-
Neuroimaging Clinics of North America Feb 2021In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic... (Review)
Review
In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.
Topics: Adult; Brain; Brain Neoplasms; Humans; Magnetic Resonance Imaging; World Health Organization
PubMed: 33220825
DOI: 10.1016/j.nic.2020.09.011 -
Radiologic Clinics of North America Nov 2019In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic... (Review)
Review
In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.
Topics: Adult; Brain; Brain Neoplasms; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; World Health Organization
PubMed: 31582041
DOI: 10.1016/j.rcl.2019.07.004 -
Indian Journal of Medical Microbiology 2023
Topics: Humans; Sparganosis; Brain Neoplasms; Magnetic Resonance Imaging
PubMed: 37356830
DOI: 10.1016/j.ijmmb.2023.02.001 -
Journal of Thrombosis and Thrombolysis May 2023Neurosurgeons often face this dilemma. Brain neoplasm patients undergoing neurosurgery are at a high risk of venous thrombosis. However, antithrombotic drugs may induce... (Meta-Analysis)
Meta-Analysis Review
Neurosurgeons often face this dilemma. Brain neoplasm patients undergoing neurosurgery are at a high risk of venous thrombosis. However, antithrombotic drugs may induce bleeding complications. Therefore, we compared the efficacy and safety of prophylaxis for venous thromboembolism (VTE) in brain neoplasm patients undergoing neurosurgery. We searched Cochrane Central Register of Controlled Trials, Ovid MEDLINE(R), and Embase from inception to January 2022 for randomized controlled trials (RCTs) comparing the prophylactic measures efficacy and safety for VTE in brain neoplasm patients undergoing neurosurgery. The main efficacy outcome was symptomatic or asymptomatic VTE. The safety outcomes included major bleeding, minor bleeding, all occurrences of bleeding, and all-cause mortality. We used (Log) odds ratio (OR) of various chemoprophylaxis regimens to judge the safety and effectiveness of VTE. Additionally, all types of intervention were ranked by the Surface Under the Cumulative Ranking (SUCRA) value. We included 10 RCTs with 1128 brain neoplasm patients undergoing neurosurgery. For symptomatic or asymptomatic VTE and proximal DVT or PE, DOACs, compared with placebo, can significantly reduce the events. DOACs were superior to all other interventions in the rank plot of these events. For major bleeding reduction, unfractionated heparin (SUCRA value = 0.21) demonstrated better safety efficacy than others. For minor bleeding reduction, DOACs had a significantly higher risk of minor bleeding compared with placebo [Log OR 16.76, 95% CrI (1.53, 61.13)], LMWH [Log OR 15.68, 95% CrI (0.26, 60.10)] and UFH [Log OR 15.93, 95% CrI (0.22, 60.16)] respectively. Except for placebo (SUCRA values of 0.13), UFH (SUCRA values of 0.37) depicted better safety efficacy than others. For all-cause mortality, we found UFH always had significantly lower all-cause mortality compared with low-molecular-weight heparin (LMWH) [Log OR = 14.17, 95% CrI (0.05, 48.35)]. UFH plus intermittent pneumatic compression (IPC) (SUCRA value of 0.12) displayed the best safety for all-cause mortality. In our study, DOACs were more effective as prophylaxis for VTE in brain neoplasm patients undergoing neurosurgery. Regarding the safety of prophylaxis for VTE, UFH of chemoprophylaxis consistently demonstrated better safety efficacy, involving either major bleeding, minor bleeding, bleeding, or all-cause mortality.
Topics: Humans; Venous Thromboembolism; Anticoagulants; Neurosurgery; Network Meta-Analysis; Heparin; Heparin, Low-Molecular-Weight; Hemorrhage; Brain Neoplasms
PubMed: 36763224
DOI: 10.1007/s11239-023-02780-3 -
Clinical & Experimental Metastasis Oct 2017
Topics: Brain Neoplasms; Humans; Neoplasm Metastasis
PubMed: 29139011
DOI: 10.1007/s10585-017-9866-6 -
Handbook of Clinical Neurology 2014Brain metastases are the most frequent neurological complication of cancer and the most common brain tumour type. Lung and breast cancers, and melanoma are responsible... (Review)
Review
Brain metastases are the most frequent neurological complication of cancer and the most common brain tumour type. Lung and breast cancers, and melanoma are responsible for up to three-quarters of metastatic brain lesions. Most patients exhibit either headache, seizures, focal deficits, cognitive or gait disorders, which severely impair the quality of life. Brain metastases are best demonstrated by MRI, which is sensitive but non-specific. The main differential diagnosis includes primary tumours, abscesses, vascular and inflammatory lesions. Overall prognosis is poor and depends on age, extent and activity of the systemic disease, number of brain metastases and performance status. In about half of the patients, especially those with widespread and uncontrolled systemic malignancy, death is heavily related to extra-neural lesions, and treatment of cerebral disease doesn't significantly improve survival. In such patients the aim is to improve or stabilize the neurological deficit and maintain quality of life. Corticosteroids and whole-brain radiotherapy usually fulfill this purpose. By contrast, patients with limited number of brain metastases, good performance status and controlled or limited systemic disease, may benefit from aggressive treatment as both quality of life and survival are primarily related to treatment of brain lesions. Several efficacious therapeutic options including surgery, radiotherapy and chemotherapy are available for these patients.
Topics: Brain Neoplasms; Combined Modality Therapy; Diagnosis, Differential; Humans; Incidence; Neoplasm Metastasis; Neurosurgical Procedures
PubMed: 24365409
DOI: 10.1016/B978-0-7020-4088-7.00077-8 -
Nature Reviews. Disease Primers Jan 2019
Topics: Brain Neoplasms; Humans; Neoplasm Metastasis; Quality of Life
PubMed: 30655539
DOI: 10.1038/s41572-019-0061-8 -
Continuum (Minneapolis, Minn.) Apr 2012Brain metastases are the most common neurologic complication related to systemic cancer. With continued improvements in systemic treatment, the incidence is expected to... (Review)
Review
PURPOSE OF REVIEW
Brain metastases are the most common neurologic complication related to systemic cancer. With continued improvements in systemic treatment, the incidence is expected to increase. This article reviews the clinical presentation, pathophysiology, prognostic factors, and treatment of metastatic brain tumors.
RECENT FINDINGS
Brain metastases from systemic cancer are up to 10 times more common than primary malignant brain tumors and are a significant burden in the management of patients with advanced cancer. Common presenting symptoms include headache, focal weakness or numbness, mental status change, and seizure. Management and treatment of metastatic brain tumors is complex and dependent on several factors, including age, performance status, number of metastases at presentation, and status of systemic disease. At the time of diagnosis, most patients have more than one brain metastasis, and treatment has traditionally consisted of whole-brain radiation therapy (WBRT). For those patients with single brain metastases, aggressive local treatment with surgery or stereotactic radiosurgery (SRS) combined with WBRT has been shown to improve survival and neurologic outcomes compared with WBRT alone. In patients with a limited number of brain metastases, SRS alone is being increasingly explored as a treatment option that spares the upfront toxicity of WBRT. Currently, the role of chemotherapy is limited to experimental settings and salvage after radiation therapy.
SUMMARY
Patients with brain metastases have complex needs and require a multidisciplinary approach in order to optimize intracranial disease control while maximizing neurologic function and quality of life. Patients with multiple metastases, uncontrolled systemic disease, and poor functional status are typically treated with WBRT alone, whereas surgery and SRS may be used for additional local control in a subset of patients with fewer tumors and good functional status. The incorporation of neuropsychological outcomes, neurologic function, and quality of life as end points in future studies will offer further guidance for providing comprehensive care to patients with metastatic brain tumors.
Topics: Brain Neoplasms; Humans; Neoplasm Metastasis; Prognosis
PubMed: 22810128
DOI: 10.1212/01.CON.0000413659.12304.a6 -
Best Practice & Research. Clinical... Mar 2022Venous thromboembolism (VTE) is a common complication in patients with primary and metastatic brain cancer. Treatment of thrombosis in these patients must be balanced... (Review)
Review
Venous thromboembolism (VTE) is a common complication in patients with primary and metastatic brain cancer. Treatment of thrombosis in these patients must be balanced against the risk of intracranial hemorrhage (ICH). A number of cohort studies conducted over the last several years have assessed the risk of ICH in patients with primary or secondary brain tumors in the setting of anticoagulation. Anticoagulation with warfarin or low-molecular weight heparin significantly increases the risk of ICH in the setting of primary brain cancers. In contrast, therapeutic anticoagulation does not appear to alter the risk of ICH among patients with metastatic brain tumors. This review summarizes current data regarding anticoagulant and antiplatelet therapy in patients with brain tumors, including emerging data on direct-acting oral anticoagulants, and other related topics, such as the use of inferior vena cava filters and resumption of anticoagulation following ICH.
Topics: Anticoagulants; Brain Neoplasms; Humans; Intracranial Hemorrhages; Vena Cava Filters; Venous Thromboembolism
PubMed: 36030073
DOI: 10.1016/j.beha.2022.101350 -
Neuro-oncology Feb 2019The 2016 World Health Organization (WHO) classification of primary central nervous system (CNS) tumors includes numerous uncommon (representing ≤1% of tumors)... (Review)
Review
The 2016 World Health Organization (WHO) classification of primary central nervous system (CNS) tumors includes numerous uncommon (representing ≤1% of tumors) low-grade (grades I-II) brain neoplasms with varying clinical behaviors and outcomes. Generally, gross tumor or maximal safe resection is the primary treatment. Adjuvant treatments, though their exact role is unknown, may be considered individually based on pathological subtypes and a proper assessment of risks and benefits. Targetable mutations such as BRAF (proto-oncogene B-Raf), TRAIL (tumor necrosis factor apoptosis inducing ligand), and PDGFR (platelet derived growth factor receptor) have promising roles in future management.
Topics: Biomarkers, Tumor; Brain Neoplasms; Combined Modality Therapy; Humans; Mutation; Neoplasm Grading; Proto-Oncogene Mas
PubMed: 30239861
DOI: 10.1093/neuonc/noy151