CONTINUUM Lifelong Learning in Neurology最新文献_第8页

Skull Base Tumors. 颅底肿瘤

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001361

Deborah A Forst, Pamela S Jones

{"title":"Skull Base Tumors.","authors":"Deborah A Forst, Pamela S Jones","doi":"10.1212/CON.0000000000001361","DOIUrl":"10.1212/CON.0000000000001361","url":null,"abstract":"Objective: This article reviews the presenting features, molecular characteristics, diagnosis, and management of selected skull base tumors, including meningiomas, vestibular schwannomas, pituitary neuroendocrine tumors, craniopharyngiomas, chordomas, ecchordosis physaliphora, chondrosarcomas, esthesioneuroblastomas, and paragangliomas.Latest developments: Skull base tumors pose a management challenge given their complex location and, as a result, the tumors and treatment can result in significant morbidity. In most cases, surgery, radiation therapy, or both yield high rates of disease control, but the use of these therapies may be limited by the surgical accessibility of these tumors and their proximity to critical structures. The World Health Organization classification of pituitary neuroendocrine tumors was updated in 2022. Scientific advances have led to an enhanced understanding of the genetic drivers of many types of skull base tumors and have revealed several potentially targetable genetic alterations. This information is being leveraged in the design of ongoing clinical trials, with the hope of rendering these challenging tumors treatable through less invasive and morbid measures.Essential points: Tumors involving the skull base are heterogeneous and may arise from bony structures, cranial nerves, the meninges, the sinonasal tract, the pituitary gland, or embryonic tissues. Treatment often requires a multidisciplinary approach, with participation from radiation oncologists, medical oncologists, neuro-oncologists, and surgical specialists, including neurosurgeons, otolaryngologists, and head and neck surgeons. Treatment has largely centered around surgical resection, when feasible, and the use of first-line or salvage radiation therapy, with chemotherapy, targeted therapy, or both considered in selected settings. Our growing understanding of the molecular drivers of these diseases may facilitate future expansion of pharmacologic options to treat skull base tumors.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Management of Complications in Neuro-oncology Patients. 神经肿瘤患者并发症的处理。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001359

Mary R Welch

{"title":"Management of Complications in Neuro-oncology Patients.","authors":"Mary R Welch","doi":"10.1212/CON.0000000000001359","DOIUrl":"10.1212/CON.0000000000001359","url":null,"abstract":"Objective: The purpose of this article is to familiarize the reader with the spectrum of neurologic and medical complications relevant to the care of patients with neurologic cancer while highlighting best practices to prevent morbidity and mortality. Topics include tumor-related epilepsy, vasogenic edema, complications of corticosteroid use, disruption of the hypothalamic-pituitary axis, venous thromboembolism, and opportunistic infection.Latest developments: In 2021, a joint guideline from the Society for Neuro-Oncology and the European Association of Neuro-Oncology reaffirmed recommendations first established in 2000 that patients with newly diagnosed brain tumors should not be prescribed an antiseizure medication prophylactically. For those with tumor-related epilepsy, monotherapy with a non-enzyme-inducing anticonvulsant is the preferred initial treatment, and levetiracetam remains the preferred first choice. Surveys of physician practice continue to demonstrate excessive use of glucocorticoids in the management of patients with both primary and metastatic central nervous system malignancy. This is particularly concerning among patients who require checkpoint inhibitors as the efficacy of these agents is blunted by concomitant glucocorticoid use, resulting in a reduction in overall survival. Finally, direct oral anticoagulants have been shown to be safe in patients with brain tumors and are now favored as first-line treatment among those who require treatment for venous thromboembolism.Essential points: Medical care for patients impacted by primary and secondary central nervous system malignancy is complex and requires a committed team-based approach that routinely calls upon the expertise of physicians across multiple fields. Neurologists have an important role to play and should be familiar with the spectrum of complications impacting these patients as well as the latest recommendations for management.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Learning Objectives and Core Competencies. 学习目标和核心能力。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001365

引用次数: 0

SELF-ASSESSMENT AND CME. 自我评估和 CME。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001369

引用次数: 0

List of Abbreviations. 缩写表。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/01.CON.0000998100.13454.35

引用次数: 0

Adult-type Diffuse Gliomas. 成人型弥漫性胶质瘤。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001352

Macarena I de la Fuente

引用次数: 0

Learning Objectives and Core Competencies. 学习目标和核心能力。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001365

引用次数: 0

SELF-ASSESSMENT AND CME. 自我评估和 CME。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001369

引用次数: 0

Neurologic Complications of Cancer Immunotherapy. 癌症免疫疗法的神经并发症。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001362

Nancy Wang

{"title":"Neurologic Complications of Cancer Immunotherapy.","authors":"Nancy Wang","doi":"10.1212/CON.0000000000001362","DOIUrl":"10.1212/CON.0000000000001362","url":null,"abstract":"Objective: Immunotherapeutic approaches have revolutionized cancer treatment with immune checkpoint inhibitors and adoptive T-cell therapy now approved to treat a variety of solid and hematologic malignancies. This article summarizes the distinctive neurologic side effects of these therapies as well as their management.Latest developments: Neurologic immune-related adverse events are rare but potentially serious complications of immune checkpoint inhibitors. Both peripheral and central nervous system disorders have been described, often necessitating a pause or cessation of immunotherapy. Immune effector cell-associated neurotoxicity syndrome is a potentially serious complication of chimeric antigen receptor T-cell therapy. While symptoms may be mild and self-limited, delirium, encephalopathy, seizures, focal neurologic deficits, and fulminant cerebral edema can be seen. Close neurologic monitoring is imperative. The mainstay of treatment for neurologic complications includes high-dose corticosteroids, although other immunomodulatory strategies may be used in severe or refractory cases.Essential points: The spectrum of neurologic complications of cancer immunotherapy is broad, encompassing both central and peripheral nervous system disorders, indolent as well as fulminant clinical presentations, and wide-ranging severity with variable response to treatment. Early identification and multidisciplinary management are crucial to balance neurologic recovery and antitumor control.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138812870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neurology and Language, In Motion. 神经学与语言》，《运动中》。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2023-12-01 DOI: 10.1212/CON.0000000000001396

Lyell K Jones

引用次数: 0