Journal of Neuro-Oncology最新文献

{"title":"Length of stay following elective craniotomy for tumor resection in children and young adults: a retrospective case series.","authors":"Emal Lesha, Jordan T Roach, L Erin Miller, C Stewart Nichols, Brandy Vaughn, David G Laird, Taylor Orr, Delaney Graham, Mustafa Motiwala, Nir Shimony, Paul Klimo","doi":"10.1007/s11060-024-04887-w","DOIUrl":"10.1007/s11060-024-04887-w","url":null,"abstract":"<p><strong>Purpose: </strong>Length of stay (LOS) is a critical metric of healthcare delivery. Prolonged LOS is associated with a heightened risk of adverse complications. We aimed to provide a comprehensive evaluation of LOS, specifically identifying variables associated with extended LOS (eLOS), in children and young adults following elective craniotomy for tumor resection.</p><p><strong>Methods: </strong>All elective craniotomies for tumor resection performed at our tertiary care children's hospital from January 2010 to December 2022 were included for review, excluding patients > 21 years of age. Demographic, clinical, and procedural variables for each craniotomy were collected. LOS was defined as the interval in days from index surgery to discharge. eLOS was defined as greater than 7 days.</p><p><strong>Results: </strong>1,276 patients underwent a total of 1,497 elective craniotomies for tumor resection. The median age was 9.45 years old, with the most common age group being > 10 years (45.6%). Most patients had supratentorial tumors (63.4%) and underwent de novo surgery (60.7%). Patients with an eLOS experienced longer ICU admissions, longer surgical times, and were younger. Variables found to be significantly associated with eLOS were posterior fossa resection (OR = 2.45), de novo craniotomy (OR = 0.49), prior shunt or ETV (OR = 1.80), tumor type (craniopharyngioma (OR = 3.74) and medulloblastoma (OR = 0.51)), and the presence of at least one postoperative event (POE) (OR = 29.85).</p><p><strong>Conclusion: </strong>This is the largest study evaluating factors (patient, tumor, surgical) associated with eLOS after elective craniotomy for tumor resection in children and young adults. The findings of this clinical study are important for preoperative counseling, neurosurgical team preparedness, and healthcare delivery optimization.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"651-658"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early versus late construct failure in spine metastatic disease: implications for surgical strategy and oncologic outcome.","authors":"Daniel Kreatsoulas, Andrew George, Samuel Kolawole, Mark Damante, Santino Cua, Vikram B Chakravarthy, J Bradley Elder","doi":"10.1007/s11060-024-04884-z","DOIUrl":"10.1007/s11060-024-04884-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify variables that portend early construct failure requiring surgical revision in patients undergoing instrumented fusion for spine metastases.</p><p><strong>Methods: </strong>A detailed retrospective chart review was performed. Demographic, surgical, and oncologic variables were collected and analyzed via independent samples t-testing, chi-square testing, and Kaplan-Meier method with log-rank testing. Significance was determined as p < 0.05.</p><p><strong>Results: </strong>482 spinal fusion operations for solid tumor metastases were performed between 2012 and 2022. Of these, 24 (5.0%) required revision surgery for construct failure. There were no major differences between the revision and non-revision patients in terms of several surgical characteristics. Thirteen (54.1%) were revised within 3 months of index surgery. These early construct failures were more likely to have functional neurological deficits at surgery (6/13 vs. 0/11 [p = 0.009]), longer constructs (mean 6.4±2.4 vs. 4.2 ± 1.4 levels [p = 0.015]), and cement-augmented pedicle screws (4/13 vs. 0/11 [p = 0.044)) compared to late construct failures (> 3 months after index surgery). Additionally, 17 symptomatic failures were identified, compared to 7 asymptomatic failures which were identified incidentally with routine follow-up imaging. All 7 asymptomatic construct failures occurred in the early revisions group [p = 0.004]. Revision surgery for early construct failure was associated with significantly reduced median overall survival compared to late failure (p = 0.010).</p><p><strong>Conclusion: </strong>Construct failures in our cohort were not associated with any classical characteristics of patients undergoing revision spine surgery. Early revision (< 3 months) portends a reduction in overall survival when compared with late revisions, and early revised patients were more likely to have had more extensive surgery and poorer neurological status at the time of index cases.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"705-714"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of adjuvant radiation treatment following subtotal resection of world health organization grade II meningiomas.","authors":"Jordan C Petitt, Roger Murayi, Mohamed E El-Abtah, Arbaz Momin, Ahmed Halima, Tamia Potter, Peter Ahorukomeye, Jakub Jarmula, Mihika Thapliyal, Erin S Murphy, Samuel T Chao, John H Suh, Pablo F Recinos, Varun R Kshettry","doi":"10.1007/s11060-024-04878-x","DOIUrl":"10.1007/s11060-024-04878-x","url":null,"abstract":"<p><strong>Purpose: </strong>Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients.</p><p><strong>Methods: </strong>A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS).</p><p><strong>Results: </strong>Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm³ vs. 6.3 cm³, p = 0.004). PFS was not significantly different between IMRT and SRS at 3 years (81.1% vs. 80.0%) or 5 years (65.5% vs. 40%) (p = 0.19). There was no significant difference in radiation necrosis between groups (IMRT = 3/32 patients vs. SRS = 0/7 patients, p = 0.32).</p><p><strong>Conclusion: </strong>Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"609-617"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of intraoperative mapping during re-resection in recurrent gliomas: a systematic review.","authors":"Mark P van Opijnen, Yasmin Sadigh, Miles E Dijkstra, Jacob S Young, Sandro M Krieg, Sebastian Ille, Nader Sanai, Jordina Rincon-Torroella, Takashi Maruyama, Philippe Schucht, Timothy R Smith, Brian V Nahed, Marike L D Broekman, Steven De Vleeschouwer, Mitchel S Berger, Arnaud J P E Vincent, Jasper K W Gerritsen","doi":"10.1007/s11060-024-04874-1","DOIUrl":"10.1007/s11060-024-04874-1","url":null,"abstract":"<p><strong>Purpose: </strong>Previous evidence suggests that glioma re-resection can be effective in improving clinical outcomes. Furthermore, the use of mapping techniques during surgery has proven beneficial for newly diagnosed glioma patients. However, the effects of these mapping techniques during re-resection are not clear. This systematic review aimed to assess the evidence of using these techniques for recurrent glioma patients.</p><p><strong>Methods: </strong>A systematic search was performed to identify relevant studies. Articles were eligible if they included adult patients with recurrent gliomas (WHO grade 2-4) who underwent re-resection. Study characteristics, application of mapping, and surgical outcome data on survival, patient functioning, and complications were extracted.</p><p><strong>Results: </strong>The literature strategy identified 6372 articles, of which 125 were screened for eligibility. After full-text evaluation, 58 articles were included in this review, comprising 5311 patients with re-resection for glioma. Of these articles, 17% (10/58) reported the use of awake or asleep intraoperative mapping techniques during re-resection. Mapping was applied in 5% (280/5311) of all patients, and awake craniotomy was used in 3% (142/5311) of the patients.</p><p><strong>Conclusion: </strong>Mapping techniques can be used during re-resection, with some evidence that it is useful to improve clinical outcomes. However, there is a lack of high-quality support in the literature for using these techniques. The low number of studies reporting mapping techniques may, next to publication bias, reflect limited application in the recurrent setting. We advocate for future studies to determine their utility in reducing morbidity and increasing extent of resection, similar to their benefits in the primary setting.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"485-493"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A four-hit mechanism is sufficient for meningioma development.","authors":"Alex Devarajan, Carina Seah, Jack Y Zhang, Vikram Vasan, Rui Feng, Emily K Chapman, Tomoyoshi Shigematsu, Joshua Bederson, Raj K Shrivastava","doi":"10.1007/s11060-024-04877-y","DOIUrl":"10.1007/s11060-024-04877-y","url":null,"abstract":"<p><strong>Purpose: </strong>Meningiomas are central nervous system tumors whose incidence increases with age. Benign meningioma pathogenesis involves germline or somatic mutation of target genes, such as NF2, leading to clonal expansion. We used an established cancer epidemiology model to investigate the number of rate-limiting steps sufficient for benign meningioma development.</p><p><strong>Methods: </strong>Incidence data was obtained from the Surveillance, Epidemiology and End Results Program (SEER) for nonmalignant meningioma from 2004 to 2020. Age-adjusted incidence rates per 100,000 person-years were divided into 5-year bands. This was repeated for vestibular schwannomas as a negative control. The Armitage-Doll methodology was applied. Mathematical solutions correcting for volatile tumor microenvironments were applied to fit higher-order models using polynomial regression when appropriate. A 75:25 training:test split was utilized for validation.</p><p><strong>Results: </strong>222,509 cases of benign meningiomas were identified. We noted strong linear relationships between log-transformed incidence and age across the cohort and multiple subpopulations: male, white, black, Hispanic, Asian/Pacific Islander, and American Indian subpopulations all demonstrated R² = 0.99. Slopes were between 3.1 and 3.4, suggesting a four-step process for benign meningioma development. Female patients exhibited nonlinear deviations, but the corrected model demonstrated R² = 0.99 with a four-hit pathway. This model performed robustly on test data with R² = 0.99. Vestibular schwannomas demonstrated a slope of 2.1 with R² = 0.99, suggesting a separate three-step process.</p><p><strong>Conclusion: </strong>Four mutations are uniquely required for the development of benign meningiomas. Correcting for volatile tumor microenvironments reliably accounted for nonlinear deviations in behavior. Further studies are warranted to elucidate genomic findings suggestive of key mutations in this pathway.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"599-607"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-related quality of life in 62 patients with diffuse low-grade glioma during a non-therapeutic and progression-free phase: a cross-sectional study.","authors":"Tiphaine Obara, Marie Blonski, Marie Forest-Dodelin, Fabien Rech, Luc Taillandier","doi":"10.1007/s11060-024-04888-9","DOIUrl":"10.1007/s11060-024-04888-9","url":null,"abstract":"<p><strong>Purpose: </strong>Few studies have evaluated the health-related quality of life (HRQoL) of patients with diffuse low-grade glioma (LGG) during a clinical and radiological monitoring period. We report a cross sectional cohort study of HRQoL in patients with LGG and compare the results with normative population data. We then explore factors associated with HRQoL.</p><p><strong>Methods: </strong>We used the European Organisation for Research and Treatment of Cancer QLQ-C30, BN-20 and the Hospital Anxiety and Depression Scale (HADS) to evaluate HRQoL. Averaged QLQC30 and HADS scores were compared with scores of a normative population. A general linear model multivariate analysis of variance was used to investigate the association between HRQoL and independent factors.</p><p><strong>Results: </strong>A total of 62 patients with LGG completed HRQoL questionnaires. Compared with a normative population, LGG patients reported statistical and clinically significant lower cognitive, emotional, role and social functioning. Fatigue, anxiety, depression and sleep disturbances were frequently reported. Awake surgery and preserved high Karnofsky Performance Status were found to be independent prognostic factors for better global HRQoL, while radiotherapy was associated with worsened HRQoL.</p><p><strong>Conclusion: </strong>Despite a non-therapeutic and progression free phase, LGG patients report noticeable limitations in several HRQoL subscales. Our study highlights the importance of HRQoL assessment not only at diagnosis or during active therapeutic stage. Further studies are needed to develop better adapted tools of HRQoL assessment.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"659-668"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computerized assessment of neuropsychological functioning in pediatric brain tumor patients.","authors":"Jia-Yun Huang, Ting-Chi Yeh, Hsi-Che Liu, Jen-Yin Hou, Tsung-Yu Yen, Chun-Chao Huang, Hsuan-Chih Lao, Che-Sheng Ho, Muh-Lii Liang","doi":"10.1007/s11060-025-04945-x","DOIUrl":"https://doi.org/10.1007/s11060-025-04945-x","url":null,"abstract":"<p><strong>Purpose: </strong>Advances in multidisciplinary treatment of childhood brain tumors have significantly prolonged survival and reduced treatment-related complications. This makes the accessibility of digital neurocognitive assessment an important issue in the post-pandemic era.</p><p><strong>Methods: </strong>Twenty pediatric brain tumor patients were recruited between August 2023 and August 2024, and a total of eight standardized Cambridge Neuropsychological Test Automated Battery (CANTAB) tests targeting executive function, memory, and attention were applied on a digital system. Subjects with test data exceeding the 5th and 95th percentile ranges were defined as outlier in this context. Three domains (DMS, PAL, SWM) of the normative data for adult patients provided by CANTAB test were used for comparison. Mann-Whitney U test was used to compare differences in treatment modalities and age groups.</p><p><strong>Results: </strong>Four patients (4/20, 20%) exhibited impairments across four to six cognitive domains, with more than 14 sub-items falling outside the 5th and 95th percentiles.Another 7 patients (7/20, 35%) had impairments confined to a single domain, even though 4 out of 7 (57%) had a total IQ above 100. The subtle neurocognitive impairment of different domains can be effectively identified by automatic digital threshold analysis and reasonably associated with clinical characteristics. The normative data provided by the CANTAB battery for adult populations further enhances the accuracy of detecting neurofunctional impairments.</p><p><strong>Conclusion: </strong>The CANTAB test was shown to be an evaluable and user-friendly neurocognitive assessment tool for post-treatment follow-up in pediatric patients with brain tumors.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancers of the brain and central nervous system: global patterns and trends in incidence.","authors":"Adalberto M Filho, Ariana Znaor, Ceren Sunguc, Mariam Zahwe, Rafael Marcos-Gragera, Jonine D Figueroa, Freddie Bray","doi":"10.1007/s11060-025-04944-y","DOIUrl":"https://doi.org/10.1007/s11060-025-04944-y","url":null,"abstract":"<p><strong>Background: </strong>Global comparisons of the burden and impact of cancers of the brain and central nervous system (CNS) are critical for developing effective control strategies and generating etiological hypotheses to drive future research.</p><p><strong>Methods: </strong>National incidence estimates were obtained from GLOBOCAN 2022, and recorded incidence data from the Cancer in Five Continents series, both developed and compiled by the International Agency for Research on Cancer. We examined the estimated age-standardized incidence rates in 185 countries, as well as time trends in recorded incidence in 35 countries, quantifying the direction and change in the magnitude of the rates using the estimated average percentage change (EAPC).</p><p><strong>Results: </strong>In 2022, 322,000 new cases of brain and CNS tumors were estimated globally. By world region, the highest incidence rate was seen in Northern America (5.46 per 100,000), Eastern Asia (3.95), and Western Europe (5.56). Africa had relatively lower incidence rates. By country and age group, Austria and the U.S. exhibited the highest rates in boys (3.5 in both), while in adolescents and young adults (AYA), Norway had the highest incidence rates in both males (4.7) and females (3.8). Among adults (+ 40yo), the highest rates in males were observed in the Northern European countries of Norway (18.6), Lithuania (18.4), and Latvia (16.7). In terms of time trends, incidence rates tended to be rather stable in most world regions over the last decade, though increases were observed in selected countries. Trends-based predictions indicate that if incidence rates remain stable, population ageing and growth would mean there would be 474,000 new cases by the year 2045, a 47% increase from 2022.</p><p><strong>Conclusion: </strong>While the increased incidence rates in certain populations require further study, the future predictions based on stable rates to 2045 are of particular concern, with a close to 50% increase in the number of brain and CNS cancer patients expected over the coming decades. A global 2% decline in rates would be needed to ensure the future brain and CNS cancer burden does not exceed present levels.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic, medical, and neighborhood barriers to clinical neuropsychological services in pediatric medulloblastoma patients treated in the United States.","authors":"Rachel K Peterson, Jeong Ha Choi, Tricia Z King","doi":"10.1007/s11060-025-04940-2","DOIUrl":"https://doi.org/10.1007/s11060-025-04940-2","url":null,"abstract":"<p><strong>Background: </strong>Medulloblastoma is the most commonly occurring malignant brain tumor of childhood. Treatment includes a combination of surgery, radiation therapy, and chemotherapy, all of which are associated with cognitive impairments. Despite appreciation of the value of neuropsychological evaluations to assess for cognitive impairments, there are barriers to these evaluations. This study aimed to identify potential demographic, medical, or neighborhood factors associated with barriers to neuropsychological evaluations.</p><p><strong>Methods: </strong>Retrospective chart review identified pediatric patients with a medulloblastoma diagnosed between 2005 and 2024. Demographic, medical, and neighborhood factors were gleaned from the medical records.</p><p><strong>Results: </strong>Of the 67 identified patients, only 36 (53.73%) completed a clinical neuropsychological evaluation. Patients who obtained a neuropsychological evaluation were more likely to be non-Hispanic [X² (1,62) = 9.20, p = <.01], diagnosed at younger ages [t(60) = - 8.40, p =  < 0.001], treated with photon radiation therapy [X² (1,62) = 15.24, p =  < 0.001], live closer to the hospital [t(60) = 3.19, p = 0.001], and live in communities with higher health-related resources [t(60) = - 2.09, p = 0.02]. The two groups did not differ by any of the medical/clinical factors.</p><p><strong>Conclusions: </strong>Neuropsychological evaluations assess for cognitive changes following cancer directed treatment, clarify other diagnostic possibilities (e.g., learning or attention difficulties), and facilitate access to appropriate accommodations and school- and community- based services. Although neuropsychological evaluations are recommended as standard of care following treatment for medulloblastoma, we identified demographic, medical, and neighborhood-level factors that serve as barriers to clinical neuropsychological evaluations. Implications for clinical care and recommendations to address these barriers are discussed.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving postsurgical paresis in brain tumor patients by transcranial magnetic stimulation.","authors":"Tizian Rosenstock, Thomas Picht, Melina Engelhardt, Ulrike Grittner, Maximilian Mönch, Peter Vajkoczy, José Pedro Lavrador, Ana Mirallave-Pescador, Francesco Vergani, Maximilian Schwendner, Axel Schroeder, Leonie Kram, Haosu Zhang, Sujit Prabhu, Sarah Prinsloo, Bernhard Meyer, Sebastian Ille, Sandro M Krieg","doi":"10.1007/s11060-024-04931-9","DOIUrl":"https://doi.org/10.1007/s11060-024-04931-9","url":null,"abstract":"<p><strong>Background and objectives: </strong>Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis.</p><p><strong>Methods: </strong>This is a secondary analysis of two randomized and three one-arm studies in brain tumor patients with new/progressive postoperative paresis. Patients underwent either low frequency contralesional nrTMS or sham stimulation followed by physiotherapy. Outcome was assessed on postoperative day 1, 7, and after 3 months using British Medical Research Council score (BMRC), Fugl-Meyer assessment (FMA), Karnofsky Performance Scale (KPS) and National Institutes of Health Stroke Scale (NIHSS).</p><p><strong>Results: </strong>A total of 135 patients (mean age of 53.8 years, 60 women) were included, of whom 51 patients were treated in RCTs (30 treatment group, 21 sham group) and 84 in prospective, single-arm studies. Linear mixed models showed an advantage for the treatment group for the BMRC (7 days: OR 3.28; 95%CI: 1.08-9.99; 3 months: OR 2.03, 95%CI: 0.65-6.39) and KPS (7 days: mean difference (MD) 11, 95%CI: 2-19; 3 months: MD 11, 95%CI: 2-20), less pronounced for the FMA (7 days: MD 0.28, 95%CI: -0.34-0.9; 3 months: MD 0.14, 95%CI: -0.52-0.81). A stronger treatment effect was evident with proven ischemia on the postoperative MRI. To observe an improvement by at least one grade at 3 months, the number needed to treat (NNT) for the entire cohort is 4 (BMRC) and 3 patients (KPS), respectively.</p><p><strong>Conclusion: </strong>Our multicenter data confirm the positive treatment effect of nrTMS to reduce transcallosal inhibition with a considerably low NNT - especially if caused by ischemia.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}