OBJECTIVE: The best results in glioblastoma (GBM) are obtained through aggressive treatment comprising maximally radical but safe resection followed by chemoradiotherapy. However, certain patients will undergo only stereotactic biopsy. This paper aims to evaluate life expectancy in GBM patients who underwent only stereotactic biopsy, including the effect of subsequent oncological treatment. PATIENTS AND METHODS: Patients with confirmed GBM histology who had undergone stereotactic biopsy between June 2006 and December 2016 were retrospectively selected. Each patient had received a CT scan, followed by an MRI scan with a contrast agent. None of the patients were amenable to microsurgical resection. RESULTS: Of the 60 patients, 41 (69%) received no subsequent oncological treatment, while 14 (23%) underwent isolated radiotherapy. Mean survival time of all patients was 2.8 months. Those who received no additional treatment had an average survival time of 2.3 months; patients who received any type of oncological treatment was 3.7 months. Of these, those receiving radiotherapy alone had a mean survival of 3.1 months. Patients who received oncological treatment with the Stupp protocol had a survival time of 6.6 months. CONCLUSION: Diagnostic and surgical advances related to GBM treatment mean that radical resections can be performed even in eloquent brain areas. However, patients not indicated for resection will experience a major reduction in life expectancy. Patients who underwent stereotactic biopsy and received some form of oncological treatment experienced slightly increased overall survival relative to patients with a natural disease course. Patients with favorable clinical factors reacted better to treatment.
- MeSH
- biopsie metody MeSH
- dospělí MeSH
- glioblastom * mortalita patologie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- naděje dožití * MeSH
- nádory mozku * mortalita patologie terapie MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stereotaktické techniky * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cíl: Cílem této práce je ukázat technické možnosti volumetrického hodnocení objemu rezidua a zhodnotit vliv přesně definovaného objemu reziduálního nádoru na celkové přežívání (overall survival; OS) u pacientů s glioblastomem (GBM). Soubor a metodika: Retrospektivně byli vybráni dospělí pacienti, kteří podstoupili resekční výkon GBM ve FN Olomouc mezi roky 2012 a 2016. Pacienti byli podrobeni pravidelným klinickým a MR kontrolám každé 3 měsíce. Do studie byly zahrnuty časné pooperační snímky MR. U každého pacienta bylo provedeno segmentování nádorového procesu s následným vytvořením 3D modelu objemu nádoru, což umožnilo výpočet jeho objemu před i po operaci. Výsledky: Výsledky retrospektivní analýzy zahrnovaly 50 pacientů. Naše práce ukázala signifikantní prodloužení OS pouze u skupiny bez postkontrastně se sytícího rezidua (medián OS = 16,1 vs. 6,3 měsíce). Pacienti s kombinací radikální resekce a onkoterapie v Stuppově režimu dosáhli dalšího prodloužení OS s průměrem 19,6 měsíce a mediánem 14 měsíců. Závěr: Naše práce popisuje postup výpočtu objemu pooperačního rezidua GBM s využitím snadno dostupného softwaru. Na základě zjištění této studie bylo dosaženo signifikantně lepších léčebných výsledků u pacientů s úplným odstraněním postkontrastně se sytící části GBM doplněným o co nejradikálnější resekci postkontrastně se nesytící části nádoru.
Aim: The aim of this study is to demonstrate the technical feasibility of volumetric assessment of residual tumor volume and to evaluate the effect of a precisely defined residual tumor volume on overall survival (OS) in patients with glioblastoma (GBM). Materials and methods: Adult patients who underwent surgical resection for GBM in the University Hospital Olomouc from 2012 to 2016 were selected retrospectively. Patients attended regular clinical and MRI follow-up every three months. Early postoperative MRI scans were used in the study. In each patient, tumor segmentation was performed followed by creating a 3D model of tumor volume, which allowed the calculation of its volume both before and after surgery. Results: Results of 50 patients were available for a retrospective analysis. Our study showed a significant prolongation of OS only in the group with no contrast-enhancing residue (median OS = 16.1 vs. 6.3 months) Patients with a combination of radical resection and oncological treatment with the Stupp protocol achieved further prolongation of OS with a mean of 19.6 months and a median of 14 months. Conclusion: Our paper describes the process of calculating the volume of the postoperative residual component of GBM using easily available software. According to the study findings, significantly better therapy results were achieved in patients with complete removal of the contrast-enhancing GBM component, supplemented by the most possible radical resection of the contrast non-enhancing components of the tumor.
- Klíčová slova
- pooperační reziduum,
- MeSH
- analýza přežití MeSH
- gliosarkom * MeSH
- lidé MeSH
- pooperační období MeSH
- retrospektivní studie MeSH
- reziduální nádor * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
The surgical treatment of paediatric thalamic gliomas has been burdened with high morbidity, and these lesions were often considered inoperable. With new approaches and intraoperative technologies, we can remove tumours once deemed inoperable. In our single centre, we have operated on 11 paediatric patients over the course of 8 years. We have performed eight GTR resections and three intended subtotal resections. The postoperative neurological deficit ranged from mild to very severe for motor weakness and none to severe for aphasia after surgery, with all of the patients improving at 3-month follow-up. Radicality in the surgical approach to thalamic gliomas in children has shown significant benefits when compared to more conservative approaches. For children with LGGs, extensive surgical resection is associated with improved prognosis and longer progression-free survival. However, it does not yield the same proportional benefit for HGGs due to its aggressive nature and worse outlook.
- Publikační typ
- časopisecké články MeSH
Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.
- Publikační typ
- časopisecké články MeSH
Background: People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients' well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods: An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results: Thirty-eight European centers completed the survey. Thirty of them offered at least one postsurgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long term. Twenty-eight of the participating centers offered postsurgical therapies. Patients who stand the highest chances of being included in evaluation and therapy postsurgically are those who underwent awake brain surgery, harbored a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between those offered to individuals with low-grade glioma vs those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion: We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents' opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (eg, professional reinsertion).
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Stroke-like syndrome is defined as a rare, delayed complication of brain oncotherapy. Cases with more favorable brain cancer diagnoses and longer life expectancy have been previously reported, but here we present, for the first time, three long-term survivors of glioblastoma with stroke-like syndromes. METHODS AND RESULTS: Three young or middle-aged patients underwent tumor resection and chemoradiotherapy. They received regular clinical and imaging follow-up with stable neurological status and no signs of tumor recurrence. They exhibited varied signs and symptoms (motor and sensory deficits, aphasia, memory and cognitive disorders, seizures, and headache) accompanied by imaging abnormalities. Stroke-like syndromes developed within 2-5 days and resolved in 2-6 weeks. Diffusion-weighted MRI and T2 brain perfusion abnormalities were demonstrated in all patients. In addition, there was focal T1 MRI contrast enhancement due to blood-brain barrier disruption. In addition to tumor recurrence, classic stroke, encephalitis, metabolic and mitochondrial disorders, and post-seizure swelling should be excluded. The imaging indicated intensive MRI scanning and symptomatic medication (steroids supplemented by antiepileptics, vasoactive agents, etc.) for judicious management. With respect to the course, an invasive procedure was still considered an option. CONCLUSION: All stroke-like syndromes are diagnoses of exclusion. To avoid misinterpretation of imaging findings as glioblastoma recurrence and avert recall oncotherapy or redundant interventions, better understanding of delayed complications of brain tumor therapy is crucial.
- MeSH
- cévní mozková příhoda * komplikace etiologie MeSH
- glioblastom * radioterapie terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- magnetická rezonanční tomografie metody MeSH
- nádory mozku * komplikace patologie terapie MeSH
- syndrom MeSH
- záchvaty etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Autoři prezentují kazuistiku vzácného syndromu útlaku nervus interosseus antebrachii anterior ("Kiloh-Nevinův syndrom"). Pacientku nejprve vyšetřili ve spádové neurologické ambulanci. Na základě minimální neuropatie nervus medianus v karpálním tunelu, verifikované na EMG a na základě klinického nálezu byla stanovena diagnóza syndromu karpálního tunelu. Konzilium na Neurochirurgické ambulanci autorského pracoviště konstatovalo nepřítomnost klinických symptomů korespondujících s uvedenou diagnózou, a to vč. EMG nálezu. Doporučené EMG došetření odhalilo neuropatii nervus interosseus antebrachii anterior (Kiloh-Nevinovův syndrom). Pacientka podstoupila, po pokusu o konzervativní terapii, operační výkon s příznivým efektem.
Authors would like to present a case of an uncommon entrapment syndrome of the anterior antebrachial interosseal nerve ("The Kiloh-Nevin syndrome). Patient was first examined by an ambulatory neurologist. EMG verified minimal neuropathic finding of the median nerve and clinical presentation first lead to the diagnosis of carpal tunnel syndrome. After a neurosurgical consult on the authors departement we found the corresponding clinical presentation misleading including the EMG presentation. Newly recommended EMG uncovered anterior antebrachial interosseal nerve neuropathy (Kiloh-Nevin syndrome). After a failed conservative therapy, patient underwent a surgical intervention with a good outcome.
- MeSH
- elektromyografie metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- mononeuropatie chirurgie diagnóza MeSH
- nervus medianus chirurgie patologie MeSH
- úžinové syndromy * chirurgie diagnóza patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
