bluuebunny/crossref_metadata_2025_split huggingface dataset:
ORTHOPTIST LED VISUAL ﬁELD MONITORING DURING AWAKE CRANIOTOMY OF LOW GRADE GLIOMA: A UK TERTIARY CENTRE EXPERIENCE
Authors: Guy Mrs Danielle , Goodden Mr John , Chumas Mr Paul , Chave-Cox Ms Rebecca , Mathew Mr Ryan 
Published: October 2024

Abstract

AIMS
To describe orthoptist led monitoring of visual function during awake craniotomy for low grade glioma and to retrospectively review visual ﬁeld outcomes comparing to published results.

METHOD
Intraoperative visual ﬁeld monitoring was performed by the same advanced orthoptist, performing ﬁelds to confrontation as well as monitoring for observed visual phenomena. Goldman visual ﬁelds were performed pre-operatively and approx. 6 weeks post operatively. Results compared to published outcomes.

RESULTS
26 awake procedures were attended with 2 being repeat surgeries therefore 28 surgical episodes. Testing was abandoned for 6 (inability to wake suﬃciently, inability to cope with the awake procedure or change in diagnosis from low to high grade). Results were retrospectively reviewed over a ﬁve year period from 2019 to 2024. Post operative visual ﬁelds were found to be unaltered or only mild superior dipping (not precluding driving) in 18 patients, loss of ﬁeld to a quadrantiopia negating driving requirements in 2, 2 patients with quadrantiopia pre and post op unchanged.

CONCLUSION
Visual ﬁeld assessment during awake craniotomy can give surgeons additional conﬁdence to continue the resection. Utilisation of an Orthoptist with minimal equipment as well as no alteration to the surgical positioning has demonstrated comparable visual outcomes to those published. The authors would recommend that other centres consider utilization of specialised allied health professionals to assess and monitor eloquent function during awake procedures; such as orthoptists for visual function.
AN ANALYSIS OF THE PATIENT REPORT OUTCOMES OF A JOINT CNS / AHP NEURO-ONCOLOGY CLINIC ON PATIENTS QUALITY OF LIFE
Authors: Powell Dr James , Lewis Mrs Cathryn , Burke Mrs Rhian , Iqbal Dr Najmus , Maclean Dr Jillian , John Ms Charlotte , Best Mrs Keri , Moore Mrs Bethan , Davies Ms Rebecca , Mackay Mrs Emma , Rogers Mrs Clare , Kwiatkowska Mrs Magdalena , Tindle Mrs Samantha 
Published: October 2024

Abstract

AIMS
Velindre Cancer Centre established a successful model of collaborative working between CNS and AHP services for neuro-oncology patients to holistically support their complex needs throughout treatment. Building on this success, the clinic has introduced a recognised reliable and valid patient reported outcome measure (PROM) to be completed pre and post clinic intervention. This is in addition to the patient reported experience measure that is already established within the pathway. This PROM will enable an analysis of the clinics impact on patients quality of life.

METHOD
A quantitative methodology will be utilised to enable a objective evaluation of the impact of the clinic on patients quality of life. An EQ-5D-5L PROM is completed with patients prior to their involvement with the clinic enabling an overview of key aspects related to quality of life including mobility, self-care, participation in usual activities, pain and anxiety / depression. Following interventions within the clinic, patient are provided with a post treatment EQ-5D-5L to enable a comparison of these key indicators of quality of life.

RESULTS
The data will build on the resounding success of collaborative working between CNS and AHP’s in the neurooncology MDT clinic. An analysis of the pre and post data will demonstrate the impact of having access to this unique and integrated way of working, enabling patient access to specialist timely support throughout their treatment.

CONCLUSION
This innovative model of working is now established in the patient pathway and ﬁndings from patient experience measures have recognised that patients experience of the clinic is extremely highly valued. Findings from this additional dataset will further evidence the impact on patients quality of life. It will add to ﬁndings from a proposed gap analysis to evidence the beneﬁts of developing an outreach service for this patient cohort.
RISKS AND OUTCOMES OF STROKE IN PATIENTS WITH PRIMARY BRAIN AND MENINGEAL TUMOURS
Authors: Innes Dr Stuart , Yin Dr Lucia , Finnerty Dr Gerald T 
Published: October 2024

Abstract

AIMS
People with primary CNS tumours are at increased risk of stroke. However, there is little guidance on stroke management. We investigated the types and timing of stroke in primary brain and meningeal tumours to inform their treatment.

METHOD
Patient data on stroke aetiology, timing, management and outcomes was collected from electronic medical records at King’s College Hospital between April 2012 to April 2022. A primary brain tumour was deﬁned using the 2021 World Health Organisation Classiﬁcation of Tumours of the Central Nervous System.

RESULTS
We identiﬁed 244 patients with a brain tumour and a stroke with a total of 317 strokes in the 10-year period (male:female = 48:52; median age, 62 years [IQR 51 – 74]). The most common brain tumours were meningiomas (43%) and glioblastomas (21%). 56% of strokes were ischaemic. Ischaemic strokes were most frequent within 30 days of brain tumour surgery (38%). Haemorrhages were more common in malignant tumours (p=4.7 x10 35% of haemorrhages were intratumoural. Strokes in malignant tumours: occurred closer to diagnosis (p=0.032); caused greater functional loss (mean Modiﬁed Rankin Scale change 2.00 vs 1.17, p 0.001); and had a higher mortality rate (HR 5.87, CI 3.41 - 10.11, p=1.8x10 Recurrent strokes occurred in 64 (26%) patients and were associated with tumour malignancy (p=0.016), radiotherapy (p=0.023) and chemotherapy (p=0.009).

CONCLUSION
Strokes in malignant brain tumours are more lethal, disabling and often recurrent in patients undergoing chemo and radiotherapy. Clinical trials are needed to improve outcomes of stroke in neuro-oncology patients.
DEXAMETHASONE WEAN POST CRANIOTOMY FOR MENINGIOMA- A CASE STUDY
Authors: Mullens Ms Laura , Hurwitz Mrs Victoria , Hedges Mrs Sarah , Kostick Ms Ellie , Suarez Mr Aeron , Sabido Ms Pat , Harding Ms Nicola , Lavrador Mr Jose , Ashkan Prof Keyoumars , Vergani Mr Francesco , Cikurel Mrs Katia , Gullan Mr Richard 
Published: October 2024

Abstract

AIMS
Case review/analysis of dexamethasone wean post craniotomy for meningioma. To identify any quality of life issues experienced during the wean, how and why steroid wean was adjusted and any impact steroid use had on serum cortisol level causing adrenal insuﬃciency.

METHOD
Review of documentation to identify steroid related side effects, how and when this impacted on the patient’s quality of life. Collection of data; steroid doses, length of time on steroids (pre-surgery and post-surgery), serum cortisol result. Clinical choices regarding dose/timings of dexamethasone reviewed and compared to literature.

RESULTS
Delays/changes with theatre dates, capacity, neurological symptoms on presentation led this individual to a four month pre-surgical dose of dexamethasone which led to weight gain, pre-diabetes and insomnia. Quality of life pre and post-surgically affected by steroid use namely mental health, employment and social belonging. This case study conﬁrms adrenal insuﬃciency was precipitated by the prolonged pre-surgical use of dexamethasone. Clinical nurse specialists are integral in adjusting steroid dose to manage neurological recovery and safely wean steroids to zero as well as identifying adrenal insuﬃciency.

CONCLUSION
Data collection from a large sample size is required to conﬁrm how many patients coming through the neurooncology surgical pathway have conﬁrmed adrenal insuﬃciency post neurosurgery secondary to Dexamethasone. Once data is collected guidance on how to manage a safe post surgical steroid wean and minimise impact of quality of life can be formalised.
LONG-TERM SURVIVAL OF TANYCYTIC EPENDYMOMA OF LATERAL VENTRICLE WITH ADJACENT FRONTAL LOBE INVASION: CASE REPORT AND LITERATURE REVIEW
Authors: Batista Mr Ruben , Dardis Mr Ronan , Edwards Mr Ian , Hajra Mr Debasish 
Published: October 2024

Abstract

AIMS
Tanycytic ependymoma (TE) of lateral ventricle is a rare variant of ependymoma often challenging to diagnose due to its distinctive histological features and similarity to other central nervous system neoplasms. This report presents a case of TE in a 48 years-old lady with 20 years of long-term survival and provides a comprehensive review of the literature to elucidate the clinical, radiological, and pathological characteristics of this entity.

METHOD
A 48-year-old woman presented with a left lateral ventricular tumor invading the left frontal lobe and pericallosal region, subsequently diagnosed as TE after stereotactic biopsy followed by radical radiotherapy. Epidemiological features, preoperative and postoperative radiological surveillance, and functional performance after adjuvant radiotherapy were reviewed. Additionally, we review the current literature to explore current perspective of TE. Three major medical database engines, PubMed (Medline), Scopus (ELSEVIER), and Cochrane were used to conduct a thorough literature search.

RESULTS
The patient exhibited notable neurological improvement following stereotactic biopsy and radical radiotherapy, with long-term surveillance demonstrating stability and reduction in tumor size over a 20-year period. Our literature review underscores the rarity of TE and its diagnostic challenges, emphasizing the importance of histopathological examination and immunohistochemical analysis for accurate diagnosis. TE exhibit unique ultrastructural features, requiring meticulous examination for proper classiﬁcation. Additionally, we discuss the implications of TE’s histological resemblance to other intramedullary tumors and its potential impact on therapeutic decisions.

CONCLUSION
Tanycytic ependymomas pose diagnostic dilemmas due to their morphological overlap with other CNS tumors. However, heightened awareness among clinicians and pathologists is crucial for accurate identiﬁcation and appropriate management. Further research into the molecular mechanisms underlying TE is warranted to enhance diagnostic precision and reﬁne treatment strategies, ultimately improving patient outcomes.
IDENTIFYING YB1 AND NPM1 AS PART OF THE MUTANT HISTONE 3 PROTEIN INTERACTOME IN H3 MUTATED PHGG
Authors: Dhillon Ms Mehar , Read Ms Eleanor , Sulman Mr Joshua , Haque Dr Farhana 
Published: October 2024

Abstract

AIMS
Paediatric high-grade gliomas (pHGG) are the leading cause of childhood cancer deaths, accounting for over 40% of deaths in the UK. pHGG tumours harbour histone H3 mutations, deﬁning 50% of pHGG cases and the major mutations are H3.3K27M and H3.3G34R/V. Our previous proteomic research on H3 intercatomes, identiﬁed unique and common interacting binding partners of H3-G34R and H3-G34V mutant proteins relative to wild type H3 protein. Among these binding proteins we have focused on YB-1 and Nucleophosmin 1 (NPM1). YB-1, is multifunctional transcription factor and a well- characterised oncogenic protein. NPM1 is a molecular chaperone and frequently overexpressed in cancers. Our aim is to analyse the role of YB-1 and NPM1 in H3 mutated pHGG, in order to identify targeted therapeutic options for these diﬃcult to treat tumours.

METHOD
H3 mutated glioma, H3 wild type pHGG and control cell lines were cultured and then subjected to comparative immunoﬂuorescence microscopy, and western blot analyses to investigate YB-1 and NPM1 expression.

RESULTS
Results showed statistically signiﬁcant altered protein expression and localisation of YB-1 and NPM1 in H3 mutated pHGG in comparison to wild type and control cells. YB-1 expression was increased in H3 mutated cells and NPM1 showed increased cytoplasmic localization in H3 mutated cells in comparison to H3 WT glioma and control cells.

CONCLUSION
Results of the study support that YB-1 and NPM1 are important interacting proteins in H3G34-mutated pHGGs and can be explored as potential therapeutic targets in H3 mutated pHGG.
INVESTIGATING CUDC-101 EFFECT AND MECHANISM OF ACTION AGAINST GLIOBLASTOMA IN VITRO
Authors: Chandler Ms Rebecca , Alder Dr Jane , Mathews Dr Roshini , Stasik Dr Izabela 
Published: October 2024

Abstract

AIMS
Glioblastoma (GB) has complex pathophysiology, diﬃcult treatment and resultant poor prognosis. Its median survival rate is approximately 15 months. The aggressive nature of GB results in rapid disease progression in 60-70% patients often within 12 weeks. Limited treatment options include maximal safe surgical resection, followed by radiotherapy and temozolomide (TMZ). The blood brain barrier restricts chemotherapeutic entry and increases dosage leading to increased side effects and decreased treatment tolerance. Furthermore, signiﬁcant disease heterogeneity means reoccurrence is expected in most cases, for which there are no standard treatment routes. This coupled with ineﬃcient treatment with temozolomide (TMZ) due to the blood brain barrier, highlights the requirement for novel treatments.

METHOD
Histone deacetylases (HDAC) and endothelial growth factor receptor (EGFR) are mutated and upregulated in GB allowing tumour inﬁltration and proliferation. CUDC-101 is known to target both HDAC and EGFR in other cancers making it a promising therapeutic to trial in GB. Cell viability of U251, T98G and U87MG human cells was measured post-CUDC-101 administration at 24, 48 and 72hrs. SVGp19 embryonic non-cancerous human glial cells were used as a control to establish CUDC-101 preliminary speciﬁcity. Targeting another major hallmark of GB, wound healing assays were performed to assess CUDC-101 capacity to inhibit migration. In addition to this, long-term cellular resistance was investigated through clonogenic assays. Western blotting was then used to identify non-/treated expression levels of activated EGFR and acetylated histone H3. Expression levels in non/-treated cells were then visualised with ﬂuorescent microscopy. In addition, ﬂow cytometry was utilised to observe cell cycle changes.

RESULTS
Overall, results indicate CUDC-101 has a dose-dependent effect on cell viability (long-term and short-term) and migration. Additionally, ﬂuorescent images show treatment does increase histone acetylation and decrease total EGFR.

CONCLUSION
Future work will solidify these datasets and show changes in activated EGFR and acetylated histone H3 using western blotting.
SUPERSOFT SPONGE-LIKE CRYOGEL AS AN IMPLANT TO TREAT GLIOBLASTOMA
Authors: Wang Mr Yu , Le Joncour Dr Vadim , Laakkonen Prof Pirjo , Newland Dr Ben 
Published: October 2024

Abstract

AIMS
Create cylindrical cryogels with well-deﬁned size. Investigate clemastine drug loading capicaty and drug release patterns. Investigate in vitro and in vivo safety and antitumor eﬃcacy.

METHOD
A 3D printed template was designed and printed to make cylindrical shape cryogels. The morphology of cryogels was characterized by bright ﬁeld photos, SEM, FTIR and confocal microscopy photos. The mechanical property was evaluated by uniaxial compression tests. The orthotropic glioblastoma tumor model was established by engrafting BT12 human glioblastoma stem cells intracerebrally into immunocompromised nude mice. The tumor was surgically removed after two weeks and the cryogel was implanted into the resection cavity. Animals were euthanized after two weeks, and their brains were collected for the immunohistochemistry.

RESULTS
Cylindrical cryogels were prepared to exactly ﬁt the biopsy resection cavity in the mouse glioblastoma tumor resected model. The macropore structure in the cryogel was observed under confocal microscopy. Young’s modulus of the cryogel was only 1.6 kPa. The loading capacity of clemastine in one cryogel was more than 100 μg. Clemastine could be sustained released for around a week. In vitro cell viability studies showed that empty cryogels were not toxic to the tumor cells and drug loaded cryogels killed the tumor cells in a time and concentration dependent manner. In vivo studies further conﬁrmed that cryogels could be safely implanted into the brain. Although the implantation of clemastine loaded cryogels did not prevent the growth of the primary tumor, it reduced the amount of invasion tumor cells compared with the mice only resected the tumor.

CONCLUSION
Cryogels were easily created by the 3D printed templates. The soft material avoided mechanical mismatch with the brain tissue. The cryogel did not show any toxicity in in vitro and in vivo studies, which indicated it would be a promising material to be implanted into the brain.
NANOPORE-BASED INTRA-OPERATIVE CLASSIﬁCATION OF CENTRAL NERVOUS SYSTEM TUMOURS IN THE NHS
Authors: Deacon Dr Simon , Cahyani Dr Inswasti , Holmes Dr Nadine , Fox Dr Graeme , Wibowo Mr Satrio , Munro Mr Rory , Patel Dr Areeba , Goldspring Dr Robert , Brandner Prof Sebastian , Sahm Prof Felix , Paine Dr Simon , Loose Prof Matthew , Smith Dr Stuart 
Published: October 2024

Abstract

AIMS
The 2021 WHO classiﬁcation of CNS tumours necessitates the use of molecular testing in order to reach a conﬁdent diagnosis of many tumour types. At present, this is achieved using array-based technology delivered by a centralised model. This approach has inherent delays that mean it is often several weeks before the treating clinical team is informed of diagnosis, delaying the start of adjuvant therapy and causing signiﬁcant distress for patients. As such, there is an urgent need to rethink this pathway and improve time to diagnosis. Nanopore longread sequencing technology has the potential to enable a paradigm shift in diagnostic and therapeutic pathways, offering rapid, comprehensive molecular diagnosis that can be performed in the intra-operative setting. We aimed to test the hypothesis that intra-operative methylation-based classiﬁcation can be performed using nanopore sequencing and thereby expediently inform surgical and oncological decision-making.

METHOD
Oxford Nanopore Technology (ONT) is a native-strand, long-read sequencing platform that can perform copy- number proﬁling along with parallel single-gene methylation, structural variant, mutational and methylation analyses. Capital and consumable costs are relatively low, and testing can be performed in the local setting on single samples. We have optimised DNA extraction and library preparation for rapid tissue processing. We have developed a robust bioinformatic pipeline which is able to produce intraoperative classiﬁcation within minutes of sequencing and full molecular proﬁling after 24 hours.

RESULTS
We demonstrate the feasibility of using ONT to deliver intra-operative methylation-based classiﬁcation of CNS tumours in ‘realtime’ within an NHS hospital setting and will discuss the challenges of implementing this testing and the opportunities to inform neuro-oncological practice.

CONCLUSION
By giving a summary of our novel protocol of rapid DNA extraction, library preparation and bioinformatic analysis, we will show that this approach can revolutionise the diagnosis of brain tumours and has the potential for rapid adoption by non-expert laboratories.
IMPROVING THE EﬃCIENCY OF THE NEURO-ONCOLOGY NEW PATIENT CLINIC AT THE ROYAL MARSDEN HOSPITAL
Authors: Lorimer Dr Cressida , Khan Dr Asadullah Anees , Yadav Dr Deepthi , Kalra Dr Babusha , Welsh Dr Liam , Creak Dr Antonia 
Published: October 2024

Abstract

AIMS
Patients seen for the ﬁrst time in the neuro oncology outpatient unit are typically reviewed by a registrar, then a consultant and a clinical nurse specialist (CNS). This can lead to repetition in history taking and prolonged appointment times. We aimed to improve this by introducing a clerking proforma.

METHOD
Prospective audit of all new patients seen in clinic over a four month period. The total clinic appointment time was recorded for each patient. A proforma was designed to cover the main domains of presenting symptoms, especially focussing on tumour related symptoms, medications including dexamethasone and antiepileptic use, and ensured the appropriate information was given to the patient about the treatment proposed and driving restrictions. The proforma was introduced in to the clinic after 2 months and results analysed to see if a difference was made in terms of overall patient time in the clinic. Qualitative feedback gathered from the team members involved.

RESULTS
10 patients were included prior to the use of the proforma and 9 patients afterwards. Patients presented with a mixture of high and low grade gliomas. Treatment options discussed included chemotherapy, radiotherapy, surveillance and best supportive care. The average time of patient stay in the department prior to the proforma was 107 minutes (range 65 to 165) and after the introduction of the proforma was 91 (range 40 to 110). The proforma was well received by the clinical team, it was felt useful to have a template to structure the new patient consultation, especially for more junior registrars, and the consultants were more conﬁdent that the appropriate information had been given.

CONCLUSION
Within the conﬁnes of a small sample size, the introduction of a proforma reduced the average new patient consultation time and standardised the clinical information collected.
WHICH BRAIN TUMOUR PATIENTS WOULD BENEﬁT FROM SURGERY TO TREAT BOTH THE TUMOUR AND TUMOUR-RELATED EPILEPSY?
Authors: Corrigan Dr Amber , Joe Dr Dorothy , Finnerty Dr Gerald T 
Published: October 2024

Abstract

AIMS
Poor seizure control is a common problem for brain tumour patients. Epilepsy surgery is considered in patients with seizures not caused by a brain tumour when trials of two anticonvulsants given in therapeutic doses fail. There are no clear guidelines on when epilepsy surgery should be considered for brain tumour patients. Given the high burden on quality of life, preventing recurrent seizures is essential.

METHOD
Retrospective data collection of patients seen in the Low-Grade Glioma and Joint Neurology-Oncology clinics of a regional Neuro-oncology service between January – June 2023. Data were analysed within STATA 18.

RESULTS
We identiﬁed 121 patients (61 male, 60 female; age range 20-84 yrs). The majority (93/121) were diagnosed with a low-grade glioma. [GF1] 44 patients had tumour-related epilepsy. Of these, 31/44 (70%) patients presented clinically with seizure(s) and 13/44 (30%) patients had their ﬁrst seizure 3 - 2421 days post diagnosis. All patients were started on anticonvulsant medication, commonly Levetiracetam (70%). Tumour surgery was performed on 28/44 (63%) patients. Recurrent seizures occurred in 22/44 (50%) patients. Seizures were not controlled in 12 (29%) patients after trying two or more anticonvulsants. Four patients were considered for epilepsy surgery.

CONCLUSION
Recurrent seizures are a common clinical problem in patients with low-grade gliomas. Surgery to treat brain tumour-related epilepsy may be performed as a last option. Brain tumour patients may beneﬁt from earlier consideration of surgery to treat both the epilepsy and the brain tumour.