bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURG-03. SURVIVAL STRATIFICATION OF IDH-WILDTYPE GLIOBLASTOMA IN THE MOLECULAR ERA: A RECURSIVE PARTITIONING ANALYSIS INCORPORATING EXTENT OF RESECTION OF CONTRAST-ENHANCING AND NON-ENHANCING TUMORS
Authors: Park Yae Won , Choi Kyu Sung , Park Ji Eun , Ahn Sung Soo , Chang Jong Hee 
Published: November 2023

Abstract

METHODS
This multicenter cohort study included a development cohort of 622 IDH-wildtype glioblastoma patients from a single institution (diagnosed between 2001 and 2021) and 445 patients as validation cohorts from two institutions. All patients completed radiotherapy plus concurrent temozolomide and had complete information on IDH mutation and MGMT promoter methylation status. EOR of CE and NE tumors were evaluated. A RPA analysis was performed on behalf of results of the Cox proportional hazards model. The RPA model was compared with a previous RTOG RPA model.

RESULTS
In the developmental cohort, older age (hazard ratio [HR] = 1.02, P &lt; 0.001), MGMT methylation (HR = 0.51, P &lt; 0.001), KPS (HR = 0.98, P &lt; 0.001), and EOR of CE and NE tumors (GTR of CE tumor and non-GTR of NE tumor, HR = 1.82, P &lt; 0.001; non-GTR of both CE and NE tumor, HR = 2.05, P &lt; 0.001; reference group as GTR of both CE and NE tumor) were independent prognostic factors on multivariable analysis. The novel RPA consisting of age, MGMT methylation, KPS, and EOR of CE and NE tumors revealed greater separation of prognostic classes compared with the previous RTOG RPA model. The prognostic significance of the novel RPA model was subsequently confirmed in the validation cohorts.

CONCLUSION
The RPA model in IDH-wildtype glioblastoma patients incorporating EOR of CE and NE tumors is a valid model. This simple RPA model has the potential to contribute to improving the accurate assessment of prognostic groups in IDH-wildtype glioblastoma patients and to influence clinical decision-making.
SURG-04. FAST DETECTION OF GLIOMA INFILTRATION USING LABEL-FREE OPTICAL MICROSCOPY AND DEEP NEURAL NETWORKS
Authors: Kondepudi Akhil , Pekmezci Melike , Scotford Katie , Jiang Cheng , Chowdury Asadur , Hou Xinhai , Wang Lin , Al-Holou Wajd , Camelo-Piragua Sandra , Lee Honglak , Freudiger Christian , Berger Mitchel , Hervey-Jumper Shawn , Hollon Todd 
Published: November 2023

Abstract

INTRODUCTION
Fast and accurate detection of tumor infiltration is a central challenge in the comprehensive management of diffuse glioma patients. Despite our best real-time tumor detection strategies, such as intraoperative MRI and fluorescence-guided surgery, dense and safely resectable tumor infiltration remains at the surgical margin in over 85% of diffuse glioma patients. Patterns of treatment failure demonstrate that glioma recurrence occurs at the surgical margin in the majority of patients due to residual tumor burden. Objective Here, we present FastGlioma, an artificial intelligence (AI)-based intraoperative diagnostic system for fast (&lt; 10 seconds) detection of diffuse glioma infiltration at microscopic resolution without the need for tumor-specific markers. Method FastGlioma is trained using large-scale, self-supervised visual feature learning on stimulated Raman histology (SRH), a rapid, label-free, optical microscopy technique, and a GPT-style whole slide SRH tumor infiltration scoring method. We pushed the performance limits of FastGlioma by investigating the trade-off between imaging speed versus accuracy for microscopic tumor detection.

RESULTS
In a large prospective external testing cohort of diffuse glioma patients (180 patients, 935 surgical margin specimens) who underwent intraoperative SRH imaging, we demonstrate that FastGlioma was able to detect and quantify microscopic tumor infiltration with an average AUROC of 92.1 +/- 0.0%, performing on par with three expert neuropathologists on the same task. FastGlioma is over 10X faster than previous SRH-based methods and 100X faster than conventional H&E histology. Finally, we demonstrate that FastGlioma was &gt; 20% more accurate at detecting dense tumor infiltration when compared to radiologic features or 5-aminolevulinic fluorescence (98.0% versus 77.8% accuracy) for both IDH-mutant diffuse gliomas and IDH-wildtype glioblastomas.

CONCLUSION
Our results demonstrate how intraoperative optical imaging and deep neural networks can achieve fast and accurate tumor detection, unlocking the role of AI in improving the surgical management of brain tumor patients.
SURG-09. TARGETING A SHARED GLIOBLASTOMA CELL STATE THROUGH ADAPTIVE NATURAL KILLER CELLS AUGMENTED WITH TRISPECIFIC KILLER CELL ENGAGER (TRIKE) IMMUNE-MODULATOR AGAINST CD276
Authors: Ning Jianfang , Davis Zachary , Zhu Shan , Miller Jeffrey , Chen Clark 
Published: November 2023

Abstract

INTRODUCTION
T and NK (Natural Killer) cells have emerged as promising platforms for immunotherapy. While T cells require antigen priming and complex MHC-dependent interactions, NK cells exhibit limited persistence and limited antigen specificity. Trispecific Killer cell Engagers (TriKEs) are constructs developed to address these limitations, combining interleukin 15 (IL15, to enhance persistence), a single-chain antibody fragment against CD16 (to immune-activate NK), and a second fragment targeting a tumor surface marker. Objective: In this study, we identified CD276 (B7H3) as the surface marker optimal for an anti-glioblastoma TriKE and tested its effect on the anti-glioblastoma activity of NK cells. Method: Mass-spectrometry, RNA-Seq, and single cell RNA-Seq profiling of glioblastoma lines. Laboratory characterization and murine modeling Result: Orthogonal analysis of mass-spec identified cell surface molecules enriched in glioblastoma lines and RNA-seq of lines with defined sensitivity to NK cells identified surface proteins highly expressed in NK-resistant lines. Screening of these candidates for genes that showed poor survival association using the TCGA identified CD276. qPCR analysis confirmed higher CD276 expression in the NK-resistant lines, though expression is also detected in NK-sensitive glioblastoma lines. Western blotting analysis and TCGA analysis showed higher level CD276 expression in all glioblastoma subtypes (proneural, neural, mesenchymal, and classical) relative to normal brain. Single cell RNA-Seq of clinical specimens confirmed high expression of CD276 in glioblastoma cells in OPC-like, NPC-like, AC-like, and MES-like cell states. Co-incubation of a IL15, CD16, and CD276 targeting TriKE with either adaptive or iPS derived NK cells enhanced anti-glioblastoma cytotoxicity against cells otherwise refractory to NK treatment in vitro. Synergy between these reagents were also observed in vivo upon orthotopic injection.

CONCLUSION
Our results suggest that a therapeutic strategy combining intra-tumoral injections of NK cells and a B7H3 specific TriKE holds promise and warrants clinical trial consideration.
SURG-23. THE INFLUENCE OF PRE-OPERATIVE VARIABLES ON SURVIVAL OF PATIENTS WITH GLIOBLASTOMA
Authors: Begley Sabrina , Pelcher Isabelle , Schulder Michael 
Published: November 2023

Abstract

BACKGROUND
Glioblastoma (GBM) is both the most common and most aggressive brain tumor in adults. Despite treatment advances, prognosis remains poor and is influenced by numerous factors.

METHODS
Patients treated at our institution for glioblastoma were reviewed to identify pre-treatment factors that could increase survival time. 183 treated for high-grade GBM between 2017 and 2021 with complete follow-up data were included. Overall (OS) and progression-free survival (PFS) were calculated with Kaplan-Meier analysis. Cox regression analysis identified the influence of several pre-treatment factors (age, Karnofsky performance status (KPS), radiographic distribution of tumor, and MGMT methylation status) on survival time.

RESULTS
Average age was 64.9 years. At presentation, 69.9% of patients had KPS &gt; 80. Multifocal tumors occurred in 24.6% of patients, involving an average of 2 distinct regions (either multifocal or unifocal lesions). MGMT methylation was confirmed in 17.5% of patients. Recurrence occurred in 46.4% of patients. Median OS was 21.6 (14.3 – 28.9) months and PFS was 13.4 (10.6 – 16.1) months. MGMT methylation was associated with significantly longer median OS (36.9 vs. 17.0 months, p = 0.012) and PFS (20.0 vs. 10.3 months, p = 0.002) compared to those without. Cox regression confirmed MGMT methylation to be significantly associated with longer PFS (HR -0.883, p = 0.004) and OS (HR -0.785, p = 0.014). Age (HR 0.03, p = 0.003) and KPS &gt; 80 (HR -0.7, p = 0.006) significantly impacted OS, but not PFS. Tumor extent did not impact survival.

CONCLUSIONS
We found that multifocal tumor, greater number of involved regions. and older age were associated with shorter OS, while MGMT methylation was associated with longer OS. Similar correlations were found for PFS. In upcoming trials, these factors may need to be controlled for between groups in order to accurately determine the effect of new treatments.
SURG-26. HYDROCEPHALUS IN LEPTOMENINGEAL DISEASE: TANDEM OMMAYA RESERVOIR-SHUNT FOR INTRATHECAL CHEMOTHERAPY ADMINISTRATION
Authors: Valeri Amber , Etame Arnold , Beer-Furlan Andre , Liu James , Yu Hsiang-Hsuan Michael , Oliver Daniel , Pina Yolanda , Vogelbaum Michael A , Forsyth Peter , Mokhtari Sepideh , Sahebjam Solmaz , Tran Nam 
Published: November 2023

Abstract

INTRODUCTION
Leptomeningeal disease (LMD) is a rare late-stage manifestation of disease progression in solid and hematologic malignancies. Although advances in intrathecal therapeutic (IT) provide treatment options beyond the traditional WBRT, these IT treatment strategies are limited when LMD patients develop associated hydrocephalus. CSF shunting can improve quality of life but may lead to decreased exposure time of IT therapies, with overall survival remaining less than 4 months. Our institution implemented placement of an Ommaya reservoir with ventricular shunt for administration of intrathecal chemotherapy while allowing for concomitant CSF diversion.

METHODS
The authors performed a retrospective chart review on all patients who underwent placement of Ommaya reservoir with a ventricular shunt for treatment of hydrocephalic LMD from Sept 2011 to Feb 2021. LMD secondary to primary glial neoplasm were excluded. Patient demographics, clinical characteristics, tumor characteristics, systemic and IT chemotherapy regimen, length of survival and complications were assessed.

RESULTS
Forty-one patients were included in the study: 18 breast, 12 lung, 5 melanoma, 2 gastric, 2 diffuse large B cell lymphoma, 1 AML, 1 pancreatic. 33.3% of breast cancer were HER-2 positive, while 40% melanoma were BRAF mutated. Patients receiving IT + shunt and WBRT (n = 22) had mean survival time of 350 days from LMD diagnosis compared with 182 days for shunt and WBRT alone (n = 19; p = 0.07). Breast and melanoma patients with IT (n = 16) had improved survival compared with patients with shunt and WBRT (n = 7) alone (419 vs 91 days, p = 0.03). Kaplan-Meier survival analysis demonstrates a positive trend towards increased survival in IT + shunt and WBRT group.

CONCLUSION
This treatment strategy of Ommaya reservoir and shunt prolongs survival in patients with LMD and associated elevated intracranial pressures. This may be very important as we enter the era of cellular immunotherapies for LMD.
SURG-29. APPROACH SELECTION FOR COMPLEX, MULTI-COMPARTMENTAL PETROCLIVAL MENINGIOMAS: A SYSTEMATIC REVIEW OF ENDOSCOPIC AND TRANSCRANIAL APPROACHES TO AN EXCEEDINGLY DIFFICULT CLASS OF SKULL BASE LESIONS
Authors: Brown Nolan , Musmar Basel , Kuo Cathleen , Nguyen Oanh , Neil Zachery , Gendreau Julian 
Published: November 2023

Abstract

INTRODUCTION
Petroclival meningiomas are among the most formidable and technically challenging tumors in skull base surgery owing to their deep-seated location and proximity to critical neurovascular structures. Herein, we seek to understand why skull base surgeons preoperatively plan the staged excision of petroclival meningiomas.

METHODS
Three databases were queried per PRISMA to identify studies describing the indications for staging surgical resection of petroclival meningiomas.

RESULTS
Fourteen studies describing 187 patients (59.3% female, age range: 5 – 81 years) met inclusion criteria. The most common presenting symptom at diagnosis was headache (24.6%). Other common symptoms included cerebellar signs (16.0%) and gait disturbances (13.4%). Petroclival meningiomas were most commonly observed extending to the cavernous sinus (52.88%) and meckel’s cave (49.04%). With respect to critical neurovasculature, the trigeminal nerve was involved in a majority (54.59%) of petroclival meningiomas, while other relevant cranial nerves with tumor involvement included the facial (16.22%) and vestibulococcular (12.43%). Additionally, the most commonly involve vascular structures were the basilar (2.16%) superior cerebellar arteries (1.62%). Of the 187 patients who underwent surgical resection of petroclival meningioma, 144 (77%) underwent surgery involving a single stage, while 43 (23%) underwent surgery in which a two-stage approach was used. The most common single-stage approaches were the retrosigmoid (n = 35) and transpetrosal (n = 22), while the most common approaches employed in a multi-stage fashion were the subtemporal (n = 6), pterional (n = 5), and suboccipital (n = 4) approaches. To clarify, these approaches were each performed as one half of a two-stage surgery involving a second, separate approach.

CONCLUSION
Common approaches used in multi-stage procedures included the retrosigmoid, anterior petrosectomy, posterior petrosectomy, orbitozygomatic, translabrynthine, and various combinations thereof. Indications for performing surgery in this manner include coexistence of lesion in both middle and posterior skull base compartments, absence of meaningful hearing function, tumor size, and surgeon preference.
SURG-30. CLINICAL CONSIDERATIONS, APPROACH SELECTION, AND OUTCOMES ASSOCIATED WITH TREATMENT STRATEGIES FOR FALCOTENTORIAL MENINGIOMAS: SYSTEMATIC REVIEW AND META-ANALYSIS OF THE CURRENT EVIDENCE
Authors: Brown Nolan , Musmar Basel , Kuo Cathleen , Gendreau Julian 
Published: November 2023

Abstract

INTRODUCTION
Meningiomas at the falcotentorial (FT) junction are rare, as they account for only 0.3%-1.1% of all intracranial meningiomas. Clinical management of FT meningiomas can be challenging.

METHODS
The authors queried three databases per PRISMA guidelines to identify all studies reporting indications for surgical resection of FT meningioma.

RESULTS
Thirty studies reporting 224 FT patients met pre-specified inclusion criteria. Patients diagnosed with FT meningioma demonstrated a predilection for headache on initial examination (p = 0.030).Headache was the mostly commonly reported symptom, present more often than visual disturbance (RR 2.28 [1.59, 3.26], I2=0%, P &lt; 0.00001), ataxia or imbalance (RR 0.21 [0.08, 0.35], I2= 0%, P = 0.002), and cognitive disturbance (RR 0.34 [0.20, 0.47], I2 = 12%, P &lt; 0.00001). An overwhelming majority of lesions (n = 97, 80.2%) were benign, WHO Grade I. The primary arterial feeders supplying the FT lesions were reported in 13 studies; most commonly, these arterial feeders included the distal branches of the ICA (n = 29), ECA (n = 25), and vertebrobasilar vasculature (n = 35). Visual deficits (n = 32, 14.3%) were the most common postoperative complication.Bassiouni classification of the tumors was reported in 10 studies, with 27 (31.8%) classified as type I, 16 (18.8%) as type II, 37 (43.5%) as type III, and five (5.9%) as type IV FT meningiomas.Simpson Grade I resection (n = 76, 43.7%) was achieved in slightly less than half of cases. Cases involving multi-stage resections appeared to confer greater risk (RR 1.42 [0.72, 2.80], I2=0%, P = 0.31) for STR (failure to achieve GTR or Simpson Grade I resection).

CONCLUSION
The primary objective when treating FT meningiomas is to achieve gross total resection (GTR) or Simpson Grade 1 resection. Grade 2 resection is also regarded as a good outcome for these lesions. This goal should be pursued while minimizing cerebellar retraction and protecting vital vascular structures, such as the Galenic venous system.
SURG-35. SURVEY ASSESSMENT OF UTILITY IN THE PREOPERATIVE MAGNETIC RESONANCE (MR) TRACTOGRAPHY SURGICAL PLANNING
Authors: Sharma Mayur , Chen Clark 
Published: November 2023

Abstract

BACKGROUND
While tractography guided surgery is used by many surgeons as a matter of preference, there is controversy in the published literature as it relates to its clinical utility. The current literature consists of experiences of select surgeons. Here we adopted a survey-based approach with the goal of attaining a broader view of how tractography influence pre-operative planning in a sampling of practicing neurosurgeons.

METHODS
Three cases were prepared where the presence of a tumor distorted the optic radiation (case 1), the arcuate fasciculus (case 2), and corticospinal tract (case 3). This survey was administered at the Medtronic Cranial Consortium attended by twenty practicing neurosurgeons. To avoid commercial bias, we used both the Brainlab and the Medtronic platform to compute tractography. Each participant is asked to vote on a surgical trajectory prior to and after seeing the tractography images as well as whether tractography added value in validating their surgical approach.

RESULTS
In the three cases surveyed, 16-44% of the surgeons changed the surgical corridor selected after seeing the tractography images. The most common finding associated with a change in surgical corridor involved intersection of the surgical corridor with visualized tracts. Consistently, &gt;80% of the surgeons surveyed felt that tractography added value in their surgical planning. These findings suggest tractography added value even in cases where the surgeon did not change their surgical approach, likely by confirming their prediction in the location of the pertinent tracts.

CONCLUSION
The clinical utility of tractography in pre-operative planning vary as a function of surgeon and the tumor anatomy, with &gt; 80% of the participating consider that tractography added value in pre-operative surgical planning.
SURG-37. ONCOGENIC MUTATIONS AND TUMOR CHARACTERISTICS IN OLFACTORY GROOVE MENINGIOMAS: IMPLICATIONS FOR PERSONALIZED TREATMENT STRATEGIES
Authors: Prilop Insa , Beyer Friederike , Herold Sylvia , Alkhatib Majd , Cahill Daniel , Wakimoto Hiroaki , Brastianos Priscilla , Eyuepoglu Ilker , Schackert Gabriele , Juratli Tareq 
Published: November 2023

Abstract

OBJECTIVE
To investigate the correlation between clinical and radiologic features of olfactory groove meningiomas (OGM) and their tumor molecular profiles, focusing on oncogenic mutations identified through genomic studies.

METHODS
Targeted next-generation sequencing analyses were conducted on 54 patients with OGM (37 females and 17 males) to determine the frequency of SMO, AKT1, PIK3CA, and other mutations. The molecular results were then correlated with clinical and radiographic tumor features.

RESULTS
Among the OGM patients, SMO mutations were found in 16 (29.6%) cases, AKT1 mutations in 13 (24.1%), and PIK3CA/PIK3R1 mutations in 9 (16.7%) cases. Less common mutations in POLR2A, SUFU, and NF1 were observed in 8 (14.8%) cases, while 8 OGM (14.8%) did not have identifiable driver mutations (Wild-type group, WT). The median age at first diagnosis was 64.1 years (25-87 years), with the youngest group represented by PIK3CA-mutant patients at 52 years (49-78 years). The sex distribution was similar across the SMO-, AKT1- and PIK3CA-mutant groups (F:M = 2.1:1). OGM with SMO mutations exhibited larger tumor volumes (329.4 ± 323.0 cm3) compared to AKT1-mutant tumors (283.3 ± 156.2 cm3). Tumor infiltration of the ethmoid cells was found in 10 cases (22.2%), with the highest rate observed in PIK3CA-mutant OGM (40%), followed by 25% in SMO-mutant OGM. Tumor-associated hyperostosis of the sphenoid planum was common in OGM (72.2%), with the highest rate in the SMO group (75.0%) and the lowest rate in the AKT1-mutant group (30.8%). The majority of cases (n = 45, 83.3%) were classified as WHO grade 1 meningioma, while the remaining nine cases were WHO grade 2 (n = 8) and 3 (n = 1).

CONCLUSIONS
Overall, our data demonstrate the presence of clinically actionable mutations in the majority of olfactory groove meningiomas, and suggest a correlation between molecular status and common clinical and radiologic tumor features.
SURG-39. EVALUATING THE EFFECTIVENESS OF NON-NAVIGATED 2D INTRAOPERATIVE ULTRASOUND IN GLIOMA SURGERY: RECONSIDERING THE PUSH FOR MORE COMPLEX INTRAOPERATIVE IMAGING
Authors: Cepeda Santiago , García-García Sergio , Arrese Ignacio , Sarabia Rosario 
Published: November 2023

Abstract

INTRODUCTION
In the swiftly evolving domain of neurosurgical technology, conventional methodologies like the non-navigated two-dimensional intraoperative ultrasound (nn-2D-IOUS) might be at risk of being overlooked. This research investigates the clinical effectiveness and surgical significance of nn-2D-IOUS, particularly for glioma removal procedures.

METHODS
This retrospective research, conducted at a single healthcare institution, reviewed 99 unselected patients diagnosed with both high and low-grade gliomas. The main objective was to examine the competency of nn-2D-IOUS in delivering satisfactory image quality, recognizing leftover tumor tissue, and its impact on the extent of tumor removal. Early postoperative MRI data were used as a reliable comparison measure to verify these findings.

RESULTS
nn-2D-IOUS exhibited notable efficiency, generating superior image quality in nearly 79% of analyzed cases. It showcased a sensitivity of 68% and a remarkable specificity of 100%, thus affirming its instrumental role in intraoperative tumor identification. In scenarios where complete tumor excision was intended, a resection surpassing 95% of the original tumor volume was accomplished in 86% of patients. Moreover, when the nn-2D-IOUS didn't detect residual tumor, the average volume of overlooked tumor tissue was significantly small, approximately 0.27 cm³.

CONCLUSION
Our research presents persuasive evidence emphasizing the critical role and effectiveness of nn-2D-IOUS in glioma surgeries. The findings underline the potential of leveraging cost-efficient, traditional technologies like nn-2D-IOUS to attain superior surgical results, even when compared to more sophisticated alternatives. This understanding has profound implications, especially for resource-limited environments, underscoring the need to maximize the usage of available tools to enhance patient care in a practical, economical manner.