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Background: Central nervous system tumors are the 10th most prevalent cause of mortality worldwide. The 2016 World Health Organization (WHO) classification of high grade gliomas (HGG) has identified Isocitrate dehydrogenase 1 (IDH 1) mutation as one of the primary molecular markers. Tumor protein 53 (p53) mutation is also closely associated with HGG. Aims and Objectives: The current study intended to ascertain the expression of IDH1 and P53 in patients with HGG and correlate that expression with clinical prognosis. Materials and Methods: The study included 34 patients with histopathological proven HGG. Relevant clinical information was recorded. The immunostaining results with anti-mouse monoclonal antibody for IDH 1 (R132H) and rabbit polyclonal antibody for p53 (RP 106-05) were statistically analyzed. Patients were followed up through telephone for a period of 1 year. Mortality within 1 year was regarded as a poor outcome. Results: About 85.29% (29/34) of the patients had Grade IV glioma, while only 14.71% (5/34) had Grade III glioma. Most patients with Grade III (3/5) (60.00%) and Grade IV (21/29) (72.41%) gliomas had p53 positivity. The majority of the patients with grade-III glioma (3/5) (60.00%) had IDH1 positivity, while most of the patients (23/29) (79.31%) with Grade IV gliomas had IDH1 negativity (P=0.0658). Age, gender, WHO grade, and adjuvant therapy did not show significant association with the outcome except for the p53 expression (P=0.0011*) and IDH1 expression (P=0.0025*). Correlation analysis showed a significant positive correlation between p53 makers with poor outcome (r=0.4781) and glioma grade (r=0.4028). Further, a negative yet insignificant correlation was recorded between IDH1 with age (r=-0.2285), p53 expression (r=-0.2568), and grade (r=-0.2988), although it showed a significant correlation with poor outcome (P=0.0001). Conclusion: p53-positive and IDH1-negative HGG had a significant correlation with the poor outcome. Thus, IDH1 and p53 are reliable markers for prognostication of HGG. [ABSTRACT FROM AUTHOR]

Introduction: Excision of intra-axial tumours with maximal resection and minimal deficits is one of the intricate procedures in neurosurgery. Fluorescence-guided Surgery (FGS) helps in better identification of tumour tissue and allows Maximal Safe Resection (MSR) of high-grade brain tumours. Sodium fluorescein dye, when injected intravenously, gets concentrated in High-grade Glioma (HGG) tissue due to a disrupted Blood-Brain Barrier (BBB), thus aiding in MSR, Extent Of Resection (EOR), and Gross Total Resection (GTR). Aim: To assess the effectiveness of intraoperative use of sodium fluorescein in achieving MSR and GTR. Materials and Methods: This was a cross-sectional study conducted on 30 patients with HGG who underwent surgery between January 2021 and May 2023 at SDM College of Medical Sciences, Dharwad, Karnataka, India. Two groups of 15 patients each were divided into those operated with the use of Fluorescein Sodium (FS) and those without FS. FS was administered at a dose of 5 mg/kg at the time of craniotomy. The primary endpoint was the number of patients with Histopathological Examination (HPE)-confirmed HGGs showing no contrast-enhancing tumour in the immediate postoperative Magnetic Resonance Imaging (MRI). Secondary endpoints included residual tumours on postoperative MRI, Focal Neurological Deficits (FND), and FS-related toxicity. The association between FS status and recurrence at different treatment time points was assessed using the Pearson Chisquare test. Recurrence rates were compared in each FS group using the Cochran Q test. Statistical significance was set at a 5% level (p-value<0.05). Results: Homogeneous or heterogeneous yellow-green fluorescence was observed on the tumour tissue in all 15 patients (100%). Of the 15 patients where FS was used, two showed lesion recurrences at six months, and 13 showed recurrences at 12 months. Among the 15 patients where FS was not used, 11 showed recurrences at six months, and four showed recurrences at 12 months. This indicates that MSR, GTR, and EOR can be improved using FS intraoperatively during tumour resection. Conclusion: Based on the results, fluorescein dye with a 560 nm yellow filter under a highly illuminated microscope can help achieve better tumour resection with minimal injury to surrounding eloquent areas. It can be utilised as an ideal adjunct for tumour resection rather than with a microscope alone. [ABSTRACT FROM AUTHOR]

Brain tumors are a leading cause of mortality in India, with over 28,000 cases reported annually, resulting in more than 24,000 deaths per year as per the International Association of Cancer Registries. Early detection, segmentation, and accurate classification are crucial in effective tumor analysis, and various algorithms have been developed to achieve this. This study proposes a new approach for the detection and classification of Meningioma and Sarcoma brain tumors using both single slices of MRI and CT, as well as input-level fused images of MRI & CT. Our approach involves the implementation of the PrinciResNet16 model for classification of brain tumors. This model is based on Principal Component Analysis (PCA) and ResNet techniques. We report that our approach significantly improves the accuracy, sensitivity, and specificity parameters to 99%, 95%, and 95%, respectively, based on a dataset of 600 fused slices and 1000 single slices obtained from reputable sources. Our findings hold promise for better brain tumour detection and therapy, which are a significant cause of mortality globally. [ABSTRACT FROM AUTHOR]

Background: Central nervous system ( CNS ) tumors are most dreaded form of cancer with high mortality and morbidity . (1)CNS tumors comprises of less then 2.1 % of all malignancies.[2]. In India,tumors of CNS constitute about 1.9 % of all tumor .[3].However, a rising global trend in these tumors has been observed over the years with newly identified potential risk factors like genetic mutation and ionizing radiation exposure etc. Despite of great advancement of ancillary studies,histopathological grading is a means of predicting the biological behaviour of neoplasm. That’s why histopathological examination is the corner ston upon which the treatment strategy depends. Tumor grade and associate genetic mutation with molecular marker influencing the choice of therapies and predict the response of therapy and outcome. Aim: The aim of present study is to know prevalence of different histological types and grades of primary brain tumors in a single tertiary care centre . Identify the age distribution, gender distribution,topography and different histological types along with WHO grading of CNS tumors . Study Design: One year Prospective study. Material and Method: It was a prospective study carried out in department of pathology,Dr S.N. Medical College Jodhpur from October 2021 to December2022. Total 94 cases of CNS tumors were included in this study. The tissues were processed and stained with routine haematoxylin and eosin and finally histopathological examination was done by light microscopy . CNS tumors were classified according to WHO 2016 Morphological classification and simultaneously WHO grading was done. The data was analyzed using excel and SPSS software. Results: 94 cases were analyzed during a study period of 1 years. Male preponderance was observed with 52 males and 42 females with M: F ratio is 1.23:1. A wide age group ranging from 4 to 85 years were affected. Overall mean age was 38.58 years. Maximum cases were recorded between 20- 40 years of age. Majority of lesions were presented as space occupying lesion ( 85 cases,90 % ). WHO Grade I tumors was predominant 40 cases,42.55 %). Glial tumors having maximum percentage ( 33 cases,35.10 %)followed by meningeal tumors ( 32 cases (34.04%). Meningothelial meningioma was most common histological type of all type of meningioma. Conclusion: The present study provides information regarding the burden of disease in our area. In developing countries like India due to lack of complete registration of newly diagnosed cases with local cancer registries,the exact tumor burden goes unnoticed. Hospital based prevalence data therefore estimating tumor burden and making appropriate infrastructure in management of these cancers with newer diagnostic as well as therapeutic treatment modalities. [ABSTRACT FROM AUTHOR]

Intracranial granulomas are a major cause of seizures in India, the most common etiologies being neurocysticercosis and tuberculosis. However, other pathologies including rare low-grade tumors may mimic these granulomas on imaging. In this article, we presented the case of a young woman patient with drug-resistant epilepsy. On imaging, there was a small calcified lesion in the brain parenchyma. In view of concordant electroclinical and imaging data on presurgical evaluation, the lesion was excised and the patient was seizure free. On histopathological evaluation, it was found to be a polymorphous low-grade neuroepithelial tumor of the young (PLNTY) – a rare, recently reported entity that can mimic an intracranial granuloma on imaging. [ABSTRACT FROM AUTHOR]

Introduction: High-grade gliomas, especially Glioblastoma Multiforme (GBM), are the most prevalent primary brain tumours in adults. Treating GBM is challenging due to resistant tumour cells, resulting in a dismal prognosis. While GBM often develops spontaneously, familial gliomas have also been identified in 1% of cases. Primary and secondary glioblastoma are the subtypes that affect patients of varying ages and develop via different paths. Aim: To estimate the two year survival and to assess factors affecting survival in patients diagnosed with GBM and to evaluate the "ability for self-care" following treatment. Materials and Methods: The cohort study investigated treatment outcomes in GBM using a sample of 65 patients from the Department of Radiation Oncology at Government Medical College Thrissur, a tertiary care centre in Kerala, India. The patients were diagnosed between January 2018 and December 2019. Survival and the factors determining survival were explored through case records and telephonic interviews with primary caregivers. Median survival and two year survival rates were calculated. The study examined possible associations of survival with patient-related, tumour-related, and treatment-related factors. Patient-related factors assessed were age, gender, and Eastern Cooperative Oncology Group (ECOG) performance status at diagnosis. Tumour-related factors assessed included tumour location, laterality, and volume based on pretreatment Magnetic Resonance Imaging (MRI). Treatment-related factors such as extent of surgery, postoperative radiotherapy, and chemotherapy were also assessed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS version 21.0). Qualitative variables were expressed in percentage and compared using the Chi-square test or Fisher's-exact test. Quantitative variables were expressed as mean and standard deviation and compared using unpaired t-tests. Telephonic interviews with primary caregivers were conducted to assess the "ability for self-care" following treatment. Results: The study included a total of 65 cases, with a mean patient age of 54 years. Out of the patients, 45 (68%) patients were male, while 20 (32%) patients were female. The median survival for GBM was found to be eight months. The one year and two year survival rates were 18.46% (12 patients) and 10.8% (7 patients), respectively. The survivors had a mean age of 48 years. There were no statistically significant differences in survival based on sex (p-value=0.527), tumour location (p-value=0.765), and laterality (p-value=0.596). Survival was found to be related to ECOG performance status at diagnosis (p-value=0.001) and tumour volume (p-value=0.002). Among the patients, 37 (58%) patients were able to perform self-care after treatment, while 28 (42%) patients were unable to do so. Conclusion: The survival of patients with GBM is related to ECOG performance status at diagnosis and the pretreatment volume of the tumour. The evidence was insufficient to establish a relationship between survival and the administration of postoperative radiotherapy and chemotherapy. Despite multimodality treatment protocols, the survival of patients with GBM remains dismal. A tailored treatment protocol that weighing morbidity of treatment and cost effectiveness on one side and survival on the other side is the need of the hour. [ABSTRACT FROM AUTHOR]

A brain tumor is a lethal neurological disease that affects the average performance of the brain and can be fatal. In India, around 15 million cases are diagnosed yearly. To mitigate the seriousness of the tumor it is essential to diagnose at the beginning. Notwithstanding, the manual evaluation process utilizing Magnetic Resonance Imaging (MRI) causes a few worries, remarkably inefficient and inaccurate brain tumor diagnoses. Similarly, the examination process of brain tumors is intricate as they display high unbalance in nature like shape, size, appearance, and location. Therefore, a precise and expeditious prognosis of brain tumors is essential for implementing the of an implicit treatment. Several computer models adapted to diagnose the tumor, but the accuracy of the model needs to be tested. Considering all the above mentioned things, this work aims to identify the best classification system by considering the prediction accuracy out of Alex-Net, ResNet 50, and Inception V3. Data augmentation is performed on the database and fed into the three convolutions neural network (CNN) models. A comparison line is drawn between the three models based on accuracy and performance. An accuracy of 96.2% is obtained for AlexNet with augmentation and performed better than ResNet 50 and Inception V3 for the 120th epoch. With the suggested model with higher accuracy, it is highly reliable if brain tumors are diagnosed with available datasets. [ABSTRACT FROM AUTHOR]

Brain tumors have always fascinated and intrigued histopathologists due to their diverse morphology and rarity. Recent surge in the molecular developments has further posed a challenge in diagnosis especially in a resource limited setting. Therefore, comprehensive tumor registries have become quintessential to compare our existing database with new found knowledge. A descriptive retrospective study was carried out on archival data of 5 years in a neuroscience institute. All neurosurgical cases operated with complete clinical history and definitive histopathological diagnosis were included. The cases were analyzed with reference to age, sex, location of the lesion, grade of the tumor, and immunohistochemical profile as available and compared with existing registries and literature. The primary brain tumors accounted for 38.29% of all pathologies. Majority of cases clustered around 40–70 years of age (65%). Pediatric (0–19 years) cases comprised 7%. Most common primary brain tumor found in the adult population was meningioma (28%) followed by Glioblastoma (25%). The most common neoplasm in pediatric age group were gliomas (46.29%) followed by embryonal neoplasms. Pituitary adenomas (PAs) constituted 16% of all intracranial neoplasm. Gonadotroph adenoma was the most common of the nonfunctional adenomas constituting one half of the PAs (51.72%). Somatotroph adenoma was most common in the functional group constituting 20% of all PAs. The layout of cases when compared with available brain tumor registries showed nearly similar trends in distribution. Our study succored data from the population in eastern part of India of which our institute is a major referral centre for neurosurgical cases. [ABSTRACT FROM AUTHOR]

Surgery of eloquent area gliomas is challenging and requires monitoring of the nearby white fiber tracts. In the present study, we analyzed 102 patients with eloquent region gliomas and discussed the concept of intraoperative dynamic white fiber tract navigation and monitoring. A total of 102 patients with an eloquent area glioma (52 insular, 29 motor area, 21 temporoparietal) were evaluated. The position of the white fiber tracts (corticospinal tract [or motor fiber; CST], inferior fronto-occipital fasciculus [ventral language fiber; IFOF], superior longitudinal fasciculus [SLF], and arcuate fasciculus [dorsal language fiber; AF) was recorded. Awake mapping of the cortical and subcortical eloquent structures was performed for all 102 patients. The suction stimulator was coregistered and used as a dynamic stimulator navigator. Of the 102 patients, 60 were men and 42 were women, with an average age of 39.8 years. Most of the white fiber tracts were normal (CST, 31.3%; IFOF, 39.2%; SLF/AF, 40.19%) or displaced (CST, 59.8%; IFOF, 47.05%; AF/SLF, 44.11%). A few were disrupted (CST, 8.8%; IFOF, 13.7%; SLF/AF, 15.7%). The extent of tumor resection was 82.8%, 86.5%, and 94% for those with insular glioma, motor area glioma, and temporoparietal glioma, respectively. Of the 102 patients, 18 had developed transient speech and language disturbances with improvement, and 14 had developed motor deficits, of whom, all except for 2, had shown gradual improvement. When the dynamic suction stimulator navigator was used, the extent of resection was 96.5%, without any added deficits. The use of intraoperative neuronavigation and neurophysiological assessment can help achieve maximal tumor resection of eloquent area gliomas. Use of the integrated suction stimulator navigator provided dynamic navigation and mapping of the peritumoral eloquent fibers. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) tumors are the second most common cause of cancer in children when incidence rates of cancer are estimated according to the Indian population dynamics based on 2011 consensus. As per the estimates, CNS tumors account for 20.1% of cancer burden in children aged between 0 and 14 years and 16.8% when 0 to 19 years age group is considered. The most common pediatric brain tumors are astrocytoma and medulloblastoma followed by other embryonal tumors, craniopharyngioma, and ependymal tumors. The incidence of CNS tumors in children from India is similar to the western high-income countries, other than slightly higher incidence of craniopharyngioma in Indian children. [ABSTRACT FROM AUTHOR]

Purpose: To compare health-related quality of life (HRQoL) and symptom burden following meningioma resection in patients from two samples from Australia and India. This will add to the body of data on the longer-term consequences of living with a meningioma in two socio-economically and culturally different countries. Methods: The European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), Brain Neoplasm Module (QLQ-BN20) and the Hospital Anxiety and Depression Scale (HADS) were administered to 159 Australian and 92 Indian meningioma patients over 24 months postoperative. A linear mixed model analysis identified differences between groups over time. Results: Australian patients reported better physical functioning in the early months after surgery (T1: mean diff: 19.8, p<0.001; T2: mean diff: 12.5, p = 0.016) whereas Indian patients reported better global HRQoL (mean: -20.3, p<0.001) and emotional functioning (mean diff:-15.6, p = 0.020) at 12–24 months. In general, Australian patients reported more sleep and fatigue symptoms while Indian patients reported more gastro-intestinal symptoms over the 2-year follow-up. Future uncertainty and symptoms common for brain tumour patients were consistently more commonly reported by patients in Australia than in India. No differences for depression and anxiety were identified. Conclusion: This is the first cross cultural study to directly compare postoperative HRQoL in meningioma patients. Some differences in HRQoL domains and symptom burden may be explained by culturally intrinsic reporting of symptoms, as well as higher care support from family members in India. Although there were differences in some HRQoL domains, clinically meaningful differences between the two samples were less common than perhaps expected. This may be due to an Indian sample with high literacy and financial resources to afford surgery and follow up care. [ABSTRACT FROM AUTHOR]

Objective: Glioblastoma Multiforme (GBM), a devastating the most common primary malignant intracranial brain tumors. In India, the incidence of this malignancy is escalating, however, there are very few studies on this tumor entity from Indian population. The present study sought to investigate the prevalence and prognostic significance of Signal Transducer and Activator of Transcription 3 (STAT3) gene expression in GBM patients from Western India. Method: STAT3 gene expression using real-time PCR was detected in total 55 GBM patients. The impact of STAT3 aberrant expression on progression-free survival (PFS) and overall (OS) was analysed using univariate and multivariate survival analysis. The data were analysed using SPSS statistical software and p value ≤0.05 was considered as significant. Results: The aberrant STAT3 expression was found in 85% (47/55) of patients with -1.12 fold change down-regulation in 49% (23/47) and 3.36 fold change up-regulation was noted in 51% (24/47) of patients. In wild type IDH tumors (n=30), down regulation and up regulation of STAT3 was noted in 63% and 27% of patients, respectively, whereas, for IDH mutant GBM tumors (n=25), the incidence of low expression and high expression of STAT3 was noted in 16% and 68% of patients, respectively. Thus, we found that incidence of STAT3 down regulation was significantly high in patients with IDH wild type tumors, whereas, in IDH mutant GBM tumors, the incidence of up-regulated STAT3 was significantly high (P=0.021, χ2=12.81, r=+0.310). In Kaplan-Meier univariate survival analysis, a part from age (P=0.006), tumor location (P=0.025), and KPS score (P=0.002), co-detection of STAT3 up regulation and presence of IDH mutation (P=0.030) remained significant prognostic factors for PFS and OS. In multivariate survival analysis also, co-detection of STAT3 high expression and presence of IDH mutation remained independent prognosticators for PFS (HR=6.45, 95% CI=1.32-31.40, P=0.021) and OS (HR=8.69, 95% CI=1.66-45.51, P=0.010). Conclusion: For GBM tumors, STAT3 up-regulation and presence of IDH mutations together predicts better survival. This reflects unique molecular etiology for GBM patients. Therefore, they would be useful in the future for targeted therapy and for clinicians they would be useful for better patient management. However, study on a larger sample size is required for validation. [ABSTRACT FROM AUTHOR]

Background  Various risk factors for tumors such as smoking, alcohol consumption, diet, and radiation, etc., were already identified. ABO blood group antigens are also present on epithelia, endothelia, and neurons. Recent evidence suggested the role of ABO antigens in the pathogenesis of certain malignancies. Materials   and Methods A retrospective observational study was conducted in a tertiary care neurosurgical center in North India from January 2016 to December 2018. The hospital information system was used to obtain patient information while the blood center information system was used to collect blood group information. Brain tumors were majorly divided into cavernoma, glioma, meningioma, neuroma, pituitary adenoma, schwannoma, and others. Results  We found a total of 1,970 patients with brain tumors admitted during our study period. Most patients had glioma (33.55%), followed by pituitary adenoma (20.05%) and neuroma (2.23%). B blood group individuals had more prevalence of cavernoma, glioma, meningioma, pituitary adenoma, schwannoma, and others followed by O, A, and AB. Only association of O blood group with neuroma tumor was found statistically significant. Conclusions  Our patient population had blood group distribution similar to our general population and no significant association was observed by blood group antigens and brain tumors. Although neuroma was significantly associated with blood group O but the prevalence of neuroma in our patient population is very low hence large sample study is required to draw a firm conclusion regarding this association. [ABSTRACT FROM AUTHOR]

Aim: The purpose of the present study was to assess the accuracy of radiotherapy (RT) structure volume generated by the Monaco treatment planning system (TPS) for three different computed tomography (CT) slice thicknesses. Further, this study addressed the important issue of 'different volumes of the same RT structure shown at different places' in the Monaco TPS. Also, the practical impact of this difference in structure volumes has been studied for brain or head and neck patients. Materials and Methods: Objects of known volumes were scanned with different CT slice thicknesses and contoured as an RT structure in Monaco TPS and two different volumes provided by the TPS for each RT structure were noted and compared with the real volumes of these objects. In addition, correlation was also assessed between TPS provided volumes and real volumes of these objects. The study was further extended to obtain correlation of volumes in cases of organs that exist in pairs (e.g., eye) in the human body. Results: Monaco TPS overestimates structure volumes except for objects with sharp corners. Although, volumes shown at different places of the same structure have nearly a linear correlation, volumes under structure table are more accurate than those shown under dose–volume histogram (DVH) statistics (total volume) table. Difference in magnitude between these two volumes has no correlation if this difference is analysed for paired organs. Findings: This study confirmed that Monaco TPS provides 'different value at different places' of the volume of a given contoured structure. It is recommended that this issue should be reviewed and resolved by the supplier. [ABSTRACT FROM AUTHOR]

Background: With the incorporation of molecular subtyping in glioma patients in 2016 WHO classification, there is a need to understand the immunohistochemistry (IHC) marker expression in various glioma patients and to clinically correlate with various subgroups. Objective: Aim of the study was to assess IHC marker expression profile in glioma patients and to clinically correlate them in various subgroups. Materials and Methods: The prospective study included 115 glioma patients. IHC markers (isocitrate dehydrogenase [IDH] 1, ATRX, P53, Ki-67 antibody) were done in all patients. Patients received treatment as per the grade of tumor. The patients were followed in 3 monthly intervals, for a period of 12 months. SPSS software version 20.0 was used for statistical analysis. Tables were prepared in Microsoft Excel sheet. Kaplan-Meier method was used for survival analysis. Results: There were 11 Grade 1, 33 Grade 2, 26 Grade 3, and 45 glioblastoma multiforme (GBM) patients out of which 10 patients were secondary GBM cases. IDH1 mutation is frequent in Grade 2 and Grade 3 tumors of both astrocytic and oligodendroglia tumors. Its mutation is also common in secondary GBM patients. ATRX mutation is specific to astrocytic lineage, Grade 2, Grade 3, and secondary GBM patients. Conclusion: Molecular nature of DA and AA cases can be accurately confirmed by combined IDH1 and ATRX IHC thereby avoiding costly investigations such as fluorescence in situ hybridization. In astrocytic tumors, p53 can act as a surrogate marker. IDH-mutant glioma patients have better prognoses than IDH wild gliomas. [ABSTRACT FROM AUTHOR]

Introduction: Primary Central Nervous System (CNS) tumours constitute less than 2% of overall cancers in adults and are the second most frequently encountered tumours in children. Meningiomas form 24-30% of primary intracranial tumours. Most intrinsic brain tumours are soft and gelatinous in consistency, smear preparation can readily made which gives excellent cytological details when compared to frozen section as the latter produces ice crystal artifacts. Aim: To assess the diagnostic utility of squash cytological evaluation of meningiomas and its comparison with final histopathological diagnosis. Materials and Methods: The cross-sectional study was done at Thanjavur Medical College, Thanjavur, Tamil Nadu, India for period of three years from January 2015 to December 2017. Total of 54 clinically diagnosed and radiologically suspected case of meningiomas were selected. Smears were prepared from the biopsy samples sent in normal saline and stained by Haematoxylin and Eosin method. The cytological features were noted and matched with biopsy findings. Descriptive statistics were used to analyse the results. Results: Total of 54 squash smears with male to female ratio was 1:1.5. Maximum number of cases were seen between 41- 50 years followed by 51-60 years. Complete concordance was obtained in 51 cases (94.44%) and partial concordance was noted in a case due to underestimation of malignancy grade in squash cytology. Out of 54 cases, two cases were found to be discordant with final histopathological diagnosis. Conclusion: Intraoperative squash cytology is easy, rapid, reliable and cost-effective technique for neurosurgical consultation with fairly high accuracy in diagnosing meningiomas. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) is the most aggressive lethal cancer with low survival rate. Efficacy of chemotherapy is decreased for GBM for blood-brain barrier that limits the delivery of chemotherapeutics to brain. Though several novel GBM-targeting drugs are showing promising results, most of them have deleterious side effects. Alternatively, phytochemicals exhibit multiple bioactivities including cytotoxicity towards various cancer cells and are showing prominence in chemotherapy for low toxicity and cost-effectiveness. This review presents a comprehensive literature regarding effective treatment of GBM by phytochemicals found in India. This study may introduce a new opportunity to use these phytochemicals alone or in combination with other chemotherapeutics against GBM. Comprehensive and systematic review of the literature was carried out on the role of phytochemicals, which are widespread in India with a focus on GBM. Peer-reviewed articles were extracted by using combination of keyword such as 'GBM,' 'phytochemicals,' 'Indian plants,' etc. in Scopus, PubMed, and Science-Direct databases from 1983 to 2022. Plethora of phytochemicals are obtained from medicinal plants. Indian subcontinent is rich in phytochemical-producing plants and those are being used successfully against GBM in combination with chemotherapy. It inhibits GBM angiogenesis and tumour proliferation. These results suggest the possibility of innovative drug therapeutic strategies using phytochemicals as lead compounds. We have reviewed the role of several plants widely spread-across India and their derived phytochemicals used to treat GBM. The inferences considered here may be extended as useful foundation towards study and development of promising chemotherapeutic agents for treatment of GBM. [Display omitted] • Glioblastoma multiforme (GBM) is an intricate and incursive brain tumour with poor prognosis • Self-renewal capability glioma stem cells increase the chances of cancer relapse and progress • Conventional chemotherapeutics to treat GBM are still insufficient • Phytochemicals are showing promising results in preclinical models against GBM • Phytochemicals with chemotherapeutics improve their potency synergistically in GBM [ABSTRACT FROM AUTHOR]

Background: Neuro-oncology is a relatively young subspecialty of neurosurgery. 2018 was the 10th year since the founding of the Indian Society of Neuro-oncology.Objective: To assess patterns in neuro-oncology practice in India.Methods: This was an online survey covering various domains of neuro-oncology such as demographics and practice setting, protocols for the medical management of patients with brain tumors, protocols for surgery and the perioperative period (including antibiotic prophylaxis, dural closure techniques, etc.), technological adjuncts used for brain/spine tumors (including intraoperative neurologic monitoring-IONM), and management protocols for certain specific clinical scenarios.Results: The response rate was 13%. Although 37% of the respondents' institutions could be considered as having reasonable surgical volumes (>1 procedure/day), only about half of these had high volumes of malignant brain tumor surgery. A wide variation was seen in medical management, perioperative protocols, use of adjuncts and intraoperative technologies, and paradigms for specific clinical scenarios.Conclusions: There is a need to standardize the protocols in neuro-oncology. This could be achieved by strengthening the formal training process in surgical neuro-oncology. [ABSTRACT FROM AUTHOR]

Infertility is on a rise, and so is the availability of assisted reproductive technique (ART) centres. The sole aim of these centers is to help these unfortunate couples achieve pregnancy. Hence, the concentration of the treatment is on the female partner, while the male is relegated to just being a source for sperm. In the era of intracytoplasmic sperm injection, when pregnancy is possible even with a single mature sperm, evaluation and management of male factor infertility (MFI) is often neglected. MFI and poor semen parameters are markers of male health. He could be suffering from erectile or ejaculatory issues or with correctable obstructive azoospermia. A simple timely varicocele correction may help resolve the issue. It is important to understand that MFI is not a disease but may be a symptom of major underlying clinical condition like testicular or brain tumors. Infertility treatment could be the only occasion when a male seeks health‑care evaluation. India has a large pool of qualified urologists trained in andrological care. In contrast, gynecologists may not be trained in the management of male patients, hence there is an important place for andrological services to be an integral part of ART centers. Andrologists would offer minimal andrological evaluation and condition‑specific treatment. This could avoid or reduce the need for invasive and expensive ART. Andrologists could also choose the most appropriate mode of sperm retrieval. Undoubtedly, availability of andrological services would improve the overall quality of care, reduce the costs and complications, and would also be medicolegally safe. [ABSTRACT FROM AUTHOR]

Objective: Glioblastoma Multiforme (GBM) is the most common CNS malignancy worldwide. There is few data regarding this entity in South Indian population. Our objective is to evaluate the demographic, clinicopathologic, treatment and survival characteristics of this entity. Materials and Method: A retrospective single centre study of 5 years (2013-2017) duration. Data of patients with tissue diagnosis of GBM, treated at Malabar Cancer Centre was studied. Results: A total of 30 cases of GBM are studied. Male predominance noted with mean age of presentation 54.5 years. 93% cases are primary GBM. The tumours are predominantly left sided (57%) with frontal lobe being the most commonly affected site. The most common histological type is GBM-NOS. Surgery is the primary treatment modality undergone by 97% of cases followed by adjuvant concurrent chemo radiation (83%). In a median follow up period of 26 months, 5 are alive without disease, 7 are alive with disease, 14 succumbed to disease, and 4 lost to follow up. The median Overall Survival (OS) is 17 months and the median Disease Free Survival is 12 months. All patients who survived beyond the median OS, where termed as Long Survivors (LS) and their characteristics were analysed. Conclusion: Multi-centric studies on demographic and survival features of GBM are of great importance in establishing Indian geographic epidemiology. Specific features of GBM with better survival warranties further studies aimed at molecular characterisation and targeted treatment protocols. [ABSTRACT FROM AUTHOR]

The article discusses the Thromboembolic events in brain tumour patients on bevacizumab. Topics include evaluated the role of genetic and non-genetic factors in causation of Venous thromboembolism (VTE); and Bevacizumab alone or in combination with chemotherapy has been approved by U.S Food and Drug Administration (FDA) in recurrent and progressive GBM seeing the improved outcomes.

OBJECTIVE This study aims to evaluate the effectiveness of Gamma Knife Radiosurgery (GKRS) in patients with two or more brain metastases. METHODS A retrospective analysis of 40 patients treated between 2002 and 2013 in one of the largest medical centers of India was performed. Patients were categorized into three categories according to RPA classification. The demographic and clinical characteristics of the patients, including age and gender, were extracted from case records. RESULTS The most common location was the frontal lobe. Breast cancer was the commonest source of metastases. The median survival of patients treated with GKRS for non-solitary brain metastases was four months. The median survival of RPA III category patients was three months, whereas it was four months in both the RPA category II and RPA category I patients. CONCLUSION The findings suggest that GKRS is a safe and effective option of palliative treatment in patients with non-solitary brain metastases. The neurocognitive morbidity associated with whole brain radiotherapy is negligible with Gamma Knife radiosurgery (GKRS). [ABSTRACT FROM AUTHOR]

Introduction: Paediatric brain tumours are the most common solid tumours in developing countries, leading to cancer related mortality in children globally. Enough data are available regarding the epidemiology of paediatric brain tumours in the western population. But limited data is available in India as only a few cases were reported. Aim: To evaluate the epidemiologic, clinicopathologic and histologic spectrum of paediatric brain and spinal cord tumours in a tertiary care referral centre of Southern India. Materials and Methods: This study was a retrospective, observational study which was undertaken at the Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. It's a 25 years study from January 1993 to December 2017. Data were collected regarding the frequencies of primary brain and spinal cord tumours (diagnosed according to World Health Organisation (WHO) classification) in total of 151 paediatric patients (comprised of all children <18 years of age) from medical records in the tertiary centre. Results: Over a period of 25 years, a total of 151 paediatric brain tumours were identified. Among these 4 were metastatic and the remaining 147 were primary. Primary tumours of brain origin were 112 and the remaining 35 were spinal cord tumours. The mean age for primary paediatric CNS tumours was 11.06 years with a slight male preponderance i.e., male: female ratio of 1.1:1. The most common brain tumour was Astrocytoma with 42 cases (37.5%) and among spinal cord, the most common tumour was Nerve sheath tumour with 13 cases (37.1%). Conclusion: Demographics in the present study are comparable with similar studies from various medical centres on this topic. It is used as a reliable profile to set priorities for rationing the limited resources and thereby aid in developing national data. Various studies like this from different cancer centres across India will help to prepare an epidemiological profile of overall Indian as well as regional Paediatric brain tumours. [ABSTRACT FROM AUTHOR]

Background: Pediatric brain tumours are the most common solid tumours in children and comprise approximately 20-25% of all pediatric malignancies worldwide. Aims: There is no data about the epidemiological profile of primary brain tumours in pediatric age group from the North-East India. The main aim of the study was to assess the epidemiological profile of pediatric brain tumours in children of the North-Eastern region of India and their patterns of care. Materials and Methods: In this analysis, data regarding age, sex, community, site of the tumour, clinical features, histology, geographical distribution and treatment delivered were collected from hospital cancer registry. Results: A total of 115 cases of pediatric primary brain tumours from age 0-18 years from 2012-2017 were identified and included in this study. According to this study, males (61.7%) slightly outnumbered females (38.3%) with a male: female ratio of 1.61:1 and incidence was most common in the 6-12 years age group. When divided according to anatomical site, primary brain tumours were found to be most common in cerebellum (44.35%) followed by cerebrum (36.26%). Infratentorial tumours (53%) were more than supratentorial tumours (47%). Histologically, the most common variety was found to be Medulloblastoma (34.8%) followed by Astocytomas (26.95%). Patients were mostly seen to belong to Middle Assam region (38.2%). Among the communities, Hindus (61.74%) were most commonly found to have primary pediatric brain tumours. Around 96% of the patients were offered to take radiotherapy out of which only 67% took radiotherapy, 2.6% defaulted treatment(drop outs) and 27% didn't turn up for treatment. 4.35% of the patients took other modalities of treatment. Conclusion: Multimodality management including surgery, radiotherapy and chemotherapy remains the cornerstone in the management of pediatric brain tumours. [ABSTRACT FROM AUTHOR]

Introduction: Pituitary adenomas are common intracranial neoplasms. In this study, we report the changes in clinical features and hormone profile in patients of pituitary adenoma following transsphenoidal surgery. Patients and methods: Thirty consecutive cases of pituitary adenoma diagnosed and operated at Bangur Institute of Neurosciences, West Bengal, India were followed up for clinical and hormonal profile resolution following trans-sphenoidal surgery between December 2010 and November 2012. The patient group included 14 female and 16 male patients and the mean age of patients was 35.86 years (range: 14-58 years). Results: Fifteen (50%) cases were nonfunctioning adenomas. Among the hormonally active pituitary adenoma, prolactin-producing adenomas were most common (66.67%), followed by growth hormone-producing adenomas (20%) and adrenocorticotrophic hormone-producing adenomas (13.33%). The most common symptom was headache and visual disturbances. Menstrual disturbances and galactorrhea were observed in six and two females respectively out of the 14 females in the study participants. Resolution of symptoms was reported by majority of our patients and hormonal derangement was corrected in 30% of our study subjects. Conclusion: We report 30 patients with pituitary adenoma who underwent surgery. Resolution of clinical symptoms and endocrine functions was observed in the majority of our patients. [ABSTRACT FROM AUTHOR]

Purpose: Pediatric glioblastoma (pGBM) tumors have been identified as an entity distinct and different from the adult variety of GBM not only with respect to pathogenesis, genetics, and molecular alterations but also in clinical outcomes and overall survival. This study aims to evaluate the immunohistochemical profile of molecular markers in pediatric GBM and correlate them with clinical features and prognosis. Materials and methods: We retrospectively analyzed 29 pGBMs (age range 3 to 18 years), operated at our institute between 2009 and 2014, and evaluated their clinical and histopathological features along with the immunohistochemical expression of clinically relevant molecular markers: H3K27M, p53, ATRX, and IDH1 (R132H), and correlated their expression with clinical features. We further assessed the prognostic value of these markers in our cohort of patients. Results: The median overall survival (OS) of the cohort was 6.00 ± 0.882 months. The mean overall survival was 7.571 ± 1.118 months which was lower than in most studies. Preoperative Karnofsky Performance Score (KPS), extent of surgical resection, and adjuvant radiotherapy were found to be the clinical factors strongly influencing median survival (p < 0.05). Loss of ATRX expression was predominantly noted in hemispheric tumors (84%), while p53 staining was maximum in thalamic tumors (8 out of 9 cases). H3K27M mutant protein expression was noted in 8/9 thalamic tumors and 5/7 tumors in the brain stem-cerebellar-peduncular region. Patients with tumors showing H3K27M immunopositivity had the worst prognosis with a mean OS of 5 months ± 0.832 months, as against patients with H3K27M-immunonegative tumors, which was 10.143 ± 1.866 months(p = 0.006). Other markers like p53, ATRX, and IDH1 did not influence the prognosis in this patient cohort. ATRX loss of expression was associated with a better OS, with a trend to significance, and such an association has not been reported earlier. Conclusions: Ours is one among the few studies from India describing the clinical parameters and evaluating the key immunohistochemical markers in pGBM and deriving their prognostic significance. The study reiterates the poor prognostic significance of H3K27M immunopositivity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Behavioral symptoms among postoperative patients with intracranial tumors and distress among caregivers are common. OBJECTIVES: This article aimed to assess the effectiveness of a brief nurse-led intervention on behavioral symptoms of postoperative patients with intracranial tumors and distress of their caregivers. METHODS: A randomized controlled trial was conducted on 80 patients with intracranial tumors and their family caregivers in a tertiary care institute in India. A brief nurse-led intervention was provided in the form of individual counseling, and a pamphlet was given to patients and caregivers in the experimental group at the time of discharge. Behavioral symptoms of patients and distress of caregivers were assessed. FINDINGS: Patients in the experimental group had significantly fewer behavioral symptoms and less severity of behavioral symptoms as compared to the control group. Caregivers in the experimental group had significantly less severity of distress as compared to the control group. [ABSTRACT FROM AUTHOR]

Background: Primary brain tumors (PBTs) are the most common solid childhood malignancies. However, epidemiologic profile of these tumors is scarce in developing nation like India. Objective of Study: The objective of this study was to study the demographic and histopathologic profile of pediatric patients with PBTs residing in Gujarat, and attending the Gujarat Cancer and Research Institute, Ahmedabad. Materials and Methods: Data regarding age, gender, anatomical site, and histopathology (according to the World Health Organization classification) of 242 patients with brain tumors (0–18 years) operated over 10 years (January 2006 to December 2015) were collected retrospectively, and analyzed. Results: Of total 242 patients with PBTs, 78.1% were from 5 to 14 years age group with the mean age being 9.38 ± 3.82 years (95% confidence interval). Brain tumors were more common in males (64.1%) as compared to females (35.9%) with a male‑to‑female ratio of 1.78:1. The most common anatomical site was cerebellum (46.3%), followed by cerebral hemispheres (14.1%). Infratentorial tumors (60.9%) were predominant than supratentorial tumors (39.1%) in 0–14 years age group while supratentorial tumors (58.3%) were predominant than infratentorial tumors (41.7%) in 15–18 years age group. Astrocytic tumors (38.9%) and embryonal tumors including medulloblastomas, supratentorial primitive neuroectodermal tumors, and atypical teratoid/rhabdoid teratomas (34.7%) were the most common histological subtypes comprising three‑quarters of all tumors. Ependymomas (16.1%) and craniopharyngiomas (5%) were third and fourth most common tumors, respectively. Among astrocytic tumors, 71.3% were of lower grade histology (Grade I and II). Conclusions: Astrocytomas and medulloblastomas, which form the major histologic subtypes in children residing in Gujarat, needs special attention with respect to the distribution of infrastructure and resources. Histopathological profiles of cohort in this study do not differ substantially from other hospital‑based and population‑based studies. [ABSTRACT FROM AUTHOR]

Context: Gliomas are the most common brain tumors. In addition to conventional magnetic resonance imaging (MRI) techniques, a variety of new techniques offers more than the anatomic information. The new MRI techniques include perfusion-weighted imaging (PWI) and diffusion-weighted imaging (DWI). Aims: The aim of this study is to assess the sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in the preoperative grading of gliomas. Setting/Design: The study was conducted in the Department of Neurosurgery, Pathology, and Radiodiagnosis, Sher-e-Kashmir Institute of Medical Sciences, Kashmir, India, which is the only tertiary care neurosurgical center in the state. It was a prospective study. Patients and Methods: Thirty-one consecutive patients with gliomas were included in the study. All the patients were evaluated by a standard conventional contrast-enhanced study on Siemens 1.5 Tesla MRI. In addition to the standard MRI, diffusion- and perfusion-weighted MRI were also performed. The histopathological grading of the tumor was done as per the WHO classification of 2007. The sensitivity, specificity, predictive value, and accuracy of diffusion- and perfusion-weighted MRI in determining tumor grade were calculated. Comparison was done between PWI, DWI findings, and WHO histopathological grading. Analysis Method: The statistical analysis was done using the Statistical Package for the Social Sciences, and receiver operating characteristic curves were used to estimate sensitivity, specificity, and accuracy. Results: The overall sensitivity of PWI (with regional cerebral blood volume cutoff of 1.7) in the preoperative assessment of high-grade gliomas was 82.6% and specificity was 75%, the positive predictive value (PPV) was 90.48%, and the negative predictive value (NPV) was 60%. The overall accuracy was 80.65%. In case of DWI, the sensitivity was 69.57% and the specificity was 75%, and the PPV and NPVs were 88.8% and 46.15%, respectively. The overall accuracy was 71%. Conclusion: Our results clearly show higher accuracy of diffusion- and perfusion-weighted MRI in assessment of glioma grade as compared to conventional MRI. This information can prove very useful for the operating neurosurgeon in preoperative assessment and surgical planning. Postoperatively, the neuropathologist can also benefit from such information. [ABSTRACT FROM AUTHOR]

Introduction: Recent advances in the molecular biology of adult diffuse gliomas have brought about a paradigm shift in their diagnostic criteria, as witnessed in the World Health Organization (WHO) 2016 guidelines for central nervous system tumors. It is now mandatory to perform several molecular tests to reach a definitive integrated diagnosis in most of the cases. This comes with additional cost and higher turnaround time, which is not always affordable in developing countries like India. In addition, the non-uniform distribution of advanced research and diagnostic testing centers adds to the difficulty.Methods: The Indian Society of Neuro-oncology (ISNO) multidisciplinary expert panel consisting of neuropathologists, neurosurgeons, and radiation/medical oncologists convened to prepare the national consensus guidelines for approach to diagnosis of adult diffuse gliomas.Results: Algorithms for arriving at an integrated diagnosis of adult diffuse gliomas predominantly using immunohistochemistry and with minimum possible additional molecular testing were agreed upon, thus addressing the problems of cost, accessibility, and turnaround time. Mandatory and optional tests were proposed for each case scenario.Conclusion: This document represents the consensus of the various neuro-oncology disciplines involved in diagnosis and management of patients with adult diffuse gliomas. The article reflects a practical adaptation of the WHO recommendations to suit a resource constrained setup. [ABSTRACT FROM AUTHOR]

Background: Treatment of childhood brain tumours requires coordinated efforts by multiple specialities - neurosurgery, neuroradiology, neuropathology, oncology, and radiotherapy. The outcome is worse in developing countries compared to developed countries because of deficiencies in proper registry, failure of timely diagnosis, lack of availability and co-ordination of multiple specialists required for comprehensive management and high abandonment rates. Method: The pediatric neuro-oncology program was initiated in collaboration with the neighbouring neurosurgery institution as a step towards improving care for pediatric brain tumor patients in our hospital. Epidemiology, treatment and follow- up of brain tumours in children aged 1-14 years attending the pediatric oncology department were studied. Patients received multimodality treatment with surgery, radiotherapy and chemotherapy by specialists in both centres. The study period was from January 2008 to December 2012. Results: There were 375 pediatric brain tumour patients during the study period. 166 patients (44.2%) had supratentorial tumors and 209 (55.73%) had infratentorial tumors. 42.6% of tumours were high-grade and 53.6% were low grade. The commonest histopathological tumour type was astrocytoma (48.8%) followed by medullobastoma (24.5%). 287 (76.5%) patients underwent surgery, 216 (57.6%) patients received radiotherapy, 97 (25.8%) patients received chemotherapy and 94 (25%) required follow-up only. Patient follow-up rates improved from 37.2% to 82.6% and treatment abandonment decreased from 35.8% to 14.8% over these years. Conclusions: Impact of the pediatric neuro-oncology program in our hospital has made it possible to provide comprehensive multidisciplinary treatment in a co-ordinated manner, describe the epidemiology of pediatric brain tumors, reduce treatment abandonment, and improve the follow-up of pediatric brain tumour patients. [ABSTRACT FROM AUTHOR]

Background: Atypical teratoid rhabdoid tumors (AT/RT) constitute a rare group of pediatric brain tumors.Aim: To study the clinical, histopathological, and immunohistochemical (IHC) profile, management and outcome of children with AT/RT of the central nervous system who presented between the years 2007 and 2015 in a regional tertiary care center in South India.Materials and Methods: This was a retrospective study. Demographic and clinical data were obtained from the clinical case files. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections. IHC was available in all the cases.Results: There were eight cases with the mean age of presentation being 4 years (range: 4 months to 15 years) and with slight male predominance (male:female = 1.66:1). Most of the presenting complaints were due to raised intra-cranial tension. The median duration of symptoms was 0.75 months. About 62.5% of the tumors were infratentorial in location. The tumors were heterogeneous showing variable expression of cytokeratin, epithelial membrane antigen, glial fibrillary acid protein, and synaptophysin. Loss of integrase interactor-1 expression was demonstrated in seven cases in which it was done. Multimodal treatment comprising surgical resection, radiotherapy and chemotherapy was tailored based on location of tumor, resectability and patient's age. The median overall survival was 2.5 months (range: 1.5-30 months).Conclusion: Awareness of this tumor is important as it portends a poor outcome in most patients, in spite of multi-modal treatment. Several new molecules which aim to prolong survival and improve quality of life are being developed to combat this enigmatic tumor. [ABSTRACT FROM AUTHOR]

Context: Tumors of the central nervous system (CNS) constitute the second most common pediatric cancers. Unlike leukemia, management of CNS tumors requires a good multidisciplinary team. Higher rates of treatment abandonment are documented in view of complexity of the treatment with long duration, involving neurosurgery, radiation, chemotherapy, and high cost of treatment. Morbidity associated with CNS tumors may be significant in terms of physical deficits as well as neuropsychological and neuroendocrine sequelae. Pediatric neurooncology is still at a very nascent stage in the developing countries. There are only a few reports on the multidisciplinary approach and outcomes of pediatric brain tumors in developing countries. Aims: The aim of this study is to identify the clinicopathological profile of Pediatric CNS tumors in a tertiary care center located in South India in comparison with reports from other low‑and middle‑income Countries. Settings and Design: A retrospective analysis of medical records of all children diagnosed with brain tumors from January 2012 to November 2016 at our institute was done. Subjects and Methods: A retrospective study of clinical, pathological profile, and outcomes of children <18 years diagnosed with brain tumors at our institute from January 2012 to November 2016 was done. Histopathological categorization was done as per the WHO classification 2007. The multidisciplinary treatment with respect to surgery, radiation, and chemotherapy was noted and the outcomes were recorded. Statistical Analysis Used: R for Statistical Computing (Version 3.0.2; 2013‑09‑25). Results: A total of 52 children were diagnosed with male preponderance of 66.6%. Highest incidence was noted in the age group of 0–4 years (50%). Majority of them were supratentorial (59.6%). CNS embryonal tumors contributed to 48% of all our brain tumors. 73% of them underwent either resection or biopsy. Eight (15.3%) of them died due to the progression of disease, but 44% abandoned treatment due to the progression/recurrence of disease. Those lost to follow‑up were mostly among the high‑risk groups with poor prognosis such as pontine glioma, medulloblastoma (high risk), and primitive neuroectodermal tumor. Conclusions: Although brain tumors constituted 30% of all our solid tumors, only 56% of them received appropriate treatment and 25% abandoned treatment. High rates of abandonment were a consequence of late diagnosis, complex multidisciplinary treatment involved, high treatment cost, lack of uniformity in management between different oncology centers and poor prognosis of the tumor subtype. [ABSTRACT FROM AUTHOR]