Highlights • Virtual reality (VR) and augmented reality (AR) have great potential in neurosurgery. • Immersive VR has the potential to be used an educational tool. • AR has the added potential of use ...in the live operative field. • Further improvement of VR and AR is crucial to its integration into neurosurgery.
Impairment of facial nerve (FN) function is a common postoperative complication in surgical resections of Vestibular Schwannomas (VS). Diffusion tensor imaging (DTI) tractography creates in vivo ...imaging of the anatomical location of white matter tracts that can be preoperatively used to visualize the displaced FN. We present an analysis of patients who underwent DTI tractography imaging prior to VS resection.
Patient charts were reviewed from March 2012 to April 2015 who underwent DTI tractography prior to surgical resection for VS. Reliability of this measure was compared to the intraoperative FN location as determined by the surgeon. House Brackmann (HB) score was used to assess facial nerve function.
A total of 11 patients were included with a mean age of 43 years (range: 19–64) and mean follow-up length of 11.9 months (range: 3.1–34.2). The average maximum tumor diameter was 2.82 cm (range: 1.7–4.2). DTI tractography was accurate in 90.9% (10/11) of patients. Postoperatively, 72.7% (8/11) had a HB score of I or II, 18.2% (2/11) had a HB score of III, and 9.1% (1/11) had a HB score of IV.
Facial nerve visualization for VS resection can be accurately visualized using DTI tractography. This modality may lead to reduction of postoperative FN damage.
•DTI tractography can be used to visualize displaced nerves.•Patients with VS underwent DTI to visualize CN VII.•DTI tractography was accurate in 90.9% of cases.•Postoperative HB scores of I or II were achieved in 72.7% of the population.
Highlights • Autophony was the most common symptom at presentation, followed by tinnitus. • Aural fullness and autophony were the most common symptoms to resolve after repair. • A small number of ...patients developed disequilibrium, vertigo or aural fullness after repair. • Number of patients with symptoms, except headache, were statistically different after repair.
Purpose
Glioblastoma (GBM) is the most common and malignant primary adult brain tumor. Current care includes surgical resection, radiation, and chemotherapy. Recent clinical trials for GBM have ...demonstrated extended survival using interventions such as tumor vaccines or tumor-treating fields. However, prognosis generally remains poor, with expected survival of 20 months after randomization. Chemokine-based immunotherapy utilizing CCL21 locally recruits lymphocytes and dendritic cells to enhance host antitumor response. Here, we report a preliminary study utilizing CPZ-vault nanoparticles as a vehicle to package, protect, and steadily deliver therapy to optimize CCL21 therapy in a murine flank model of GBM.
Methods
GL261 cells were subcutaneously injected into the left flank of eight-week-old female C57BL/6 mice. Mice were treated with intratumoral injections of either: (1) CCL21-packaged vault nanoparticles (CPZ-CCL21), (2) free recombinant CCL21 chemokine empty vault nanoparticles, (3) empty vault nanoparticles, or 4) PBS.
Results
The results of this study showed that CCL21-packaged vault nanoparticle injections can decrease the tumor volume in vivo. Additionally, this study showed mice injected with CCL21-packaged vault nanoparticle had the smallest average tumor volume and remained the only treatment group with a negative percent change in tumor volume.
Conclusions
This preliminary study establishes vault nanoparticles as a feasible vehicle to increase drug delivery and immune response in a flank murine model of GBM. Future animal studies involving an intracranial orthotopic tumor model are required to fully evaluate the potential for CCL21-packaged vault nanoparticles as a strategy to bypass the blood brain barrier, enhance intracranial immune activity, and improve intracranial tumor control and survival.
Neurofibromatosis type 2 (NF2) is a genetic neoplastic disorder that presents with hallmark bilateral vestibular schwannomas and multiple meningiomas. Though the current standard of care for ...meningiomas includes surgery, the multiplicity of meningiomas in NF2 patients renders complete resection of all developing lesions infeasible. Stereotactic radiosurgery (SRS) may be a viable non-invasive therapeutic alternative to surgery. We describe a particularly challenging case in a 39-year-old male with over 120 lesions who underwent more than 30 surgical procedures, and review the literature. We also searched three popular databases and compared outcomes of SRS versus surgery for the treatment of multiple meningiomas in patients with NF2. A total of 50 patients (27 radiosurgical and 23 surgical) were identified. For patients treated with SRS, local tumor control was achieved in 22 patients (81.5%) and distal control was achieved in 14 patients (51.8%). No malignant inductions were observed at an average follow-up duration of 90 months. Complications in the SRS-treated cohort were reported in 9 patients (33%). Eight patients (29.6%) died due to disease progression. Six patients experienced treatment failure and required further management. For NF2 patients treated with surgery, 11 patients (48%) showed tumor recurrence and 10 patients (43.5%) died due to neurological complications. SRS may be a safe and effective alternative for NF2-associated meningiomas. Further studies are required to identify the ideal radiosurgical candidate.
•EMP2 is a membrane protein found to be upregulated in human cancers.•Antibodies targeting EMP2 may have implications for improving patient outcomes.•EMP2 may be the basis for future therapies ...against GBM and other cancers.
Epithelial membrane protein 2 (EMP2) is a cell surface protein that has recently emerged as an object of neuro-oncological interest due to its potential to be utilized as a biomarker and target for antibody therapies. Preclinical studies have demonstrated that EMP2 is associated with disease prognosis in a number of human cancers, including glioblastoma. The four large extracellular domains of EMP2 and its association with the extracellular matrix makes it an attractive target for future cancer therapies. Translational research suggests that EMP2 may be targeted with antibodies to improve tumor control and survival in a variety of murine models and cancer types. However, in order to translate these preclinical findings into the clinic, future research will need to focus on elucidating the role EMP2 in the normal human body by better understanding its molecular and chemical interactions. The focus of this review is to provide a comprehensive insight into current research endeavors, discuss the potential for clinically translatable applications, and predict the future directions of such research.
The number of patient imaging studies has increased because of precautious physicians ordering scans when a vague symptom is presented; subsequently, the number of incidental meningiomas detected has ...increased as well. These brain tumors do not present with related symptoms and are usually small. MRI and computed tomographic scans most frequently capture incidental meningiomas. Incidental meningiomas are managed with observation, radiation, and surgical resection. Ultimately, a conservative approach is recommended, such as observing an incidental meningioma and then only radiating if the tumor displays growth, whereas a surgical approach is to be used only when proven necessary.
Abstract Objectives Atypical meningioma (AM) is an aggressive subtype of meningioma that is associated with high recurrence rates following surgical resection. Recent studies have compared outcomes ...of various treatment strategies, but advantages of adjuvant radiosurgery (ARS) over serial surveillance (SS) following subtotal resection (STR) remain unclear. To further elucidate this issue, the authors systematically analyze the current literature on AM and compare outcomes of ARS versus SS after STR. Methods Embase, PubMed, and Cochrane databases were queried using relevant search terms. Retrospective case series that described patients with AM treated with ARS and SS after STR were included. Tests of proportions were performed to detect significant variations in recurrence rate, 5-year progression-free (PFS), and 5-year overall survival (OS) between the treatment strategies (ARS versus SS) and among individual studies. Results A total of 619 patients (263 ARS and 356 SS) were identified. Mean recurrence rates, 5-year PFS, and 5-year OS were 53.5%, 50.3%, and 74.9% for ARS versus 89.8%, 19.1%, and 89.8% for SS, respectively. Recurrence rates between treatment strategies and ARS studies differed (p < .001). 5-year PFS between treatment strategies, ARS, and SS studies differed (p < .001, p = .007 and p < .001, respectively). Conclusion The evidence demonstrates significant differences in recurrence rates and 5-year PFS between ARS and SS, suggesting a potential benefit of ARS. As we further our understanding of the clinical outcomes of various treatment strategies for AM, we also move closer to integrating modalities, such as radiosurgery, into management guidelines.
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