bluuebunny/crossref_metadata_2025_split huggingface dataset:
P07.06.B The Impact of Using Intraoperative Ultrasound on Surgical Resection of High-Grade Glioma: A Systematic Review and Meta-Analysis
Authors: Solomou G , Christou A , Gillespie C S , Khouli O , Plaha P 
Published: September 2022

Abstract

Background
Despite operative and adjuvant therapies, high-grade glioma (HGG) remains incurable, with the extent of surgical resection being one of the modalities that can improve patient survival. Enabling maximal safe and minimising post-operative neurological morbidity is a key aim of surgical resection. Numerous intraoperative surgical adjuncts are used at surgery and intraoperative ultrasound (IoUS), is one such adjunct. IoUS is a cost-effective, easy to use, repeatable surgical adjunct, safe for the patient and potentially available in all centres. Although it’s commonly used, no up to date systematic review exists collating and quantifying the level of evidence, delineating its impact on the extent of surgical resection.

Material and Methods
A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study was registered with the PROSPERO database (CRD42022300034). Keywords across Medline/PubMed and Embase between 1996 and November 2021 were used. We included articles with adult supratentorial, histopathologically confirmed HGG patients aimed for resection, evaluating the correlation of IoUS use and gross-total resection (GTR). Meta-analyses were conducted according to the statistical heterogeneity between the studies using the Open Meta Analyst software.

Results
2942 articles were identified of which 16 were qualitative assessed and 10 used for quantitative meta-analysis. In qualitative assessment, a mean 4.63/8 Newcastle-Ottawa-Scale score was found for studies with no cohorts (no use of IoUS) and a mean score of 6/9, for studies including exposed versus non-exposed cohorts. The RCT was of moderate quality according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. A pooled analysis across 10 studies of HGG aimed for resection with the use of IoUS, led to GTR achieved in 168/365 cases, resulting in an overall GTR rate of 51.1% (95% CI, 33.9%-68.3%, p&lt;0.001), with great heterogeneity across studies (93.02% p&lt;0.001). In a subgroup meta-analysis of 3 studies of HGG aimed for complete resection only, GTR was achieved in 43/62 cases, yielding a 72.7% GTR rate (95% CI 41.6%-100%, p&lt;0.001) with significant heterogeneity across studies (I2 92.1%, p&lt;0.001). In 4 case-controlled studies, a total of 43.6% (48/110) GTR rate was achieved when IoUS was used versus 24.7% (65/263) when IoUS was not used, resulting in an odds ratio = 2.009 (95% CI 1.157-3.490, p &lt;0.001) for achieving GTR.

Conclusion
The meta-analysis showed a high GTR rate (72.7%) when HGG were aimed for complete resection and a two-fold probability of achieving GTR when IoUS is used than not used.
P07.07.A Fluorescence lifetime imaging for improved visualization of 5-ALA fluorescence during biopsies of suspected brain tumors
Authors: Millesi M 
Published: September 2022

Abstract

Background
Stereotactic brain tumor biopsies represent a standard neurosurgical technique enabling a precise histopathological tumor diagnosis which is of utmost importance for optimal further treatment allocation. However, non-diagnostic biopsies are not uncommon in routine clinical practice. To overcome this shortcoming, serial biopsies or intraoperative histopathology are typically performed prolonging the operating times and potentially increasing the risk of complications. Recently, the value of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence for visualization of diagnostic tumor tissue was demonstrated in navigation-guided brain tumor biopsies. However, a not negligible proportion of brain tumors lack visible fluorescence. In some of these tumors, a subvisual concentration of PpIX could be detected by spectroscopic analysis. Thus, detection of such subvisual PpIX accumulation in tumor samples in biopsies by the new “Fluorescence Lifetime Imaging” (FLIM) technique might lead to further improvement of this approach.

Material and Methods
Patients that underwent navigation-guided biopsy of a suspected brain tumor were eligible for inclusion in this study. After administration of 5-ALA, the tissue samples were checked for visible fluorescence during the navigation-guided stereotactic biopsy with a sterile microscope. In each sample the observed fluorescence signal was documented. Additionally, the tissue samples were investigated ex-vivo by FLIM for detection of PpIX accumulation. In each case, a histopathological diagnosis was established according to the WHO classification of CNS tumors.

Results
A total number of 20 tissue samples could be retrieved in 16 patients with suspected brain tumors. The biopsy with assistance of 5-ALA was feasible in all patients and no relevant side effects occurred. Visible PpIX fluorescence could be observed in 75% of cases. In contrast, 25% of samples did not show visible fluorescence. In one specimen, no fluorescence signal could be evaluated as the sample was covered by too much blood. However, significant accumulation of PpIX could be detected by FLIM in all samples in which evaluation was possible (n=19). A final histopathological diagnosis was feasible in all patients.

Conclusion
Fluorescence Lifetime Imaging is a promising new technique for improved detection of brain tumor tissue during navigation-guided biopsies. Thus, this new technique might lead in future to reduced operating times and complication rate by minimizing the cases that need serial biopsies or intraoperative histopathology.
P07.08.B Surgical management of recurrent lower-grade gliomas: analysis of oncological and functional outcomes and associated factors
Authors: Gay L , Rossi M , Sciortino T , Conti Nibali M , Simonelli M , Navarria P , Rudà R , Soffietti R , Bello L 
Published: September 2022

Abstract

Background
Presently, there are no clear evidence-based recommendations for the surgical management of progressive or recurrent lower-grade gliomas (LGGs). In our work, we evaluated the oncological (PFS, OS) and functional (neurological, neuropsychological, quality of life evaluation) outcomes of a series of LGGs treated in a 5-year period. The aim was to identify clinical, imaging, and molecular factors, associated with better outcomes, to be implemented in the treatment decision making process.

Material and Methods
In our retrospective analysis, 738 recurrent LGGs were included (follow-up 7.9 years; IQR:6-9); 550 were surgically treated, 495 with open resection (with brain mapping techniques), and 55 with tumor biopsy (with frameless stereotactic technique).

Results
Overall, 521 patients (70.6%) recurred. Of those treated with open resection 63.5% relapsed. Tumor progression was histologically confirmed in 72.5% of cases, no valuable tumor (effect of treatment) in 27.5% of cases (particularly in cases previously treated with RT and CHT), histo-molecular conversion (astrocytoma instead of oligodendroglioma diagnosis) in 7.5% of cases, malignant transformation in 38.7% of cases. Among the clinical (patient functional status, previous PFS, previous EOR, previous CHT and duration of CHT, previous RT), imaging (type of recurrence, i.e. typical versus atypical, speed of growth, contrast enhancement), and molecular (IDH, codeletion, ATRX, MGMT, tumor grade, CDNK status) factors analyzed, longest PFS of recurrent tumors was associated with patient functional status, previous PFS, previous EOR, speed of growth (&gt;6 mm/year), atypical type of recurrence, tumor grade, presence of codeletion, and CDNK status. Best functional outcome associated with surgical resection, EOR, and tumor grade; worst functional outcome with RT and malignant transformation. Longest OS associated with previous EOR, surgical resection, tumor grade, presence of co-deletion. Malignant transformation was associated to previous EOR. Among patients submitted solely to tumor biopsy, changes in MGMT methylation status and in IDH status were observed in 65.3% and 5% of cases, respectively. Modification in IDH status was associated with atypical (distant) type of recurrence. New histo-molecular profile helped in the treatment decision making process.

Conclusion
Surgical resection of recurrent LGGs is associated with longer PFS and OS. Tumor biopsy should be considered, when surgery considered unfeasible, to tailor adjuvant treatment.
P07.10.B Preoperative brain mapping using transcranial magnetic stimulation applied to brain tumour resection surgery
Authors: Brugada-Bellsolà F , Lucente G , Teixidor Rodríguez P , Garcia-Armengol R , Hostalot Panisello C , Tardáguila Serrano M , González Crespo A , Pastor Cabeza M , Menéndez Girón S , Domínguez Alonso C 
Published: September 2022

Abstract

Background
Brain oncological surgery must pursue maximal tumour resection to achieve oncological benefits while preserving acceptable neurological function. Neuromonitoring techniques and brain mapping have been developed over the last decades to intraoperatively assess the exact location of neurological functions and secure their preservation. However, the fact that they cannot offer preoperative information and require in some cases the patient’s collaboration during displeasing awake surgeries raised the interest during last years on noninvasive techniques offering preoperative functional information. Navigated transcranial magnetic stimulation (nTMS) is a noninvasive technique able to create small magnetic fields and electrically stimulate brain cortex, emulating the effect obtained by cortical direct electrical stimulation (DES). It is a promising tool for performing pre-operative cortical brain mapping.

Material and Methods
We performed a unicenter prospective descriptive study including patients diagnosed with intra axial brain tumours neighboring cortical zones apparently implicated in motor and/or language functions who were planned for surgical resection. We performed preoperative nTMS (SofTaxic Neuro navigation system 3.0, EMS, Bologna) in all of them to define the location of these functions.

Results
Between November 2020 and December 2021 we included 18 patients (11 men, 7 women) with a mean age of 56 years (range 29-71). Location (8 temporal, 6 frontal, 3 parietal and 1 insular) and laterality (12 left, 6 right) of the brain tumours were registered. In all cases, cortical brain motor mapping with nTMS was performed with positive results, obtaining a mean anteroposterior diameter of the motor cortex of 22,75 mm. In 11 cases language mapping was also performed, detecting a total of 40 cortical language positive sites (31 frontal, 9 temporal) in those patient’s left hemispheres. No relevant side effects were noticed after nTMS performance. Definitive pathological results after surgery revealed high-grade glioma in 15 cases and low-grade glioma in 3.

Conclusion
nTMS is a recent noninvasive technique that allows the realization of preoperative cortical brain mapping. The information provided by this technique is of extreme value to better define surgical candidates and to plan brain tumour resection surgeries, according to functional cortical sites identified. The available literature describes its applications, mainly in localizing motor and language cortices, showing good concordance with intraoperative cortical DES, which is still the gold standard technique for brain mapping. Its integration in the pre-operative brain tumour assessment offers important advantages without adding relevant morbidity.
P07.11.A Impact of awake craniotomy on extent-of-resection and performance in glioma: a retrospective, propensity-score matched cohort study
Authors: Schnitzler S J P , van der Vaart T , van Garderen K , van den Bent M J , Vincent A J P E 
Published: September 2022

Abstract

Background
The goal of awake craniotomy is to safely optimize the extent-of-resection in patients with glioma. Lower postoperative tumor volume is associated with better overall survival, emphasizing the importance of optimal surgical resection. Awake craniotomy causes less postoperative neurological deficits than surgery under general anesthesia, however, it is unclear whether awake craniotomy leads to lower postoperative tumor volume compared with general anesthesia in presumed lower grade glioma.

Methods
Retrospective, matched cohort study in patients with astrocytoma, IDH-mutant grade 2 and 3, oligodendroglioma, IDH-mutant, and 1p/19q-codeleted grade 2 and 3, and low-grade glioma, IDH-wildtype (now designated glioblastoma, IDH-wildtype), who underwent resection with awake craniotomy or under general anesthesia between 2003 and 2021 at Erasmus MC Brain Tumor Center. Pre- and postoperative tumor volumes were measured by semi-automatic 3D MRI-segmentation. First, we performed a multivariate logistic regression to assess which factors predicted selection for awake craniotomy. Thereafter, matching based on propensity score was attempted. Outcome variables were postoperative tumor volume, resection percentage and Karnofsky Performance Status (KPS) 3 months after surgery.

Results
We identified 181 awake craniotomy-patients and 135 general anesthesia-patients. Awake craniotomy-patients were younger, in better condition, more often male, with tumors more often in eloquent areas, in the left side of the brain and non-contrast enhancing. When performing matching without replacement, only 68 awake craniotomy-patients could be matched with 68 general anesthesia-patients, underscoring the imbalance in the dataset. Matching with replacement yielded a matched dataset of 181 awake craniotomy-patients with 60 general anesthesia-patients with adequate matching on most baseline variables, except for eloquent area (47% for awake craniotomy and 21.7% for general anesthesia, p &lt; 0.001). In this matched dataset, median postoperative volume in awake craniotomy was 5.8 mL (IQR 0 - 92.8) vs 12.2 mL (IQR 0 - 90.1) in general anesthesia (p-value = 0.114). Resection percentages did not differ between the awake craniotomy- and general anesthesia-groups. KPS scores at 3 months after surgery did not differ between awake craniotomy and general anesthesia (p = 0.15).

Conclusion
Postoperative tumor volume was not lower in awake craniotomy-patients than in general anesthesia-patients. Neither were resection percentage and KPS scores at 3 months after surgery significantly different between the groups. Adequate matching was only obtainable using replacement, underscoring the risk of bias in unmatched datasets. These data should be interpreted with care, given the retrospective nature, potential residual confounding and potential lack of generalizability due to unmatched normal resection patients.
P08.05.B Communication in the context of glioblastoma treatment: what matters most to patients and caregivers
Authors: Boele F W , Butler S , Nicklin E , Pointon L , Short S C , Murray L 
Published: September 2022

Abstract

Background
Given the poor prognosis of glioblastoma, with short survival times regardless of treatment, it is critical that the benefits and risks of treatments are clearly discussed with patients and family caregivers. The respective value of quantity versus quality of life varies for each individual. Yet, effective communication can be complicated by emotional responses following diagnosis, patients’ neurocognitive deficits, and sometimes, lower health literacy. We aimed to investigate patient and caregiver experiences and preferences around glioblastoma treatment communication.

Material and Methods
Semi-structured qualitative interviews were conducted with adult glioblastoma patients and their caregivers, interviewed as dyads or individuals. Purposive sampling was used to capture views across the entire disease trajectory. Interviews were recorded, transcribed verbatim, and analysed for common themes. Analysis is ongoing and will be completed by June 2022, with preliminary findings described below.

Results
In total, 15 glioblastoma patients and 13 caregivers took part, 8 as dyads. Five main themes were found. 1) Communication experiences. A rush to get treatment underway can limit adequate communication. Patients and caregivers described that risks of treatment were clearly explained, but perceived it as ‘the only option’. 2) Communication preferences. Balanced and sensitive communication of prognostic information was desired, with uncertainty providing hope as well as being a burden. Patients and caregivers can have different information and support needs, requiring separate and proactive communication. 3) What matters most. Participants valued feeling involved, having clear and reliable information and support from the treatment team, and developing a personable relationship. In terms of treatment goals, they valued extending life with good quality of life. 4) Decision-making. Participants emphasised the importance of being involved in decisions, involving caregivers, and following treatment team advice. While faced with extremely limited treatment options, they valued having a sense of control over declining, pausing or stopping treatment. 5) Impact of Covid-19. In general, patients described limited impact of the measures taken during the pandemic (e.g., masks, telephone consultations), whilst caregivers highlighted specific issues around not being able to support patients in emergencies, expressing/reading nonverbal cues, or fully participating in telephone consultations.

Conclusion
Glioblastoma patients and caregivers value sensitive, comprehensive and comprehensible communication around treatment risks and benefits, and supportive care. Involving and supporting caregivers is critical.
P08.06.A Work resumption following lower-grade glioma surgery: a multicenter cohort study
Authors: Kommers I O , van Genderen M N G , Eijgelaar R S , Witte M G , de Haan Y , Ille S , Mandonnet E , Krieg S M , Barkhof F , de Witt Hamer P C 
Published: September 2022

Abstract

Background
Patients with lower-grade glioma (LGG) are often of working age. For LGG patients post-surgical work resumption is at risk from treatment including resective surgery. However, little is known on determinants of returning to work. In this study we examined determinants of post-surgical work resumption after nine months using patient- and tumor-related characteristics, such as tumor and resection cavity locations.

Material and Methods
This retrospective multicenter cohort study included adults with supratentorial WHO grade II and III gliomas who underwent a first-time surgery in Paris, Munich or Amsterdam between 2011 and 2016. Patient-related characteristics included age, sex, patient condition, received treatments, classification of work type and skill level. Presurgical tumors and postsurgical resection cavities were manually segmented on MRI and registered to standard brain space. These segmentations were mapped to Schaefer, XTRACT and Harvard-Oxford atlas parcellations of cortical, white matter and grey nuclei structures. Predictors of postsurgical return to work were examined in multivariable logistic regression and Bayesian hurdle regression models.

Results
The cohort consisted of 219 patients. Before surgery 192 (88%) patients were able to work, and after surgery 119 (62%) resumed work. Independent predictors of returning to work were male sex (OR = 3.21, CI = 1.44 - 7.46, p = 0.005) and lower age (per 1 year older, OR = 0.96, CI = 0.92 - 0.99, p = 0.029). No associations were found between work resumption and locations of the tumor or resection cavity.

Conclusion
Many patients are able to work before and many return to work after first-time LGG surgery. Inability to resume work is exclusively associated with patient-related characteristics and not with tumor or resection locations. This novel information may inform patient counseling.
P08.08.B Long-term survival and health-related quality of life in meningioma patients: a mixed-methods systematic review
Authors: Frances S , Murray L , Wright J , Velikova G , Boele F 
Published: September 2022

Abstract

Background
Meningiomas account for approximately 36% of all primary brain tumours. These tumours have a relatively favourable prognosis with approximately 92% of meningioma patients surviving &gt;5 years after diagnosis. Yet, patients report high disease burden and survivorship issues even years after treatment, including cognitive issues and anxiety/depression affecting health-related quality of life (HRQOL). We aimed to systematically review the literature and synthesise evidence on HRQOL in meningioma patients across long-term survival, defined as &gt;2 years post diagnosis.

Material and Methods
Systematic literature searches were carried out using Medline, EMBASE, CINAHL, PsycINFO, and Web of Science Core Collection up to November 2021. Two independent assessors carried out screening. Any published, peer reviewed article with primary quantitative or qualitative data covering the physical, mental, and/or social aspects of HRQOL were included. Quality was assessed using the Mixed Methods Appraisal Tool, before a data-based convergent synthesis design was used to interpret findings.

Results
The search returned 2252 articles. Following screening 12 papers were included in the review. The majority of studies used quantitative methods, with only one study reporting mixed-methodology. Two of these were articles from the same study. Most used cross-sectional assessments (n =10) with two reporting longitudinal assessments (n = 2). Included meningioma patient samples (n=2990 in total) represented a wide range of survival lengths (range: 24 months - 10 years). HRQOL was impacted predominantly through physical and mental issues, including persevering symptoms (e.g. headaches, fatigue, vision problems) and emotional difficulties (e.g. poorer mental and general health perceptions). Returning to work proved difficult for patients due to cognitive and social deficits (e.g. issues with concentration, procrastination and isolation). Factors including age and comorbidities, but also treatment type appears to affect patients’ satisfaction with their HRQOL.

Conclusion
While overall prognosis following a meningioma diagnosis is good, meningioma patients’ HRQOL appears affected throughout long-term survivorship. Findings from this review could be beneficial in addressing the HRQOL and supportive-care needs of patients across long-term survivorship.