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Child's Nervous System : ChNS :... Mar 2020Effects of tumor location on cognitive performance of patients with brain tumor are controversial: some studies reported higher risks related to supratentorial...
PURPOSE
Effects of tumor location on cognitive performance of patients with brain tumor are controversial: some studies reported higher risks related to supratentorial locations, some to infratentorial locations, and still others did not find any differences. We aimed to address this issue by comparing school-aged children with supratentorial or infratentorial tumor with respect not only to cognitive outcomes but also to the associations between core cognitive domains and academic abilities.
METHODS
32 children with infratentorial tumor and 22 with supratentorial tumor participated in the study. To detect relationships among cognitive domains, we tested which neuropsychological variable(s) predicted academic skills, controlling for the effects of radiotherapy and time since diagnosis.
RESULTS
Radiotherapy and time since diagnosis, but not tumor location, predicted cognitive outcomes. Radiotherapy negatively influenced attention and executive functioning, as well as reading speed and arithmetic operations accuracy. Unexpectedly, longer time since diagnosis was associated with improvement in attention and reading speed. Tumor location showed an effect on the relationships between core cognitive domains and academic skills: verbal and visual-spatial memory influenced reading and mathematical performance in supratentorial patients; in infratentorial patients, an only effect of visual-spatial memory on mathematical performance was detected.
CONCLUSIONS
Tumor location seems not to influence cognitive performance, while radiotherapy constitutes a key risk factor for cognitive impairment. Attentional and reading abilities may improve over time, possibly due to the weakening of cancer care effects. Different patterns of cognitive associations seem to characterize supratentorial and infratentorial patients, probably associated with different neuroplastic reorganization processes after tumor occurrence.
Topics: Brain Neoplasms; Child; Cognition; Executive Function; Humans; Infratentorial Neoplasms; Neuropsychological Tests; Supratentorial Neoplasms
PubMed: 31832765
DOI: 10.1007/s00381-019-04434-3 -
The Journal of Pathology. Clinical... Nov 2021The majority of supratentorial ependymomas in children contain oncogenic fusions, such as ZFTA-RELA or YAP1-MAMLD1. In contrast, posterior fossa (PF) ependymomas lack...
The majority of supratentorial ependymomas in children contain oncogenic fusions, such as ZFTA-RELA or YAP1-MAMLD1. In contrast, posterior fossa (PF) ependymomas lack recurrent somatic mutations and are classified based on gene expression or methylation profiling into group A (PFA) and group B (PFB). We have applied a novel method, NanoString nCounter Technology, to identify four molecular groups among 16 supratentorial and 50 PF paediatric ependymomas, using 4-5 group-specific signature genes. Clustering analysis of 16 supratentorial ependymomas revealed 9 tumours with a RELA fusion-positive signature (RELA+), 1 tumour with a YAP1 fusion-positive signature (YAP1+), and 6 not-classified tumours. Additionally, we identified one RELA+ tumour among historically diagnosed CNS primitive neuroectodermal tumour samples. Overall, 9 of 10 tumours with the RELA+ signature possessed the ZFTA-RELA fusion as detected by next-generation sequencing (p = 0.005). Similarly, the only tumour with a YAP1+ signature exhibited the YAP1-MAMLD1 fusion. Among the remaining unclassified ependymomas, which did not exhibit the ZFTA-RELA fusion, the ZFTA-MAML2 fusion was detected in one case. Notably, among nine ependymoma patients with the RELA+ signature, eight survived at least 5 years after diagnosis. Clustering analysis of PF tumours revealed 42 samples with PFA signatures and 7 samples with PFB signatures. Clinical characteristics of patients with PFA and PFB ependymomas corroborated the previous findings. In conclusion, we confirm here that the NanoString method is a useful single tool for the diagnosis of all four main molecular groups of ependymoma. The differences in reported survival rates warrant further clinical investigation of patients with the ZFTA-RELA fusion.
Topics: Age Factors; Biomarkers, Tumor; Cluster Analysis; Ependymoma; Gene Expression Profiling; Humans; Infratentorial Neoplasms; Predictive Value of Tests; Prognosis; Retrospective Studies; Supratentorial Neoplasms; Transcriptome
PubMed: 34314101
DOI: 10.1002/cjp2.236 -
Modern Pathology : An Official Journal... Jan 2020Ependymomas show poor correlation between World Health Organization grade and clinical outcome. A subgroup of supratentorial ependymomas are characterized by...
Ependymomas show poor correlation between World Health Organization grade and clinical outcome. A subgroup of supratentorial ependymomas are characterized by C11orf95-RELA fusions, presumed to be secondary to chromothripsis of chromosome 11, resulting in constitutive activation of the NF-κB signaling pathway and overexpression of cyclin D1, p65, and L1 cell adhesion molecule (L1CAM). These RELA-fused ependymomas are recognized as a separate, molecularly defined World Health Organization entity and might be associated with poor clinical outcome. In this study, we show that immunohistochemistry for NF-κB signaling components, such as L1CAM, p65, and cyclin D1, can help distinguish RELA-fused from non-RELA-fused supratentorial ependymomas. Furthermore, these three markers can reliably differentiate RELA-fused ependymomas from a variety of histologic mimics. Lastly, we report that RELA-fused ependymomas may be associated with different chromosomal copy number changes and molecular alterations compared to their non-RELA-fused counterparts, providing additional insight into the genetic pathogenesis of these tumors and potential targets for directed therapies.
Topics: Adolescent; Adult; Biomarkers, Tumor; Child; Ependymoma; Female; Humans; Male; Middle Aged; NF-kappa B; Oncogene Fusion; Oncogene Proteins, Fusion; Proteins; Supratentorial Neoplasms; Transcription Factor RelA; Young Adult
PubMed: 31375768
DOI: 10.1038/s41379-019-0329-2 -
BMC Neurology Jul 2021The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to...
The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions.
BACKGROUND
The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients.
METHODS
A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses.
RESULTS
The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486-0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548-0.874, P = 0.014) for the ONSD/ETD ratio.
CONCLUSIONS
The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.
Topics: Coma; Glasgow Outcome Scale; Humans; Optic Nerve; Prognosis; Retrospective Studies; Supratentorial Neoplasms
PubMed: 34215217
DOI: 10.1186/s12883-021-02285-7 -
Current Opinion in Anaesthesiology Oct 2016The article reviews the recent evidence on the anesthetic management of patients undergoing craniotomy for supratentorial tumor resection. (Review)
Review
PURPOSE OF REVIEW
The article reviews the recent evidence on the anesthetic management of patients undergoing craniotomy for supratentorial tumor resection.
RECENT FINDINGS
A rapid recovery of neurological function after craniotomy for supratentorial tumor allows for the prompt diagnosis of intracranial complications and possibly an early hospital discharge. Intraoperative esmolol infusion was shown to reduce the anesthetic requirements, and may facilitate a more rapid recovery of neurological function. Outpatient craniotomy for supratentorial tumor resection has been associated with several clinical and economic benefits, but has not gained widespread use because of skepticism and medical-legal concerns. Awake craniotomy is associated with advantageous outcomes compared with surgery under general anesthesia, and is regarded as the standard of care for tumors that reside in or in close proximity to the eloquent brain. Recent studies have demonstrated that intraoperative electroacupuncture, dexmedetomidine, pregabalin, and lidocaine may facilitate postcraniotomy pain management. The use of volatile anesthetic agents in cancer surgery is associated with a worse survival compared with intravenous anesthetics, possibly by hindering immunologic defenses against cancer cells.
SUMMARY
Recent evidence has yielded valuable information regarding anesthetic management of patients undergoing supratentorial tumor craniotomy. Despite a plethora of studies that compare short-term outcomes using different anesthetic and analgesic regimens, randomized controlled trials that examine the long-term outcomes (i.e., neurocognitive function, quality of life, tumor recurrence, and survival) that are of particular interest to patients are needed.
Topics: Analgesics; Anesthesia; Anesthetics, Inhalation; Cognition; Craniotomy; Electroacupuncture; Humans; Neoplasm Recurrence, Local; Pain Management; Pain, Postoperative; Perioperative Care; Quality of Life; Supratentorial Neoplasms; Treatment Outcome
PubMed: 27285727
DOI: 10.1097/ACO.0000000000000365 -
Clinical Neuroradiology Mar 2016Ganglioglioma is an uncommon intracranial disorder. The purpose of our study was to describe the different MR characteristics between supratentorial and infratentorial... (Comparative Study)
Comparative Study
PURPOSE
Ganglioglioma is an uncommon intracranial disorder. The purpose of our study was to describe the different MR characteristics between supratentorial and infratentorial gangliogliomas and to evaluate the diagnostic value of MR imaging for the disorder.
METHODS
The MR images of 33 patients with intracranial gangliogliomas from July 2007 to November 2012 were retrospectively reviewed. We evaluated the images in relation to the following variables: location, size, cystic changes, cortical changes, and enhancement pattern.
RESULTS
Histological diagnosis was achieved in all cases by surgery. Tumors were divided into a supratentorial group (n = 24) and an infratentorial group (n = 9) according to their location. In the supratentorial group, tumor dimensions varied from 0.5 to 5 cm (mean dimension, 2.7 cm). Cystic (n = 2), cystic-solid (n = 10), and solid (n = 12) tumors without cortical changes had variable enhancement in this group. In the infratentorial group, tumor dimensions varied from 4 to 7 cm (mean dimension, 5.2 cm). Solid (n = 7) tumors with ipsilateral cerebellar cortical atrophy (n = 7) had remarkable heterogeneous enhancement in this group.
CONCLUSIONS
MR imaging features of supratentorial gangliogliomas are non-specific. Relatively larger solid masses with remarkable heterogeneous enhancement and ipsilateral cerebellar cortical atrophy in the infratentorial region are suggestive of ganglioglioma. As such, cerebellar cortical atrophy may be a specific finding that is well demonstrated with MR imaging. Although MR findings can provide some evidence for this rare entity, a differential diagnosis is still needed.
Topics: Adult; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Ganglioglioma; Humans; Image Enhancement; Infratentorial Neoplasms; Male; Observer Variation; Reproducibility of Results; Sensitivity and Specificity; Supratentorial Neoplasms
PubMed: 25150188
DOI: 10.1007/s00062-014-0333-3 -
Acta Neurochirurgica Apr 2020For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances... (Observational Study)
Observational Study
BACKGROUND
For supratentorial craniotomy, surgical access, and closure technique, including placement of subgaleal drains, may vary considerably. The influence of surgical nuances on postoperative complications such as cerebrospinal fluid leakage or impaired wound healing overall remains largely unclear. With this study, we are reporting our experiences and the impact of our clinical routines on outcome in a prospectively collected data set.
METHOD
We prospectively observed 150 consecutive patients undergoing supratentorial craniotomy and recorded technical variables (type/length of incision, size of craniotomy, technique of dural and skin closure, type of dressing, and placement of subgaleal drains). Outcome variables (subgaleal hematoma/CSF collection, periorbital edema, impairment of wound healing, infection, and need for operative revision) were recorded at time of discharge and at late follow-up.
RESULTS
Early subgaleal fluid collection was observed in 36.7% (2.8% at the late follow-up), and impaired wound healing was recorded in 3.3% of all cases, with an overall need for operative revision of 6.7%. Neither usage of dural sealants, lack of watertight dural closure, and presence of subgaleal drains, nor type of skin closure or dressing influenced outcome. Curved incisions, larger craniotomy, and tumor size, however, were associated with an increase in early CSF or hematoma collection (p < 0.0001, p = 0.001, p < 0.01 resp.), and larger craniotomy size was associated with longer persistence of subgaleal fluid collections (p < 0.05).
CONCLUSIONS
Based on our setting, individual surgical nuances such as the type of dural closure and the use of subgaleal drains resulted in a comparable complication rate and outcome. Subgaleal fluid collections were frequently observed after supratentorial procedures, irrespective of the closing technique employed, and resolve spontaneously in the majority of cases without significant sequelae. Our results are limited due to the observational nature in our single-center study and need to be validated by supportive prospective randomized design.
Topics: Adult; Aged; Cerebrospinal Fluid Leak; Craniotomy; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurosurgical Procedures; Postoperative Complications; Prospective Studies; Reoperation; Supratentorial Neoplasms; Treatment Outcome; Wound Closure Techniques; Wound Healing
PubMed: 31940095
DOI: 10.1007/s00701-019-04196-6 -
Journal of Clinical Neuroscience :... Aug 2015We conducted a meta-analysis to comprehensively evaluate the current data on the overall efficacy of levetiracetam (LEV), a new generation antiepileptic drug, in... (Meta-Analysis)
Meta-Analysis Review
We conducted a meta-analysis to comprehensively evaluate the current data on the overall efficacy of levetiracetam (LEV), a new generation antiepileptic drug, in patients with brain tumors. The efficacy of LEV in patients diagnosed with brain tumors has been evaluated in several studies, however, with inconsistent results. Bibliographic searches of the EMBASE, MEDLINE, ClinicalTrials.gov and Cochrane Central Register of the Controlled Trials databases were performed to identify articles and conference abstracts that investigated the efficacy of LEV in the treatment of brain tumor patients. Fourteen studies were included in this meta-analysis. Among the 14 included studies, two were randomized controlled trials. The subgroup analysis demonstrated that the complete response rate of LEV was 94% during the postoperative period and 84% during the long-term follow-up period. Our results suggest that LEV is a relatively effective drug for the treatment of brain tumor patients and its efficacy is slightly lower during the long-term follow-up period than during the postoperative period. Further randomized controlled trials are warranted.
Topics: Anticonvulsants; Epilepsy; Humans; Levetiracetam; Piracetam; Randomized Controlled Trials as Topic; Supratentorial Neoplasms; Treatment Outcome
PubMed: 26051171
DOI: 10.1016/j.jocn.2015.01.025 -
Neuroradiology May 2024This article is the second in a two-part series aimed at exploring the spectrum of supratentorial intraventricular masses in children. In particular, this part delves... (Review)
Review
PURPOSE
This article is the second in a two-part series aimed at exploring the spectrum of supratentorial intraventricular masses in children. In particular, this part delves into masses originating from cells of the ventricular lining, those within the septum pellucidum, and brain parenchyma cells extending into the ventricles. The aim of this series is to offer a comprehensive understanding of these supratentorial intraventricular masses, encompassing their primary clinical findings and histological definitions.
METHODS
We conducted a review and analysis of relevant epidemiological data, the current genetics/molecular classifications as per the fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (WHO CNS5), and imaging findings. Each supratentorial intraventricular mass was individually evaluated, with a detailed discussion on its clinical and histological features.
RESULTS
This article covers a range of supratentorial intraventricular masses observed in children. These include colloid cysts, subependymal giant cell astrocytomas, ependymomas, gangliogliomas, myxoid glioneuronal tumors, central neurocytomas, high-grade gliomas, pilocytic astrocytomas, cavernous malformations, and other embryonal tumors. Each mass type is characterized both clinically and histologically, offering an in-depth review of their individual imaging characteristics.
CONCLUSION
The WHO CNS5 introduces notable changes, emphasizing the vital importance of molecular diagnostics in classifying pediatric central nervous system tumors. These foundational shifts have significant potential to impact management strategies and, as a result, the outcomes of intraventricular masses in children.
Topics: Child; Humans; Glioma; Brain; Ependymoma; Astrocytoma; Tomography, X-Ray Computed; Brain Neoplasms; Supratentorial Neoplasms
PubMed: 38085360
DOI: 10.1007/s00234-023-03253-3 -
Clinical Neurology and Neurosurgery Sep 2020The LACE+ index risk prediction tool has not been successfully used to predict short-term outcomes after neurosurgery. This study assessed the ability of LACE+ to...
OBJECTIVES
The LACE+ index risk prediction tool has not been successfully used to predict short-term outcomes after neurosurgery. This study assessed the ability of LACE+ to predict 30-day (30D) adverse outcomes after supratentorial brain tumor surgery.
PATIENTS AND METHODS
LACE+ scores were retrospectively calculated for consecutive patients (n = 624) who received surgery for supratentorial tumors at one multi-center health system (2017-2019). Coarsened exact matching was employed to control for confounding variables. Outcomes including unplanned hospital readmission, emergency department visits, and death were compared for patients with different LACE+ score quartiles (Q1, Q2, Q3, Q4).
RESULTS
134 patients were matched between Q1 and Q4; 152 patients between Q2 and Q4; 192 patients between Q3 and Q4. LACE+ score was not found to predict readmission within 30D of discharge for Q1 vs Q4 (p = 0.239), Q2 vs Q4 (p = 0.336), or Q3 vs Q4 (p = 0.739). LACE + score also did not predict 30D risk of emergency department visits for Q1 vs Q4 (p = 0.210), Q2 vs Q4 (p = 0.839), or Q3 vs Q4 (p = 0.167). LACE + did predict death within 30D of surgery for Q3 vs Q4 (1.04 % vs 7.29 %, p = 0.039), but not for Q1 vs Q4 (p = 0.625) or Q2 vs Q4 (p = 0.125).
CONCLUSION
LACE + may not be suitable for characterizing short-term risk of certain perioperative events in a patient population undergoing supratentorial brain tumor surgery.
Topics: Aged; Female; Humans; Length of Stay; Male; Middle Aged; Neurosurgical Procedures; Patient Discharge; Patient Readmission; Prognosis; Retrospective Studies; Supratentorial Neoplasms; Treatment Outcome
PubMed: 32619899
DOI: 10.1016/j.clineuro.2020.106016