmund , Tandon Nitin , Martir Magda , Blanco Angel , Amsbaugh Mark 
Published: November 2024

Abstract
Re-irradiation with stereotactic radiosurgery (SRS) is an increasingly used treatment for recurrent high-grade glioma (HGG). We analyzed the patterns of failure and outcomes of salvage Gamma Knife SRS for recurrent HGG to better identify which patients would most benefit. We reviewed all patients who received SRS for recurrent HGG from January 2008 to May 2020. Pattern of failure was defined by the distance of recurrence from the SRS isodose line as follows: in-field local, marginal local, regional local, and distant failure. Overall survival (OS), progression-free survival (PFS), and local-failure free survival (LFS) were estimated using Kaplan-Meier methods, and regression model analysis was performed to analyze clinical predictors of failure. A total of 146 patients with HGG underwent SRS treatment to 410 target lesions. The median target volume was 3.3 cm3 and median total dose was 18 Gy. Sixty-one (41.8%) patients developed progression following SRS. PFS at 6 and 12 months were 65.8% and 37.3% respectively. Median OS was 12.4 months from salvage SRS. There were 113 (79.5%) local failures (53.1% in-field, 45.1% marginal, and 1.8% regional), 2 (1.4%) distant, and 27 (19%) concomitant local and distant failures. LFS at 6 and 12 months was 82.9% and 66.6%, respectively. Non-white race (HR = 0.37), SRS dose ≥ 20 Gy (HR = 0.34), age &lt; 60 years (HR = 0.43), and KPS ≥ 70 (HR = 0.44) were associated with longer time to local failure. Non-white race (HR = 5.55) and SRS dose ≥ 20 Gy (HR = 5.62) were associated with more distant failure. No grade 4 or 5 toxicity was observed. In conclusion, the dominant pattern of failure remains local and in-field despite conformal dose distribution with SRS and infiltrative tumor histology. This supports the role of reirradiation with SRS in well selected patients with recurrent HGG.
SURG-49. INVESTIGATING LITT-BASED COMBINATION THERAPIES IN PRECLINICAL GLIOMA MODELS
Authors: Woodiwiss Timothy , Giles David , Han Rowland , Li Derek , McCornack Colin , Beck Loren , Fu Yiwei , Leidig Will , Anzaldua-Campos Markus , Cleary Ryan , Kim Albert 
Published: November 2024

Abstract

BACKGROUND
Laser interstitial thermal therapy (LITT) is a minimally invasive means of tumor cyto-destruction with the potential for additional clinical benefits, such as altering the blood-brain barrier or the brain tumor microenvironment (TME). Using a murine model of GBM, we utilized a clinically relevant laser ablation model to identify and exploit immune TME changes after LITT to generate therapies that improve mouse survival, with the potential for rapid clinical translation.

METHODS
Right frontal lobe implantation of the immune “cold” SB28 murine glioma cells were performed in C57BL/6J mice. Tumor location was verified by MRI followed by stereotactic insertion of a paired fiberoptic laser and thermocouple to perform real-time hyperthermic ablation with temperature monitoring. Pulsed laser application maintained a peri-lesional temperature of 44°C for 150-180 seconds. Following LITT (or sham surgery), spectral flow cytometry was used to profile the immune TME. Survival studies were performed using a combination of LITT and immune modulating therapies.

RESULTS
Laser ablation alone provided a survival benefit compared to sham surgery (median survival: 29 vs 22.5 days, P&lt;0.0001) in in glioma-bearing mice. Survival studies combining LITT with anti-PD1 lacked a significant response in the SB28 model but showed some long-term survivors. Flow cytometry performed on brain tissue post-LITT days 3 and 7 demonstrated little to no change in CD4+/CD8+ T cell responses but did show an increase in neutrophils, which expressed TLR2 and 4. The TME showed negligible numbers of phagocytic cells with obvious tumor cell uptake post-LITT. Using these results, we generated strategies for LITT-based combination immune therapies. Survival studies are ongoing using combinations of LITT/anti-PD1 with neutrophil depletion, inhibition of anti-CD47, and addition of broad TLR2/4 agonists as a neutrophil stimulus.

CONCLUSIONS
A clinically relevant immunocompetent murine LITT model enables the generation of novel treatment strategies with potential for rapid clinical translation.
SURG-51. DECOMPRESSIVE HEMICRANIECTOMY IN HIGH-GRADE GLIOMA PATIENTS: CLINICAL AND RADIOGRAPHIC OUTCOMES
Authors: Diaz Maria , Joanta-Gomez Adela , Welch Mary , McKhann Guy , Sisti Michael , Lassman Andrew 
Published: November 2024

Abstract

BACKGROUND
Decompressive hemicraniectomy (DHC) is an uncommonly needed treatment in high-grade gliomas (HGG), most used for refractory increased intracranial pressure (ICP) from vasogenic edema, mass effect, or related complications. Outcomes and imaging following DHC are not well described.

METHODS
We retrospectively identified cases of DHC for HGG at our institution since 2019.

RESULTS
Three patients with HGG underwent DHC (2 females, ages 39-70) for newly diagnosed (2 patients) or recurrent tumor (1 patient). Causes of increased ICP were tumor/vasogenic edema (2 patients) or abscess (1 patient). Subsequent cranioplasty was performed in 2 patients: at 1.8 months after DHC in one patient, and at 8.6 months in another patient who developed sinking skin flap syndrome (SSFS). SSFS presented as progressive worsening of tumor-related neurologic deficits after completion of radiation therapy with no change in imaging, followed by frank signs of increased ICP 8 months after DHC. Two patients died of disease progression (5.3 months and 9.1 months after DHC), and one patient remains alive at 13.5 months (patient with SSFS; neurologic deficits virtually resolved after cranioplasty repair). Imaging will be described for all patients.

CONCLUSION
DHC can be a life-saving intervention in HGG. When feasible, early cranioplasty should be considered to avoid complications, including SSFS, which may present with neurological deficits without corresponding imaging change.