Posts Tagged brain tumor

[Survey] Driving with an intracranial tumor

EAN Scientific Panel Neuro-oncology invites you to take part in their survey

Meningeomas and brain tumors may interfere with the ability to drive a vehicle in a number of ways. Seizures, cognitive impairment, motor dysfunction and visual field defects may all impair safe driving. Intracranial tumors are highly heterogenous, ranging from benign meningeomas that nevertheless may cause seizures, to high grade gliomas and brain metastasis. The clinician always considers seizure frequency, compliance and focal deficits when assessing the ability to drive for neurological patients. However, oncological prognosis, risk of recurrence and effects of treatment are factors unique to patients with intracranial tumors. These factors must be evaluated when deciding if or when a patient with a brain tumor or a meningeoma may drive. In addition, different medical professions may differ in awareness of the driving dilemma as well as in practice policy concerning this issue.

Clinical studies and reviews that address driving ability in patients with brain tumors are sparse. Most countries do not have national guidelines concerning this issue, and general as well as specific driving legislations vary between countries. In the absence of guidelines or legislation, most clinicians probably prohibit or allow driving on a case-by-case basis, or by adhering to legislation concerning epilepsy or neoplastic disease in general. The use of neuro-psychological evaluation or practical testing is unknown.

The EAN Scientific Panel of neuro-oncology wants to address this issue by performing a survey of national legislations and practice patterns among European neurologists. As a start, we aim to do a survey among the members of the Scientific Panels of Neuro-Oncology and Epilepsy.

The answers will be a guidance for whether there are inconsistences in clinical practice and reason to do a more extensive survey.


Thomas S1Mehta MPKuo JSIan Robins HKhuntia D. Current practices of driving restriction implementation for patients with brain tumors.
J Neurooncol.
 2011l;103(3):641-7. doi: 10.1007/s11060-010-0439-7.

Louie AV, D’Souza DP, Palma DA, Bauman GS, Lock M, Fisher B, Patil N, Rodrigues GB.

Fitness to drive in patients with brain tumours: the influence of mandatory reporting legislation on radiation oncologists in Canada.

Curr Oncol. 2012;19(3):e117-22. 

Chan E, Louie AV, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Sathya A, D’Souza DP.

Multidisciplinary assessment of fitness to drive in brain tumour patients in southwestern Ontario: a grey matter.

Curr Oncol. 2013;20(1):e4-e12. doi: 10.3747/co.20.1198

Louie AV, Chan E, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Warner A, D’Souza DP. Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine. Curr Oncol. 2013;20(2):90-6.

Mansur A1,2Desimone A2Vaughan S2Schweizer TA1,2,3Das S. To drive or not to drive, that is still the question: current challenges in driving recommendations for patients with brain tumours. J Neurooncol. 2018;137(2):379-385. doi: 10.1007/s11060-017-2727-y.

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[ARTICLE] Imaging in neuro-oncology – Full Text

Imaging plays several key roles in managing brain tumors, including diagnosis, prognosis, and treatment response assessment. Ongoing challenges remain as new therapies emerge and there are urgent needs to find accurate and clinically feasible methods to noninvasively evaluate brain tumors before and after treatment. This review aims to provide an overview of several advanced imaging modalities including magnetic resonance imaging and positron emission tomography (PET), including advances in new PET agents, and summarize several key areas of their applications, including improving the accuracy of diagnosis and addressing the challenging clinical problems such as evaluation of pseudoprogression and anti-angiogenic therapy, and rising challenges of imaging with immunotherapy.

The roles of imaging in neuro-oncology primarily consist of diagnosis, prognosis, and treatment response assessment of central nervous system (CNS) tumors. Imaging assessment is currently an important surrogate endpoint for clinical trials. With ongoing evaluation and discovery of novel treatment agents, including immunotherapy agents, the ability to accurately assess progression and discern treatment-related changes is a central goal of neuro-oncologic imaging. In this review, we will summarize several clinically available imaging techniques as well as some novel methods under development, and provide an up-to-date review of some clinical challenges in treatment of glioblastomas where imaging can have important roles.

Diffusion-weighted magnetic resonance imaging (DW-MRI) can characterize tissues based on the differences in the degree of free movement of protons. It has been shown that the cellularity or cell density of tumor is associated with apparent diffusion coefficient (ADC), a calculated metric from DW-MRI.1 This property allows one to distinguish between both tumor subtypes and tumor grades (low versus high). More recently, high b-value DW-MRI, using a b-value >3000 s/mm2, has been demonstrated to be superior to standard DW-MRI in distinguishing tumor tissue from normal brain parenchyma.2 DW-MRI data can also be further quantified to generate imaging markers using techniques such as diffusion kurtosis imaging (DKI),3 histogram curve-fitting,4 and functional diffusion map (fDM).5 Restriction spectrum imaging (RSI) is an DW-MRI technique that can isolate the diffusion properties of tumor cells from extracellular process such as edema, potentially improving specificity of tumor detection and characterization.6 Diffusion tensor imaging (DTI) measures the directionality of proton motion as fractional anisotropy (FA), which is often altered in the presence of brain tumors.7 Applications of these methods will be reviewed in the following sections.

Perfusion-weighted magnetic resonance imaging (PW-MRI) techniques assess blood flow to tissue by calculating parameters derived from the time–intensity curve. Using the normal brain as reference, these techniques can detect pathological alterations of tissue vascularity that commonly occur among brain tumors due to increased vascular permeability as well as intravascular blood volume because of tumor-induced angiogenesis. Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) quantifies first-pass bolus of paramagnetic contrast agent,8,9 and is currently the most common perfusion-weighted imaging method in clinical use. Dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) can characterize vascular permeability within or surrounding tumors by using pharmacokinetic models to quantify the movement of contrast agents crossing the blood–brain barrier.1012 DCE-MRI has an advantage over DSC-MRI due to its greater signal-to-noise ratio and spatial resolution, although imaging acquisition time is also longer. Perfusion imaging measurements are highly dependent on imaging acquisition parameters and postprocessing techniques, including variations in postprocessing software tools.13 Clinical application of this technique therefore requires efforts in standardization, particularly in multicenter settings.

Magnetic resonance spectroscopy (MRS) measures concentrations of metabolites within tissues noninvasively.14 The single-voxel spectroscopy (SVS) method collects average MRS data within a target region of interest selected on standard MRI images. The multivoxel spectroscopy (MVS) method can obtain two- or three-dimensional maps of the region of interest to detect voxel-wise spatial changes of specific metabolites. Both SVS and MVS approaches have been evaluated in tumor diagnosis, grading, pre-therapy planning and post-therapy assessment. One major limitation of the technique is its operator dependency, requiring experienced staff to manually select regions of interest during acquisition. It is also less sensitive to lesions with volume <1.5 cm3.

18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is an important imaging tool in oncology.15 Similar to systemic cancers, brain tumors often exhibit increased metabolic activity resulting in elevated 18F-FDG uptake that can be detected by PET.16 The role of FDG-PET in brain tumor imaging, however, has been quite limited due to its relative lack of specificity and high background uptake by the normal brain. This limitation is particularly important for small lesions, as currently the resolution of PET imaging is limited to 5 mm. More recently, amino acid PET tracers including 11C-methionine, 18F-fluorothymidine (FLT), 18F-fluoro-ethyl-tyrosine (FET), and 18F-dihydroxyphenylalanine (DOPA) have been developed and evaluated for brain tumor imaging. This class of radiotracers is avidly taken up by malignant brain tumors that have higher cellular proliferation compared to the normal brain.1720 The advantage of high lesion-to-background uptake ratio makes amino acid PET suitable for imaging of brain tumors, including applications such as predicting tumor grade, detecting recurrent tumor, and assessing treatment response. Novel PET radiotracer (18)F-fluoromisonidazole (18F-FMISO) has been evaluated as a marker of tissue hypoxia before and after treatment.21,22

With increasing computing speed and availability of pre-engineered algorithms, imaging data can be analyzed for voxel-level intensity variations to generate texture-type features that can be correlated with tumor biology or treatment response. This approach can be applied to any imaging modality individually or simultaneously through spatial co-registration. As a result, imaging features can be regarded as tumor phenotypes and this type of biomarker can be summarized by the term ‘radiomics’.23 Screening or combining a large number of radiomic features allows generation of models that can aid oncologic diagnosis, prognostication, and treatment response prediction. This approach has been successful in a number of systemic cancers.2428 The radiomic approach is particularly suitable for evaluating high-grade gliomas, a tumor type that is well known for its genetic heterogeneity and highly complex imaging phenotypes.

Imaging plays a key role in the diagnosis of brain tumors and has become one routine management step during preoperative evaluation to aid determination of tumor grade and prognosis. It can also provide important spatial information on tumor tissue characteristics for some tumor subtypes that can influence surgical and radiation treatment planning. In addition, imaging has shown increasing ability to detect tumor genetic profile that can further provide valuable prognostic and predictive information for optimal treatment planning. Finally, imaging findings are often combined with clinical data such as age, gender, and presenting symptoms and signs to increase the accuracy of diagnosis for various tumor types, as well as identifying non-tumor mimics.

One common clinical dilemma during preoperative diagnosis of brain tumors is to distinguish between high-grade glioma and lymphoma. Standard management of CNS lymphoma is nonsurgical and biopsy is the preferred approach if lymphoma is suspected preoperatively, whereas maximal surgical resection provides the best prognosis for high-grade glioma. On conventional imaging sequences, these tumor types commonly exhibit contrast enhancement and peritumoral edema, which make it challenging to differentiate. Lymphomas typically exhibit low ADC values due to high cellularity.29,30 However, this histological feature can be seen in high-grade gliomas and metastases.

Quantitatively, the FA and ADC values of primary cerebral lymphoma are significantly lower than those of glioblastoma.31,32 There is also evidence that DSC-MRI and DCE-MRI parameters of the enhancing regions of the tumor can discriminate between lymphomas and glioblastomas as well as between lymphomas and metastasis,32,33 although a direct comparison of DCE-MRI and DW-MRI shows that ADC measurement is superior to DCE-MRI in differentiating the two tumor types.34 Detection of intratumoral microhemorrhage using the susceptibility-sensitive MRI technique also allows differentiation of glioblastoma and primary CNS lymphomas.35 Texture features generated from post-contrast images of lymphoma and glioblastoma also allow diagnostic differentiation.36

Analysis of nonenhancing signal abnormalities surrounding brain lesions can provide independent diagnostic information. ADC values measured within fluid-attenuated inversion recovery (FLAIR) abnormalities surrounding the enhancing regions can differentiate high-grade gliomas from solitary metastases.37,38 The difference could be due to the presence of tumor infiltration by glioma, resulting in higher cellularity than tumor-induced edema.39 This is also supported by MRS and DSC-MRI measurements of the peritumoral region showing higher choline to N-acetylaspartic acid (NAA) ratio and greater vascularity among high-grade gliomas compared to brain metastases.32,40,41 Combined evaluation of both the enhancing and nonenhancing regions can potentially enhance diagnostic accuracy.32,42 Beyond the margins of signal abnormalities outlined by conventional MRI, including T1- and T2-weighted imaging, MRS can identify regions of brain containing tumor and improve surgical resection and patient outcome.43,44

Molecular data of gliomas have demonstrated prognostic significance and have been incorporated into the 2016 World Health Organization (WHO) criteria.45 The imaging characteristics of brain tumors can be directly related to a specific set of tumor genomics, providing opportunities to noninvasively predict tumor genotype preoperatively. Radiomic models have been developed based on conventional MRI, DTI, and DSC-MRI for predicting gene expression profiles of newly diagnosed glioblastomas.46 Specific genetic alterations of tumors can also be predicted by analysis of MRI data and predictive models have been generated for O6-methylguanine-DNA methyltransferase (MGMT) methylation status,47,48 epidermal growth factor (EGFR) amplification status,25,49 and EGFR receptor variant III status.50 Isocitrate dehydrogenase 1/2 (IDH) mutations are commonly present in low-grade gliomas as well as secondary glioblastomas. These mutant tumors accumulate 2-hydroxyglutarate (2HG), an onco-metabolite that can be detected by MRS (Figure 1).51 Measurement of 2HG concentration allows diagnosis of IDH mutant tumor preoperatively and also opportunities to monitor tumor activity during treatment.52,53 Static and dynamic FET-PET measurements have also been correlated with IDH and 1p/19q status.54 More recently, multimodal MRI imaging can be evaluated by machine learning algorithms to generate predictive models for IDH status in gliomas.5557

Continue —-> Imaging in neuro-oncology – Hari Nandu, Patrick Y. Wen, Raymond Y. Huang, 2018

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[NEWS] Novel artificial intelligence algorithm helps detect brain tumor


A brain tumor is a mass of abnormal cells that grow in the brain. In 2016 alone, there were 330,000 incident cases of brain cancer and 227,000 related-deaths worldwide. Early detection is crucial to improve patient prognosis, and thanks to a team of researchers, they developed a new imaging technique and artificial intelligence algorithm that can help doctors accurately identify brain tumors.


Image Credit: create jobs 51 /

Image Credit: create jobs 51 /

Published in the journal Nature Medicine, the study reveals a new method that combines modern optical imaging and an artificial intelligence algorithm. The researchers at New York University studied the accuracy of machine learning in producing precise and real-time intraoperative diagnosis of brain tumors.

In the past, the only way to diagnose brain tumors is through hematoxylin and eosin staining of processed tissue in time. Plus, interpretation of the findings relies on pathologists who examine the specimen. The researchers hope the new method will provide a better and more accurate diagnosis, which can help initiate effective treatments right away.

In cancer treatment, the earlier cancer has been diagnosed, the earlier the oncologists can start the treatment. In most cases, early detection improves health outcomes. The researchers have found that their novel method of detection yielded a 94.6 percent accuracy, compared to 93.9 percent for pathology-based interpretation.

The imaging technique

The researchers used a new imaging technique called stimulated Raman histology (SRH), which can reveal tumor infiltration in human tissue. The technique collects scattered laser light and emphasizes features that are not usually seen in many body tissue images.

With the new images, the scientists processed and studied using an artificial intelligence algorithm. Within just two minutes and thirty seconds, the researchers came up with a brain tumor diagnosis. The fast detection of brain cancer can help not only in diagnosing the disease early but also in implementing a fast and effective treatment plan. With cancer caught early, treatments may be more effective in killing cancer cells.

The team also utilized the same technology to accurately identify and remove undetectable tumors that cannot be detected by conventional methods.

“As surgeons, we’re limited to acting on what we can see; this technology allows us to see what would otherwise be invisible, to improve speed and accuracy in the OR, and reduce the risk of misdiagnosis. With this imaging technology, cancer operations are safer and more effective than ever before,” Dr. Daniel A. Orringer, associate professor of Neurosurgery at NYU Grossman School of Medicine, said.

Study results

The study is a walkthrough of various ideas and efforts by the research team. First off, they built the artificial intelligence algorithm by training a deep convolutional neural network (CNN), containing more than 2.5 million samples from 415 patients. The method helped them group and classify tissue samples into 13 categories, representing the most common types of brain tumors, such as meningioma, metastatic tumors, malignant glioma, and lymphoma.

For validation, the researchers recruited 278 patients who are having brain tumor resection or epilepsy surgery at three university medical centers. The tumor samples from the brain were examined and biopsied. The researchers grouped the samples into two groups – control and experimental.

The team assigned the control group to be processed traditionally in a pathology laboratory. The process spans 20 to 30 minutes. On the other hand, the experimental group had been tested and studied intraoperatively, from getting images and processing the examination through CNN.

There were noted errors in both the experimental and control groups but were unique from each other. The new tool can help centers detect and diagnose brain tumors, particularly those without expert neuropathologists.

“SRH will revolutionize the field of neuropathology by improving decision-making during surgery and providing expert-level assessment in the hospitals where trained neuropathologists are not available,” Dr. Matija Snuderl, associate professor in the Department of Pathology at NYU Grossman School of Medicine, explained.

Journal references:

Patel, A., Fisher, J, Nichols, E., et al. (2019). Global, regional, and national burden of brain and other CNS cancer, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology.

Hollon, T., Pandian, B, Orringer, D. (2019). Near real-time intraoperative brain tumor diagnosis using stimulated Raman histology and deep neural networks. Nature Medicine.


via Novel artificial intelligence algorithm helps detect brain tumor

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[WEB SITE] Increased intracranial pressure (ICP): Symptoms, causes, and treatment

Last reviewed

Increased intracranial pressure is a medical term that refers to growing pressure inside a person’s skull. This pressure can affect the brain if doctors do not treat it.

A sudden increase in the pressure inside a person’s skull is a medical emergency. Left untreated, an increase in the intracranial pressure (ICP) may lead to brain injury, seizure, comastroke, or death.

With prompt treatment, it is possible for people with increased ICP to make a full recovery.

In this article, we look at the symptoms, causes, and treatments of increased ICP.

Symptoms of increased ICP

The symptoms of increased ICP can vary depending on a person’s age.

Infants with increased ICP may have different symptoms to older children or adults with the condition, as discussed below.

Symptoms in adults

Woman with a headache who is sleepy, possibly caused by increased intracranial pressure

Symptoms of increased ICP can include headache, sleepiness, and blurred vision.
Symptoms of increased ICP in adults include:

  • pupils that do not respond to light in the usual way
  • headache
  • behavior changes
  • reduced alertness
  • sleepiness
  • muscle weakness
  • speech or movement difficulties
  • vomiting
  • blurred vision
  • confusion

As raised ICP progresses, a person may lose consciousness and go into a coma. High ICP may cause brain damage if a person does not receive emergency treatment.

Symptoms in infants

Infants with increased ICP may show some of the same symptoms as adults. In addition, the shape of their heads may be affected.

Infants still have soft plates in their skull that fibrous tissue called skull sutures knit together. Increased ICP may cause the skull sutures to separate and the soft plates to move apart.

Increased ICP in infants may also cause their fontanel to bulge out. The fontanel is the soft spot on the top of the skull.


The following is a list of medical conditions and other causes that can lead to increased ICP:

In infants, high ICP may be the result of child abuse.

If a person handles a baby or infant too roughly, it may cause them to develop a brain injury. This is known as shaken baby syndrome.

One source has estimated that between 1,000 and 3,000 children in the United States experience shaken baby syndrome each year. The condition may arise if an adult shakes a baby violently to stop them crying.

Anyone who suspects a child may be experiencing abuse can contact the National Child Abuse Hotline anonymously at 1-800-4-A-CHILD (1-800-422-4453).


Woman having a CT scan

If a person has the symptoms of increased ICP, they should see a doctor straight away. This is a medical emergency and may lead to brain injury if a person does not receive rapid treatment.

A doctor will measure the ICP in millimeters of mercury (mm/Hg). The normal range is less than 20 mm/Hg. When ICP goes above this, a person may be experiencing increased ICP.

To diagnose increased ICP, a doctor may ask if a person has:

  • experienced a blow to a head
  • a previous diagnosis of a brain tumor

Then, the doctor may carry out the following tests:

  • neurological exam to test a person’s senses, balance, and mental state
  • spinal tap that measures cerebrospinal fluid pressure
  • CT scan that produces images of the head and brain

After these initial tests, the doctor may use an MRI scan to examine a person’s brain tissue in more detail.


If a person has a diagnosis of increased ICP, a doctor will immediately work to reduce the pressure inside the skull to lessen the risk of brain damage. They will then work to treat the underlying cause of the increased pressure.

Treatment methods for reducing ICP include:

  • draining the excess cerebrospinal fluid with a shunt, to reduce pressure on the brain that hydrocephalus has caused
  • medication that reduces brain swelling, such as mannitol and hypertonic saline
  • surgery, less commonly, to remove a small section of the skull and relieve the pressure

A doctor may give the person a sedative to help reduce anxiety and lower their blood pressure. The person may also need breathing support. The doctor will monitor their vital signs throughout their treatment.

In rare cases, the doctor may put a person with high ICP into a medically induced coma to treat their condition.


Complications of increased ICP include:

  • brain damage
  • seizure
  • stroke
  • coma

Without proper treatment, increased ICP can be fatal.


A sudden increase in ICP is a medical emergency and can be life-threatening. The sooner a person receives treatment, the better their outlook. Many people respond well to treatment, and a person who has experienced increased ICP can make a full recovery.

Preventing increased ICP and its complications

Increased ICP is not always preventable, but it is possible to reduce the risk of some underlying conditions that may lead to increased ICP. We explore how below.


seniors exercising in a park

A person can reduce ther risk of stroke by exercising regularly.

Stroke may cause increased ICP. A person can reduce their risk of stroke in the following ways:

  • taking steps to lower high blood pressure
  • stopping smoking
  • managing blood sugar levels
  • controlling cholesterol levels
  • exercising regularly

High blood pressure

High blood pressure may cause increased ICP. A person can maintain healthy blood pressure by:

  • losing weight if overweight or maintaining a healthy weight
  • avoiding drugs that increase blood pressure
  • eating a healthful, balanced diet
  • reducing salt intake
  • exercising regularly

Head injury

A head injury may cause increased ICP. Some examples of how a person can reduce their risk of head injury include:

  • avoiding extreme sports or dangerous activities
  • always wearing a helmet for activities such as riding a bike
  • always wearing a seatbelt when in a car


Increased ICP is when the pressure inside a person’s skull increases. When this happens suddenly, it is a medical emergency. The most common cause of high ICP is a blow to the head.

The main symptoms are headache, confusion, decreased alertness, and nausea. A person’s pupils may not respond to light in the usual way.

A person with increased ICP may need urgent treatment. The immediate aim of treatment is to bring down the pressure on their brain tissue, which helps to reduce the risk of brain damage.

Without proper treatment, this condition may lead to seizure, coma, stroke, or brain damage. In severe cases, increased ICP can be fatal. Rapid treatment may improve a person’s outlook. Making a full recovery with timely treatment is possible.

Increased ICP is not always preventable, but a person can reduce their risk of some causes through lifestyle changes.


via Increased intracranial pressure (ICP): Symptoms, causes, and treatment

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[Abstract] Intracranial EEG analysis in tumor-related epilepsy: Evidence of distant epileptic abnormalities – Clinical Neurophysiology


  • In most patients with TRE, at least part of SOSz lies distant from the tumor.
  • Resection of the brain tumor plus SOSz results in excellent seizure outcome.
  • On iEEG, interictal spikes are most abundant and sharpest in the peritumoral region.


Objective: In patients with tumor-related epilepsy (TRE), surgery traditionally focuses on tumor resection; but identification and removal of associated epileptogenic zone may improve seizure outcome. Here, we study spatial relationship of tumor and seizure onset and early spread zone (SOSz). We also perform quantitative analysis of interictal epileptiform activities in patients with both TRE and non-lesional epilepsy in order to better understand the electrophysiological basis of epileptogenesis.

Methods: Twenty-five patients (11 with TRE and 14 with non-lesional epilepsy) underwent staged surgery using intracranial electrodes. Tumors were outlined on MRI and images were coregistered with post-implantation CT images. For each electrode, distance to the nearest tumor margin was measured. Electrodes were categorized based on distance from tumor and involvement in seizure. Quantitative EEG analysis studying frequency, amplitude, power, duration and slope of interictal spikes was performed.

Results: At least part of the SOSz was located beyond 1.5 cm from the tumor margin in 10/11 patients. Interictally, spike frequency and power were higher in the SOSz and spikes near tumor were smaller and less sharp. Interestingly, peritumoral electrodes had the highest spike frequencies and sharpest spikes, indicating greatest degree of epileptic synchrony. A complete resection of the SOSz resulted in excellent seizure outcome.

Conclusions: Seizure onset and early spread often involves brain areas distant from the tumor.

Significance: Utilization of epilepsy surgery approach for TRE may provide better seizure outcome and study of the intracranial EEG may provide insight into pathophysiology of TRE.

Source: Intracranial EEG analysis in tumor-related epilepsy: Evidence of distant epileptic abnormalities – Clinical Neurophysiology

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[ARTICLE] Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation – Full Text


Background: Mapping of the motor cortex by navigated transcranial magnetic stimulation (nTMS) can be used for preoperative planning in brain tumor patients. Just recently, it has been proven to actually change outcomes by increasing the rate of gross total resection (GTR) and by reducing the surgery-related rate of paresis significantly in cohorts of patients suffering from different entities of intracranial lesions. Yet, we also need data that shows whether these changes also lead to a changed clinical course, and can also be achieved specifically in high-grade glioma (HGG) patients.

Methods: We prospectively enrolled 70 patients with supratentorial motor eloquently located HGG undergoing preoperative nTMS (2010–2014) and matched these patients with 70 HGG patients who did not undergo preoperative nTMS (2007–2010).

Results: On average, the overall size of the craniotomy was significantly smaller for nTMS patients when compared to the non-nTMS group (nTMS: 25.3 ± 9.7 cm2; non-nTMS: 30.8 ± 13.2 cm2; p = 0.0058). Furthermore, residual tumor tissue (nTMS: 34.3%; non-nTMS: 54.3%; p = 0.0172) and unexpected tumor residuals (nTMS: 15.7%; non-nTMS: 32.9%; p = 0.0180) were less frequent in nTMS patients. Regarding the further clinical course, median inpatient stay was 12 days for the nTMS and 14 days for the non-nTMS group (nTMS: CI 10.5 – 13.5 days; non-nTMS: CI 11.6 – 16.4 days; p = 0.0446). 60.0% of patients of the nTMS group and 54.3% of patients of the non-nTMS group were eligible for postoperative chemotherapy (OR 1.2630, CI 0.6458 – 2.4710, p = 0.4945), while 67.1% of nTMS patients and 48.6% of non-nTMS patients received radiotherapy (OR 2.1640, CI 1.0910 – 4.2910, p = 0.0261). Moreover, 3, 6, and 9 months survival was significantly better in the nTMS group (p = 0.0298, p = 0.0015, and p = 0.0167).

Conclusions: With the limitations of this study in mind, our data show that HGG patients might benefit from preoperative nTMS mapping.

Full Text —> BMC Cancer | Full text | Changing the clinical course of glioma patients by preoperative motor mapping with navigated transcranial magnetic brain stimulation.

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[VIDEO] CyberKnife Brain Tumor Education Video – YouTube

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[VIDEO] Gamma Knife Radiosurgery Treatment for Brain Tumors – YouTube

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[ARTICLE] Effect of Virtual Reality-Based Rehabilitation on Upper-Extremity Function in Patients with Brain Tumor: Controlled Trial.

…Virtual reality-based rehabilitation combined with conventional occupational therapy may be more effective than conventional occupational therapy, especially for proximal upper-extremity function in patients with brain tumor. Further studies considering hand function, such as use of virtual reality programs that targeting hand use, are required…

more–> Effect of Virtual Reality-Based Rehabilitation on Upper-Extr… : American Journal of Physical Medicine & Rehabilitation.

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