bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURG-08. THE CLEARPOINT ARRAY® FRAME: A NOVEL MRI COMPATIBLE SYSTEM THAT SUPPORTS NON-CRANIOTOMY, MULTI-TRAJECTORY (NCMT) STEREOTACTIC PROCEDURES
Authors: Hamade Youssef , Chen Clark 
Published: November 2023

Abstract

BACKGROUND
With continued evolution in stereotactic techniques and an expanding armamentarium of therapeutic options, non-craniotomy stereotactic procedures in neuro-oncology are becoming increasingly complex, often requiring multi-trajectory approaches. Here we demonstrate that the ClearPoint SmartFrame Array®, a second-generation MRI-compatible stereotactic frame, supports such non-craniotomy, multi-trajectory (NCMT) stereotactic procedures.

METHODS
Through a case report, we previously established the feasibility of NCMT through the ClearPoint SmartFrame Array®. Here we prospectively followed the next ten consecutive patients who underwent such multi-trajectory procedures to establish procedural safety and clinical utility.

RESULTS
Ten patients underwent complex, multi-trajectory stereotactic procedures, including combinations of needle biopsy + cyst drainage and laser interstitial thermal therapy (LITT) targeting geographically distinct regions of neoplastic lesions under the same anesthetic event. For each intended target, the maximal radial error of stereotaxis ranged 0.1-2.7 mm (with a median of 1.0 mm). In all cases, definitive diagnosis was achieved, and &gt;90% of the intended targets were ablated. The average stereotaxis time (time required to establish the trajectories) for the multi-trajectory procedure was 119 + 22.2 minutes, which is not statistically different from our published results for single-trajectory procedures (80 + 9.59 minutes, p = 0.125). There were no procedural complications. Post-procedure, the neurologic condition of one patient improved, while the remaining nine patients remained stable. All patients were discharged home, with a median hospital stay of one day (range: 1-12 days). With a median follow-up of 376 days (range: 155-1438 days), there were no 30-day readmission or wound complications. There were two 90-day readmissions (a patient with hydrocephalus and another with new spine metastasis) unrelated to the procedures performed.

CONCLUSION
Geographically distinct regions of a brain cancer can be safely and accurately accessed through the ClearPoint Array® frame in NCMT stereotactic procedures.
SURG-13. PEDIATRIC PRIMARY CENTRAL NERVOUS SYSTEM NEOPLASMS: RELATIVE UTILITY OF OPEN, MULTI-STAGE CRANIAL SURGERY
Authors: Brown Nolan , Bui Nicholas , Kuo Cathleen , Gendreau Julian 
Published: November 2023

Abstract

OBJECTIVE
Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes in pediatric patients. Despite its extensive applications, there is a paucity of information regarding open multi-stage resection of intrinsic, intra-axial neoplasms. We reviewed the literature in order to shed light on relevant considerations including the timing between surgeries, indications for staged approaches, and clinical outcomes following staged resection of pediatric intra-axial neoplasms.

METHODS
We conducted a literature search using PubMed, Web of Science, and Cochrane databases according to PRISMA recommendations.

RESULTS
Of 115 results, 7 articles were included for final analysis and consisted of 17 pediatric patients, including 6 (35%) male, 5 (29%) female, and 6 (35%) unspecified sex patients. Age ranged from 18 months to 17 years (mean 9 years). Tumor pathologies consisted of 5 (29%) astrocytomas, 2 (12%) ependymomas, 2 (12%) teratoid rhabdoid tumors, 2 (12%) oligodendromas, 1 (6%) glioma, 1 (6%) dysembryoplastic neuroepithelial tumor, 1 (6%) meningioangiomatosis, 1 (6%) pleomorphic xanthoastrocytoma, 1 (6%) ganglioglioma, and 1 (6%) germ cell tumor. Primary sites of the tumor included 4 (24%) temporal lobe, 3 (18%) thalamic, 3 (18%) thalamopeduncular, 3 (18%) frontal lobe, 2 (12%) posterior fossa, 1 (6%) cerebral hemisphere, and 1 (6%) frontoparietal lobe. Three studies reported complications, which included subtle hemiparesis, hydrocephalus, cranial nerve (CN) VI and VII palsies, truncal ataxia, and cerebellar mutism. Timing between surgeries varied from 5 days to several weeks

CONCLUSION
Indications for performing multi-stage resections included large tumor volume requiring multiple long stages of debulking, significant tumor vascularity, multicompartmental lesions, and planned staging due to presence of large tumors requiring resection around eloquent speech and motor cortical and white matter tract lesions that enabled use of awake functional mapping after a primary debulking performed in proximity to less eloquent regions.
SURG-16. SAMPLING AND PROCESSING OF TUMOR TISSUE DURING RESECTION OF DIFFUSE INTRACRANIAL GLIOMA: INTERNATIONAL SURVEY AND RECOMMENDATIONS FOR STANDARDIZATION ON BEHALF OF FOUR RANO GROUPS
Authors: Karschnia Philipp , Smits Marion , Reifenberger Guido , Rhun Emilie Le , Ellingson Benjamin , Galldiks Norbert , Kim Michelle M , Huse Jason , Schnell Oliver , Harter Patrick , Mohme Malte , von Baumgarten Louisa , Albert Nathalie , Huang Raymond Y , Mehta Minesh , van den Bent Martin , Weller Michael , Vogelbaum Michael A , Chang Susan , Berger Mitchel , Tonn Joerg-Christian 
Published: November 2023

Abstract

BACKGROUND
Surgical resection represents the standard of care for newly diagnosed diffuse gliomas and allows neuropathological evaluation for diagnosis. Moreover, tissue specimens form the basis for research allowing the identification of pathogenetic mechanisms and targets. However, there is no consensus which tumor portions should be systematically sampled to achieve a genuinely representative evaluation in a condition characterized by intratumoral heterogeneity. Guidelines for biospecimen handling and long-term storage are also lacking, limiting comparative analyses between different biobanks.

METHODS
Four international RANO groups from the fields of surgical and medical neuro-oncology, radiation oncology, neuroimaging, and neuropathology aimed to generate a framework for tissue sampling and processing during resection of diffuse glioma.

RESULTS
A core committee of 21 representatives from the four RANO groups identified areas of interest based upon expert consensus and drafted recommendations for best practice guidelines. Those were eventually sent to 38 leading experts in the field for further evaluation using a two-staged eDelphi process, leading to refinement of the recommendations. Only recommendations which were scored as of ‘critical importance’ by ≥ 70% of the expert panelists were accepted. Consensus recommendations were developed for (I) tissue volume and (neuroimaging-based) tumor-specific regions from where the tumor should be sampled; (II) definitions how regions for sampling of non-contrast-enhancing tumor on MRI should be identified; (III) blood and CSF sampling; (IV) handling and storage to enable both neuropathological diagnosis and in-depth research analyses; and (V) the preferred sample labelling to avoid communication errors. These recommendations resulted in a sophisticated intraoperative workflow proposal to accurately depicture the tumor composition during sampling.

CONCLUSION
These RANO recommendations offer a framework to standardize the surgical and post-surgical workflow for prospective biobanking studies which will be presented together with the results of the eDelphi survey at the SNO meeting.
SURG-18. ONCO-FUNCTIONAL OUTCOME AFTER RESECTION FOR ELOQUENT GLIOBLASTOMA (GLIOFO STUDY): A PROPENSITY-SCORED ANALYSIS OF AN INTERNATIONAL, MULTICENTER COHORT STUDY
Authors: Gerritsen Jasper , Mekary Rania , Pisica Dana , Zwarthoed Rosa , Kilgallon John , Nawabi Noah , Jessurun Charissa , Versyck Georges , Pruijn Koen , Fisher Fleur , Larivière Emma , Solie Lien , Kloet Alfred , Tewarie Rishi Nandoe , Schouten Joost , Bos Eelke , Smith Timothy , Dirven Clemens , Broekman Marike , Vincent Arnaud , De Vleeschouwer Steven 
Published: November 2023

Abstract

BACKGROUND
Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood. We therefore developed a novel onco-functional outcome (OFO) classification and evaluated its benefit in subgroups based on age, preoperative neurological morbidity (NIHSS), and preoperative Karnofsky Performance Score (KPS).

METHODS
Propensity-score matching was used to match OFO 1 (no residual volume, no postoperative functional loss) vs. non-OFO 1 patients for the overall cohort and subgroups based on age, NIHSS, and KPS. Cox proportional-hazard regressions were performed to analyze the association between OFO class and postoperative neurological deficits, KPS deterioration, receipt of adjuvant therapy, overall survival, and progression-free survival. Logistic regressions were performed to analyze the predictive value of perioperative factors on OFO class. Findings Between 2010 and 2020, 858 patients with tumor resection for primary eloquent glioblastoma were included as the overall unmatched cohort. After matching, the overall matched cohort comprised of 512 patients: 256 received OFO 1 and 256 received non-OFO 1. In the overall matched cohort and matched subgroups, OFO 1 resulted in fewer postoperative neurological deficits, lower rates of postoperative KPS deterioration, higher rates of receipt of adjuvant therapy, longer overall survival (median 21.0 months vs. 13.0 months, p &lt; 0.001), and longer progression-free survival (median 10.0 months vs. 7.5 months, p &lt; 0.001). Patients who underwent awake craniotomy more often received OFO 1 (43.0% vs. 26.9%, p &lt; 0.001), and awake craniotomy was an independent predictor for OFO 1 (OR 1.93, p = 0.0070). Interpretation OFO 1 is beneficial in patients with glioblastoma in eloquent areas to improve surgical outcomes, irrespective of age, preoperative NIHSS, or KPS. Furthermore, awake craniotomy was significantly associated with achieving this status. These results might aid neurosurgeons with their surgical decision making in individual patients.
SURG-19. RE-PURPOSING DEEP BRAIN STIMULATORS AS ELECTRIC FIELD THERAPY (EFT) AS TREATMENT FOR GLIOBLASTOMA
Authors: Ma Jun , Dhawan Sanjay , Chen Clark 
Published: November 2023

Abstract

INTRODUCTION
Though alternating electric field therapy (EFT) for glioblastoma received FDA approval, biophysical modeling suggests that field strength generated by scalp electrodes may not sufficiently extend to deep, subcortical regions. Objective: We explore the anti-tumor activity of electric field (EF) generated by electrode directly implanted into glioblastomas, with the goal of repurposing deep brain stimulators as a therapeutic platform. Method: Laboratory characterization and murine modeling Result: In vitro, activation of leads of a deep brain stimulator induced tumoricidal activity within the region encompassed by the EF. To further characterized this tumoricidal activity, a customized two-electrode array was designed and fabricated to allow study of glioblastoma cells seeded at the center of the EF. Consistent with the observations made using the deep brain stimulator electrode, electric field therapy (EFT) induced both necrosis and apoptosis of glioblastoma cells. To characterize this effect in vivo, a four-electrode array was designed and fabricated such that tumor cells can be implanted through a center channel equidistant the electrodes. Mice were implanted with this array, followed by luciferase labelled murine glioblastomas through the center channel. After tumor engravement, mice were randomized to EFT or placebo. EFT was associated with significant diminishment of tumor growth (measured by bio- bioluminescence) and prolonged survival. Analysis of brain sections following EFT showed a notable increase in peri-tumoral microglia accumulation, suggesting potential of EFT as an immune-modulation platform.

CONCLUSION
Our results suggest therapeutic potential for repurposing of deep brain stimulator as glioblastoma therapy, with opportunities for therapeutic enhancement through novel electrode design and stimulation parameter modulation.
SURG-25. SURGICAL MORBIDITY IN RELATION TO THE SURGICAL APPROACH FOR OLFACTORY GROOVE MENINGIOMAS—A POOLED ANALYSIS OF 1016 PATIENTS AND PROPOSAL OF A NEW REPORTING SYSTEM
Authors: Kasper Ekkehard , Mirza Farhan , Kaya Serdar , Walker Robert , Starnoni Daniele , Daniel Roy , Nair Ramesh , Lam Fred 
Published: November 2023

Abstract

BACKGROUND
There is no consensus regarding whether a frontal or lateral approach is superior for resection of olfactory groove meningiomas (OGM). Objective: 1) To compare surgical approaches for microsurgical resection of OGMs for extent of resection and complication rates. 2) To develop a novel preoperative scoring system to guide choice of approach to decrease surgical morbidity.

METHODS
A PRISMA-guided pooled analysis of 20,672 surgical reports on OGMs published in the MRI era using search terms such as ‘olfactory groove meningioma’ and ‘surgery’. After title screening and removal of duplicates, we assessed 871 studies on surgical management of OGMs. Following exclusion criteria, 27 studies were chosen for the final pooled cohort analysis of reported patient outcomes.

RESULTS
The 27 studies identified a total of 1,016 individual patients who underwent open microsurgical resection of OGMs. The approaches used included: pterional/unilateral, bifrontal with variations, and anterior interhemispheric approaches. Across all studies, gross total resection (Simpson Grades I or II) was achieved in 91.4% of cases, and subtotal resection (Grades III and IV) was reported in 8.6% of cases. A cumulative 27% of surgical OGM patients sustained some form of complications. Minor complications 22.2% (CSF leak, seizures, infection, transient cranial nerve palsies, hydrocephalus). Major complications 4.7% (hemorrhage, ischemic infarct, malignant cerebral edema). Correlation between complications and the surgical approach was performed. Among 426 patients who underwent unilateral approaches, 14% experienced minor complications, and 2.1% experienced major complications. The 410 patients who underwent bifrontal approaches, 24.6% experienced minor complications, and 7% experienced major complications.

CONCLUSIONS
Unilateral approaches appear to have lower complication rates than bilateral approaches, however, the extent of resection is not uniformly reported, making it difficult to identify differences. We herein propose a novel preoperative imaging-based classification scoring system to help select the most suitable surgical approach to achieve lower post-surgical complication rates.
SURG-27. 17-YEAR EXPERIENCE OF SURGICAL MANAGEMENT OF INTRADURAL EXTRAMEDULLARY (IDEM) TUMORS: CLINICAL OUTCOMES FROM A LOW- AND MIDDLE-INCOME COUNTRY
Authors: Ozair Ahmad , Suresh Vinay , Suresh H S , Raju Bharath , Ahluwalia Manmeet 
Published: November 2023

Abstract

INTRODUCTION
Surgical outcomes of intradural extramedullary (IDEM) tumors have been well-reported in the literature from high-income countries. However, limited contemporaneous data from low- and middle-income countries (LMICs) exists. This study sought to analyze the clinical outcomes of all IDEM tumor cases operated during a 17-year period at a resource-limited setting in an LMIC.

METHODS
The present work was conducted and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. A retrospective cohort study was carried out to analyze all IDEM tumor cases, operated upon by a consultant neurosurgeon, during 2004-2021, at a resource-limited setting in Southern India. All patients underwent routine biochemical and radiological investigations, including contrast-enhanced MRI. Laminectomy and tumor resection under the microscope were done without using intraoperative neuro-monitoring. Nerve fibers running through the tumor were sacrificed. Bilateral facet joints were preserved to ensure integrity without spinal fusion. All cases received a dural closure with 5-0 Prolene, with postoperative MRI confirming complete resection. Patients received telephonic and/or in-person follow-up visits.

RESULTS
50 patients with a mean age of 46.3 years (range 13-80) were included, with 31 males and 19 females. Their clinical presentation included radiculopathy (78%), radiculomyelopathy (12%), and radiculomyelopathy with bowel and bladder symptoms (10%). Histologically, schwannomas were the most common (52%), followed by neurofibromas (34%), meningiomas (12%), and ependymomas (2%). Two individuals were diagnosed with Neurofibromatosis Type 1. All meningiomas occurred in the thoracic region, with 83.3% of cases being in females. All patients had symptomatic relief postoperatively. No major adverse events occurred, including CSF leaks, permanent neurological deficits, or spinal instability. Recurrence occurred in two 'dumbbell' tumors (4%) at 5 and 7 years after primary excision during follow-up, managed with successful re-resection.

CONCLUSION
Microsurgical excision of IDEM tumors carries high safety and efficacy, including in resource-limited settings like LMICs.
SURG-28. MULTI-STAGE, OPEN CRANIAL APPROACHES FOR RESECTION OF PRIMARY INTRACRANIAL NEOPLASMS: A SYSTEMATIC REVIEW OF THE HISTORY AND CURRENT APPLICATIONS
Authors: Bui Nicholas , Brown Nolan , Kuo Cathleen , Gendreau Julian , Abraham Mickey 
Published: November 2023

Abstract
Staged surgery for skull base lesions has been utilized to facilitate maximal safe resection and optimize outcomes while minimizing morbidity and complications. Conversely, staged surgery for primary intraparenchymal neoplasms is less commonly performed and has not been reported as extensively within the literature. As such, we performed a systematic review to examine the unique surgical indications for staging, timing between stages, specific surgical approaches utilized, and postoperative complications of staged surgery for primary intra-axial neoplasms. METHODS: A literature search was conducted in August 2021 using PubMed, Web of Science, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. Titles and abstracts were evaluated independently by 2 authors, after which articles were selected for final analysis based on application of strict inclusion criteria during full text screen. Each included article was then qualitatively assessed and relevant variables—including operative approaches, timing, and outcomes—were extracted for synthesis. RESULTS: Of 115 results, 7 articles were included for final analysis and consisted of 17 pediatric and 4 adult patients. Staged approaches were more commonly utilized in the pediatric patient population for resection of astrocytoma and glioma. Pediatric patients had a timing of surgeries ranging from 5–10 days between operations, compared with 18 days to 4 months in adult patients. Complications in pediatric patients were most commonly hemiparesis, hydrocephalus, cranial nerve VI and VII palsies, truncal ataxia, and cerebellar mutism, while complications in adult patients included language and abstract thinking deficits, respiratory failure, and motor weakness. CONCLUSION: This study reports the first comprehensive review of staged surgical procedures for primary, intra-axial cranial neoplasms. There exists a large degree of heterogeneity in complications resulting from staged surgeries for intra-axial neoplasms, which are similar to complications associated with single-stage surgery for intraparenchymal lesions as well as multi-stage surgeries for skull base lesions.
SURG-31. DEFINING THE NEW POSSIBILITIES FOR CESIUM BRACHYTHERAPY IN PATIENTS WITH PERIVENTRICULAR GBM
Authors: Ablyazova Faina , Sharma Anurag , Huang Lyu , Wang Lin , Ben-Shalom Netanel , Ellis Jason , D'Amico Randy , Boockvar John , Potters Louis , Wernicke A Gabriella 
Published: November 2023

Abstract

INTRODUCTION
Re-irradiation of patients with external beam radiotherapy (EBRT) for recurrent glioblastoma (GBM) continues to present a therapeutic dilemma due to a high risk of radiation induced necrosis (RN). In contrast, brachytherapy represents a safer, more conformal radiation option aimed at optimizing local control while minimizing the risk of brain tissue damage. Immediate intra-operative implantation with brachytherapy prevents tumor repopulation and offers patients two procedures in one setting. However, due to the risk of seed migration, surgical resection and brachytherapy in periventricular regions was deemed unachievable. In heavily pretreated periventricular GBM, where further EBRT is complicated by RN, a barrier between the ventricular lining and tumor cavity is needed to prevent seed migration. We present two patients where such a barrier allowed successful implantation of brachytherapy to improve disease control.

METHODS
Two patients, previously treated with surgery and EBRT, presented with recurrent GBM abutting the ventricles. Following GTR of the tumors, a barrier was created by patching the ventricle with Gelfoam to prevent seed migration. Intraoperative brachytherapy implantation of suture stranded Cs-131 seeds (Isoray) for patient 1 and collagen embedded Cs-131 (GammaTile) for patient 2 was performed. A total of 20 Cs-131 seeds on strings threaded through Surgicel, and 6 GammaTiles (24 Cs-131 seeds), were used implanted in patients 1 and 2, respectively. Surgicel covered the implanted seeds and the resection cavity filled with Adherus.

RESULTS
Post-operative CT scan demonstrated all 20 Cs-131 seeds and 24 Cs-131 seeds in the surgical cavities of patients 1 and 2, respectively, and had serial post operative imaging with MRI scans showing Cs-131 seeds layering surgical cavity, as late as 6 months in total follow up. To date, both patients have had durable local control and no seed migration.