273 results on '"Torstein R. Meling"'
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2. Neurosurgical fellowship in Europe: It's time to cooperate – A call from the EANS Young Neurosurgeons' Committee
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Cesare Zoia, Giorgio Mantovani, Cristina Aldea, Jiri Bartek, Marlies Bauer, Diogo Belo, Evangelos Drosos, Stanislav Kaprovoy, Felix Stengel, Milan Lepic, Laura Lippa, Malte Mohme, Stefan Motov, Michael Schwake, Toma Spiriev, Fabio Torregrossa, Claudius Thomé, Torstein R. Meling, and Giovanni Raffa
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2024
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3. The Integration of 3D Virtual Reality and 3D Printing Technology as Innovative Approaches to Preoperative Planning in Neuro-Oncology
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Pablo González-López, Artem Kuptsov, Cristina Gómez-Revuelta, Jaime Fernández-Villa, Javier Abarca-Olivas, Roy T. Daniel, Torstein R. Meling, and Juan Nieto-Navarro
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surgical planning ,neuroanatomy ,virtual reality ,3D printing technology ,surgical simulation ,Medicine - Abstract
Our study explores the integration of three-dimensional (3D) virtual reality (VR) and 3D printing in neurosurgical preoperative planning. Traditionally, surgeons relied on two-dimensional (2D) imaging for complex neuroanatomy analyses, requiring significant mental visualization. Fortunately, nowadays advanced technology enables the creation of detailed 3D models from patient scans, utilizing different software. Afterwards, these models can be experienced through VR systems, offering comprehensive preoperative rehearsal opportunities. Additionally, 3D models can be 3D printed for hands-on training, therefore enhancing surgical preparedness. This technological integration transforms the paradigm of neurosurgical planning, ensuring safer procedures.
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- 2024
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4. Cavernous malformations of the central nervous system: An international consensus statement
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Anastasia Tasiou, Alexandros G. Brotis, Adamantios Kalogeras, Christos Tzerefos, Cargill H. Alleyne, Jr., Alexandros Andreou, Andreas K. Demetriades, Nikolaos Foroglou, Robert M. Friedlander, Bengt Karlsson, Neil Kitchen, Torstein R. Meling, Aristotelis Mitsos, Vasilios Panagiotopoulos, Themistoklis Papasilekas, Giacomo Pavesi, Lukas Rasulic, Alejandro N. Santos, Robert F. Spetzler, Ulrich Sure, Stavropoula Tjoumakaris, Christos M. Tolias, Peter Vajkoczy, and Kostas N. Fountas
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Cavernous malformation ,Consensus ,Deep-seated ,Developmental venous anomaly ,Stereotactic radiosurgery ,Surgery ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: Cavernous malformations (CM) of the central nervous system constitute rare vascular lesions. They are usually asymptomatic, which has allowed their management to become quite debatable. Even when they become symptomatic their optimal mode and timing of treatment remains controversial. Research question: A consensus may navigate neurosurgeons through the decision-making process of selecting the optimal treatment for asymptomatic and symptomatic CMs. Material and methods: A 17-item questionnaire was developed to address controversial issues in relation to aspects of the treatment, surgical planning, optimal surgical strategy for specific age groups, the role of stereotactic radiosurgery, as well as a follow-up pattern. Consequently, a three-stage Delphi process was ran through 19 invited experts with the goal of reaching a consensus. The agreement rate for reaching a consensus was set at 70%. Results: A consensus for surgical intervention was reached on the importance of the patient's age, symptomatology, and hemorrhagic recurrence; and the CM's location and size. The employment of advanced MRI techniques is considered of value for surgical planning. Observation for asymptomatic eloquent or deep-seated CMs represents the commonest practice among our panel. Surgical resection is considered when a deep-seated CM becomes symptomatic or after a second bleeding episode. Asymptomatic, image-proven hemorrhages constituted no indication for surgical resection for our panelists. Consensus was also reached on not resecting any developmental venous anomalies, and on resecting the associated hemosiderin rim only in epilepsy cases. Discussion and conclusion: Our Delphi consensus provides an expert common practice for specific controversial issues of CM patient management.
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- 2023
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5. President's address EANS2023
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Torstein R. Meling, MD, DPhil, FEBNS
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Neurology. Diseases of the nervous system ,RC346-429 - Published
- 2023
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6. Novel human melanoma brain metastasis models in athymic nude fox1nu mice: Site‐specific metastasis patterns reflecting their clinical origin
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Henrik A. Svendsen, Torstein R. Meling, Vigdis Nygaard, Stein Waagene, Hege Russnes, Siri Juell, Siril G. Rogne, Jens Pahnke, Eirik Helseth, Øystein Fodstad, and Gunhild M. Mælandsmo
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athymic nude fox1nu mice ,brain metastasis model ,human melanoma ,site specificity ,tissue‐specific metastasis ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Malignant melanomas frequently metastasize to the brain, but metastases in the cerebellum are underrepresented compared with metastases in the cerebrum. Methods We established animal models by injecting intracardially in athymic nude fox1nu mice two human melanoma cell lines, originating from a cerebral metastasis (HM19) and a cerebellar metastasis (HM86). Results Using magnetic resonance imaging (MRI), metastases were first detected after a mean of 34.5 days. Mean survival time was 59.6 days for the mice in the HM86 group and significantly shorter (43.7 days) for HM19‐injected animals (p
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- 2021
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7. Management of cavernous sinus meningiomas: Consensus statement on behalf of the EANS skull base section
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Marco V. Corniola, Pierre-Hugues Roche, Michaël Bruneau, Luigi M. Cavallo, Roy T. Daniel, Mahmoud Messerer, Sebastien Froelich, Paul A. Gardner, Fred Gentili, Takeshi Kawase, Dimitrios Paraskevopoulos, Jean Régis, Henry W.S. Schroeder, Theodore H. Schwartz, Marc Sindou, Jan F. Cornelius, Marcos Tatagiba, and Torstein R. Meling
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Neurosurgery ,Cavernous sinus ,Meningioma ,Microsurgery ,Gross total resection ,Cranial nerves ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: The evolution of cavernous sinus meningiomas (CSMs) might be unpredictable and the efficacy of their treatments is challenging due to their indolent evolution, variations and fluctuations of symptoms, heterogeneity of classifications and lack of randomized controlled trials. Here, a dedicated task force provides a consensus statement on the overall management of CSMs. Research question: To determine the best overall management of CSMs, depending on their clinical presentation, size, and evolution as well as patient characteristics. Material and methods: Using the PRISMA 2020 guidelines, we included literature from January 2000 to December 2020. A total of 400 abstracts and 77 titles were kept for full-paper screening. Results: The task force formulated 8 recommendations (Level C evidence). CSMs should be managed by a highly specialized multidisciplinary team. The initial evaluation of patients includes clinical, ophthalmological, endocrinological and radiological assessment. Treatment of CSM should involve experienced skull-base neurosurgeons or neuro-radiosurgeons, radiation oncologists, radiologists, ophthalmologists, and endocrinologists. Discussion and conclusion: Radiosurgery is preferred as first-line treatment in small, enclosed, pauci-symptomatic lesions/in elderly patients, while large CSMs not amenable to resection or WHO grade II-III are candidates for radiotherapy. Microsurgery is an option in aggressive/rapidly progressing lesions in young patients presenting with oculomotor/visual/endocrinological impairment. Whenever surgery is offered, open cranial approaches are the current standard. There is limited experience reported about endoscopic endonasal approach for CSMs and the main indication is decompression of the cavernous sinus to improve symptoms. Whenever surgery is indicated, the current trend is to offer decompression followed by radiosurgery.
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- 2022
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8. Relaxation time of brain tissue in the elderly assessed by synthetic MRI
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Martin Ndengera, Bénédicte M. A. Delattre, Max Scheffler, Karl‐Olof Lövblad, Torstein R. Meling, and Maria Isabel Vargas
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brain ,elderly ,MRI ,radiology ,relaxation times ,synthetic imaging ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Abstract Background Synthetic MRI (SyMRI) is a quantitative technique that allows measurements of T1 and T2 relaxation times (RTs). Brain RT evolution across lifespan is well described for the younger population. The aim was to study RTs of brain parenchyma in a healthy geriatric population in order to define the normal value of structures in this group population. Normal values for geriatric population could help find biomarker for age‐related brain disease. Materials and methods Fifty‐four normal‐functioning individuals (22 females, 32 males) with mean age of 83 years (range 56–98) underwent SyMRI. RT values in manually defined ROIs (centrum semiovale, middle cerebellar peduncles, thalamus, and insular cortex) and in segmented whole‐brain components (brain parenchyma, gray matter, white matter, myelin, CSF, and stromal structures) were extracted from the SyMRI segmentation software. Patients' results were combined into the group age. Main ROI‐based and whole‐brain results were compared for the all dataset and for age group results as well. Results For white matter, RTs between ROI‐based analyses and whole‐brain results for T2 and for T1 were statistically different and a trend of increasing T1 in centrum semiovale and cerebellar peduncle was observed. For gray matter, thalamic T1 was statistically different from insular T1. A difference was also found between left and right insula (p
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- 2022
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9. Update in Cushing disease: What the neurosurgeon has to KNOW, on behalf of the EANS skull base section
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Sayoa Eulate-Beramendi, Ainhoa Casajús, Lola Ollero, Lynnette K. Niemann, Juan Carlos Fernández-Miranda, Michaël Bruneau, Moncef Berhouma, Luigi Maria Cavallo, Jan Frederick Cornelius, Roy T. Daniel, Sebastien Froelich, Emmanuel Jouanneau, Ekkehard Kasper, Diego Mazzatenta, Torstein R. Meling, Mahmoud Messerer, Henry W.S. Schroeder, Marcos Tatagiba, Massimiliano Visocchi, Eduard H. Voormolen, and Idoya Zazpe
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Pituitary adenoma ,Transsphenoidal adenomectomy ,Hypercortisolism ,ACTH ,Cushing disease ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: Cushing's disease is a state of chronic and excessive cortisol levels caused by a pituitary adenoma Research question: CD is a complex entity and often entails difficulties in its diagnosis and management. For that reason, there are still controversial points to that respect. The aim of this consensus paper of the skull base section of the EANS is to review the main aspects of the disease a neurosurgeon has to know and also to offer updated recommendations on the controversial aspects of its management. Material and methods: PUBMED database was used to search the most pertinent articles published on the last 5 years related with the management of CD. A summary of literature evidence was proposed for discussion within the EANS skull base section and other international experts. Results: This article represents the consensual opinion of the task force regarding optimal management and surgical strategy in CD Discussion and conclusion: After discussion in the group several recommendations and suggestions were elaborated. Patients should be treated by an experienced multidisciplinary team. Accurate clinical, biochemical and radiological diagnosis is mandatory. The goal of treatment is the complete adenoma resection to achieve permanent remission. If this is not possible, the treatment aims to achieving eucortisolism. Radiation therapy is recommended to patients with CD when surgical options have been exhausted. All patients in remission should be tested all life-long.
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- 2022
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10. Posterior spine fusion in a Jehovah's Witness patient with severe rigid idiopathic scoliosis – A case report
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Michele Da Broi, Andrea Amarossi, Mauro Spina, Torstein R. Meling, and Massimo Balsano
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Idiopathic scoliosis ,Spine surgery ,Jehovah's Witness ,Posterior spine fusion ,Case report ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: Early onset scoliosis (EOS) represent a challenge for spine surgeons. The selection of the best treatment is complex. Some patients, such as Jehovah's Witnesses who refuse blood transfusions, are at high risk of complication when surgical treatment is required because blood loss is a major cause of morbidity and postoperative transfusion rates. Research question: Describe blood-saving techniques that allowed an extensive and invasive surgical procedure in a Jehovah's Witness patient. Material and method: 17-year-old Jehovah's Witness girl with severe 120° Cobb Lenke 1A idiopathic scoliosis started as EOS was prepared with 4 cycles of recombinant human erythropoietin, iron and folic acid supplementation that brought her hemoglobin level from 13.6 g/dl to 16.2 g/dl. In the first surgical time, a temporary rod was implanted. Spine dissection using bipolar sealer and a special electrocautery that operates at lower temperatures than traditional ones was performed. Facetectomies and multilevel Ponte osteotomies was performed using an ultrasonic bone scalpel. The second surgical time, the definitive rods were placed, and the correction of the deformity was achieved using the rod link reducer technique. Results: A good correction of the main curve in the coronal plane is achieve. The Hb nadir was 7.2 g/dl four days after the second operation. The postoperative course was uneventful. Discussion and conclusion: The integration of modern and traditional preoperative, intraoperative, and postoperative blood sparing techniques allowed us to perform an extensive and invasive surgical procedure in a Jehovah's Witness girl with a severe idiopathic scoliosis.
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- 2022
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11. Surgical management of giant pituitary neuroendocrine tumors: Meta-analysis and consensus statement on behalf of the EANS skull base section
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Giulia Cossu, Emmanuel Jouanneau, Luigi M. Cavallo, Sebastien Froelich, Daniele Starnoni, Lorenzo Giammattei, Ethan Harel, Diego Mazzatenta, Micheal Bruneau, Torstein R. Meling, Moncef Berhouma, Ari G. Chacko, Jan F. Cornelius, Dimitrios Paraskevopoulos, Henry W.S. Schroeder, Idoya Zazpe, Romain Manet, Paul A. Gardner, Henry Dufour, Paolo Cappabianca, Roy T. Daniel, and Mahmoud Messerer
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Giant pituitary adenoma ,Giant PitNET ,Surgery ,Endoscopy ,Transcranial approach ,Apoplexy ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Introduction: The optimal surgical treatment for giant pituitary neuroendocrine tumors(GPitNETs) is debated. Research question: The aim of this paper is to optimize the surgical management of these patients and to provide a consensus statement on behalf of the EANS Skull Base Section. Material and methods: We constituted a task force belonging to the EANS skull base committee to define some principles for the management of GPitNETs. A systematic review was performed according to PRISMA guidelines to perform a meta-analysis on surgical series of GPitNETs. Weighted summary rates were obtained for the pooled extent of resection and according to the surgical technique. These data were discussed to obtain recommendations after evaluation of the selected articles and discussion among the experts. Results: 20articles were included in our meta-analysis, for a total of 1263 patients. The endoscopic endonasal technique was used in 40.3% of cases, the microscopic endonasal approach in 34% of cases, transcranial approaches in 18.7% and combined approaches in 7% of cases. No difference in terms of gross total resection (GTR) rate was observed among the different techniques. Pooled GTR rate was 36.6%, while a near total resection (NTR) was possible in 45.2% of cases. Cavernous sinus invasion was associated with a lower GTR rate (OR: 0.061). After surgery, 35% of patients had endocrinological improvement and 75.6% had visual improvement. Recurrent tumors were reported in 10% of cases Discussion and conclusion: After formal discussion in the working group, we recommend the treatment of G-PitNETs tumors with a more complex and multilobular structure in tertiary care centers. The endoscopic endonasal approach is the first option of treatment and extended approaches should be planned according to extension, morphology and consistency of the lesion. Transcranial approaches play a role in selected cases, with a multicompartmental morphology, subarachnoid invasion and extension lateral to the internal carotid artery and in the management of residual tumor apoplexy.
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- 2022
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12. Improved prognostication of glioblastoma beyond molecular subtyping by transcriptional profiling of the tumor microenvironment
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Marine Jeanmougin, Annette B. Håvik, Lina Cekaite, Petter Brandal, Anita Sveen, Torstein R. Meling, Trude H. Ågesen, David Scheie, Sverre Heim, Ragnhild A. Lothe, and Guro E. Lind
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glioblastoma ,infiltration ,microenvironment ,stratification ,survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Glioblastoma (GBM), the most aggressive form of brain cancer, is characterized by a high level of molecular heterogeneity, and infiltration by various immune and stromal cell populations. Important advances have been made in deciphering the microenvironment of GBMs, but its association with existing molecular subtypes and its potential prognostic role remain elusive. We have investigated the abundance of infiltrating immune and stromal cells in silico, from gene expression profiles. Two cohorts, including in‐house normal brain and glioma samples (n = 70) and a large sample set from TCGA (n = 393), were combined into a single exploratory dataset. A third independent cohort (n = 124) was used for validation. Tumors were clustered based on their microenvironment infiltration profiles, and associations with known GBM molecular subtypes and patient outcome were tested a posteriori in a multivariable setting. We identified a subset of GBM samples with significantly higher abundances of most immune and stromal cell populations. This subset showed increased expression of both immune suppressor and immune effector genes compared to other GBMs and was enriched for the mesenchymal molecular subtype. Survival analyses suggested that tumor microenvironment infiltration pattern was an independent prognostic factor for GBM patients. Among all, patients with the mesenchymal subtype with low immune and stromal infiltration had the poorest survival. By combining molecular subtyping with gene expression measures of tumor infiltration, the present work contributes with improving prognostic models in GBM.
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- 2020
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13. Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis
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Sandrine Morel, Isabel C. Hostettler, Georg R. Spinner, Romain Bourcier, Joanna Pera, Torstein R. Meling, Varinder S. Alg, Henry Houlden, Mark K. Bakker, Femke van’t Hof, Gabriel J. E. Rinkel, Tatiana Foroud, Dongbing Lai, Charles J. Moomaw, Bradford B. Worrall, Jildaz Caroff, Pacôme Constant-dits-Beaufils, Matilde Karakachoff, Antoine Rimbert, Aymeric Rouchaud, Emilia I. Gaal-Paavola, Hanna Kaukovalta, Riku Kivisaari, Aki Laakso, Behnam Rezai Jahromi, Riikka Tulamo, Christoph M. Friedrich, Jerome Dauvillier, Sven Hirsch, Nathalie Isidor, Zolt Kulcsàr, Karl O. Lövblad, Olivier Martin, Paolo Machi, Vitor Mendes Pereira, Daniel Rüfenacht, Karl Schaller, Sabine Schilling, Agnieszka Slowik, Juha E. Jaaskelainen, Mikael von und zu Fraunberg, Jordi Jiménez-Conde, Elisa Cuadrado-Godia, Carolina Soriano-Tárraga, Iona Y. Millwood, Robin G. Walters, The ICAN Study Group, Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study Investigators, International Stroke Genetics Consortium (ISGC), Helen Kim, Richard Redon, Nerissa U. Ko, Guy A. Rouleau, Antti Lindgren, Mika Niemelä, Hubert Desal, Daniel Woo, Joseph P. Broderick, David J. Werring, Ynte M. Ruigrok, and Philippe Bijlenga
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intracranial aneurysm ,subarachnoid hemorrhage ,risk factors ,location ,smoking ,hypertension ,Medicine - Abstract
Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.
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- 2022
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14. Management of Recurrent Meningiomas: State of the Art and Perspectives
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Marco Vincenzo Corniola and Torstein R. Meling
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meningioma ,recurrence ,overall survival ,progression-free survival ,retreatment ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: While meningiomas often recur over time, the natural history of repeated recurrences and their management are not well described. Should recurrence occur, repeat surgery and/or use of adjuvant therapeutic options may be necessary. Here, we summarize current practice when it comes to meningioma recurrence after initial surgical management. Methods: A total of N = 89 articles were screened. N = 41 articles met the inclusion criteria and N = 16 articles failed to assess management of meningioma recurrence. Finally, N = 24 articles were included in our review. Results: The articles were distributed as follows: studies on chemotherapy (N = 14), radiotherapy, protontherapy, and stereotaxic radiosurgery (N = 6), boron-neutron capture therapy (N = 2) and surgery (N = 3). No study seems to provide serious alternatives to surgery in terms of progression-free and overall survival. Recurrence can occur long after the initial surgery and also affects WHO grade 1 meningiomas, even after initial gross total resection at first surgery, emphasizing the need for a long-term and comprehensive follow-up. Conclusions: Surgery still seems to be the state-of-the-art management when it comes to meningioma recurrence, since none of the non-surgical alternatives show promising results in terms of progression-free and overall survival.
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- 2022
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15. The Role of Adjuvant Treatment in Craniofacial Malignancy: A Critical Review
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Marton König, Terje Osnes, Øyvind Bruland, Kirsten Sundby Hall, Åse Bratland, and Torstein R. Meling
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skull base malignancies ,adjuvant therapies ,sinonasal cancer ,olfactory ,neuroblastoma ,mucosal melanoma ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Tumors originating from the craniofacial region usually present in a locally advanced stage with frequent involvement of adjacent sites and have a strong tendency for local recurrence in the absence of adjuvant therapy, even when the original surgical resection was presumed to be radical. In the past decades, several advances in the radiological diagnosis and treatment of craniofacial malignancies have been introduced. There are, however, no randomized trials that define the optimal multimodal treatment of these tumors because of their rarity as well as heterogeneity in both histology and site of origin. The aim of this study was to conduct a critical review of the role of adjuvant therapy in the treatment of craniofacial malignancy.Method: We conducted a critical review of the past and contemporary literature available, focusing on adjuvant oncological treatments of the most common craniofacial malignancies.Results: Preoperative radiotherapy can have a documented role in the treatment of olfactory neuroblastoma and soft tissue sarcoma, while preoperative chemotherapy can be advocated in the treatment of sinonasal undifferentiated carcinoma, neuroendocrine carcinoma, olfactory neuroblastoma, and craniofacial sarcoma (both soft-tissue and high-grade osteosarcoma). Postoperative radiotherapy has a well-established role in the treatment of most craniofacial malignancies. The role of postoperative chemotherapy is unclear in most histologies, but is commonly used during the treatment of well-selected cases of paranasal sinus carcinoma, olfactory neuroblastoma, mucosal melanoma, soft tissue sarcoma and high-grade craniofacial osteosarcoma.Discussion: Alongside developments in surgery, there have also been improvements in diagnostics, radiotherapy, and chemotherapy. Implementation of novel radiation techniques allows delivery of higher radiation doses while minimizing irradiation-related morbidity. Better understanding of tumor biology allows the construction of more complex treatment strategies, incorporating adjuvant chemotherapy either pre- or postoperatively. In the era of personalized targeted therapy, rapid strides are being made to identify specific tumor-targets for use of novel biologic agents, with the potential to change current management paradigms.
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- 2020
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16. Preservation of Interference Effects in Working Memory After Orbitofrontal Damage
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Anaïs Llorens, Ingrid Funderud, Alejandro O. Blenkmann, James Lubell, Maja Foldal, Sabine Leske, Rene Huster, Torstein R. Meling, Robert T. Knight, Anne-Kristin Solbakk, and Tor Endestad
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orbitofrontal cortex ,recent probes task ,working memory ,recency ,event-related potentials ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Orbitofrontal cortex (OFC) is implicated in multiple cognitive processes, including inhibitory control, context memory, recency judgment, and choice behavior. Despite an emerging understanding of the role of OFC in memory and executive control, its necessity for core working memory (WM) operations remains undefined. Here, we assessed the impact of OFC damage on interference effects in WM using a Recent Probes task based on the Sternberg item-recognition task (1966). Subjects were asked to memorize a set of letters and then indicate whether a probe letter was presented in a particular set. Four conditions were created according to the forthcoming response (“yes”/“no”) and the recency of the probe (presented in the previous trial set or not). We compared behavioral and electroencephalography (EEG) responses between healthy subjects (n = 14) and patients with bilateral OFC damage (n = 14). Both groups had the same recency pattern of slower reaction time (RT) when the probe was presented in the previous trial but not in the current one, reflecting the proactive interference (PI). The within-group electrophysiological results showed no condition difference during letter encoding and maintenance. In contrast, event-related potentials (ERPs) to probes showed distinct within-group condition effects, and condition by group effects. The response and recency effects for controls occurred within the same time window (300–500 ms after probe onset) and were observed in two distinct spatial groups including right centro-posterior and left frontal electrodes. Both clusters showed ERP differences elicited by the response effect, and one cluster was also sensitive to the recency manipulation. Condition differences for the OFC group involved two different clusters, encompassing only left hemisphere electrodes and occurring during two consecutive time windows (345–463 ms and 565–710 ms). Both clusters were sensitive to the response effect, but no recency effect was found despite the behavioral recency effect. Although the groups had different electrophysiological responses, the maintenance of letters in WM, the evaluation of the context of the probe, and the decision to accept or reject a probed letter were preserved in OFC patients. The results suggest that neural reorganization may contribute to intact recency judgment and response after OFC damage.
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- 2020
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17. From Focused Ultrasound Tumor Ablation to Brain Blood Barrier Opening for High Grade Glioma: A Systematic Review
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Luca Paun, Alessandro Moiraghi, Gianpaolo Jannelli, Aria Nouri, Francesco DiMeco, Johan Pallud, Torstein R. Meling, Shahan Momjian, Karl Schaller, Francesco Prada, and Denis Migliorini
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focused ultrasound ,high grade glioma ,glioblastoma ,brain-blood barrier opening ,tumor ablation ,ultrasound ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Focused Ultrasound (FUS) is gaining a therapeutic role in neuro-oncology considering its novelty and non-invasiveness. Multiple pre-clinical studies show the efficacy of FUS mediated ablation and Blood-Brain Barrier (BBB) opening in high-grade glioma (HGG), but there is still poor evidence in humans, mainly aimed towards assessing FUS safety. Methods: With this systematic review our aim is, firstly, to summarize how FUS is proposed for human HGG treatment. Secondly, we focus on future perspectives and new therapeutic options. Using PRISMA 2020 guidelines, we reviewed case series and trials with description of patient characteristics, pre- and post-operative treatments and FUS outcomes. We considered nine case series (five about tumor ablation and four about BBB opening) with FUS-treated HGG patients between 1991 and 2021. Results: Sixty-eight patients were considered in total, mostly males (67.6%), with a mean age of 50.5 ± 15.3 years old. Major complication rates were found in the tumor ablation group (26.1%). FUS has been rarely applied for direct tumoral ablation in human HGG patients with controversial results, but at the best of current studies, FUS-mediated BBB opening is showing good results with very low complication rates, paving the way for a new reliable technique to improve local chemotherapy delivery and antitumoral immune response. Conclusions: FUS can become a complementary technique to surgical resection and standard radiochemotherapy in recurrent HGG. Ongoing trials could provide in the near future more data on FUS-mediated BBB opening impact on progression-free survival, overall survival and potential drug-delivery capacities.
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- 2021
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18. Neuropsychological Outcomes after Surgery for Olfactory Groove Meningiomas
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Paul E. Constanthin, Renato Gondar, Julia Fellrath, Isaline Mottet Wyttenbach, Karima Tizi, Leo Weman, Pia Vayssière, Karl Schaller, and Torstein R. Meling
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surgery ,neurosurgery ,cognition ,outcome ,meningioma ,neuropsychology ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: In recent years, several studies have reported abnormal pre- and postoperative neuropsychological functioning in patients with meningiomas located in the prefrontal cortex (notably the ventromedial region). In the case of olfactory groove meningiomas, the tumor is in direct contact with the inferior aspect of the prefrontal cortex, a cortical region with crucial roles in decision-making, cognition and memory functions, potentially negatively impacting neuropsychological functions. Materials and Methods: We retrospectively compared pre- and post-operative neuropsychological testing of 17 patients undergoing surgical removal of olfactory groove meningiomas in our institution between January 2013 and December 2018. Neuropsychological results were obtained from the patients’ medical history and normalized as z-scores of their respective cognitive functions. Results: Assessment of cognitive follow-up showed an important heterogeneity among patients. Pre-operative cognitive impairment was observed in most patients, particularly in cognitive flexibility (mean z-score: −1.35). Immediate post-operative cognitive status showed an overall impairment in all domains of cognition, significant for the domains of attention (p = 0.0273) and flexibility (p = 0.0234) and almost significant for the domain of language (p = 0.0547). The late follow-up at one year showed a trend towards general improvement, although attention and flexibility remained impaired. Discussion: Olfactory groove meningiomas impact pre-frontal cortex cognitive functions, particularly in the domain of cognitive flexibility. After an initial postoperative worsening, patients tended to improve in most aspects after one year, aside from cognitive flexibility and attention.
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- 2021
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19. Meningiomas and Cognitive Impairment after Treatment: A Systematic and Narrative Review
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Renato Gondar, Gildas Patet, Karl Schaller, and Torstein R. Meling
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meningioma ,cognition ,neuropsychology ,language ,memory ,attention ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Clinical outcomes after surgery for intracranial meningiomas might be overvalued as cognitive dimensions and quality of life are probably underreported. This review aims to summarize the current state of cognitive screening and treatment-related outcomes after meningioma surgery. We present a systematic review (Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) 2015-based) of cognitive outcomes after intracranial meningioma surgery. A total of 1572 patients (range 9–261) with a mean age of 58.4 years (range 23–87), and predominantly female (n = 1084, 68.9%) were identified. Mean follow-up time after treatment was 0.86 ± 0.3 years. Neuropsychological assessment was very heterogeneous, but five dimensions of cognition were described: memory (19/22); attention (18/22); executive functions (17/22); language (11/22); flexibility (11/22 studies). Cognitive abilities were impaired in 18 studies (81.8%), but only 1 showed deterioration in all dimensions simultaneously. Memory was the most affected. with significant post-therapy impairment in 9 studies (40.9%). Postoperatively, only 4 studies (18.2%) showed improvement in at least one dimension. Meningioma patients had significantly lower cognitive scores when compared to healthy subjects. Surgery and radiotherapy for meningiomas were associated with cognitive impairment, probably followed by a partial recovery. Cognition is poorly defined, and the assessment tools employed lack standardization. Cognitive impairment is probably underreported in meningioma patients.
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- 2021
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20. Predictors of Survival in Atypical Meningiomas
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Michele Da Broi, Paola Borrelli, and Torstein R. Meling
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intracranial tumor ,atypical meningioma ,neurosurgery ,retreatment-free survival ,recurrence rate ,gross total resection ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: Predictors of survival and progression of disease in atypical meningiomas are less well documented in the literature compared to benign meningiomas. Higher grade meningiomas tend to recur often and one of the most critical aspects is how to best deal with relapses. Methods: A total of 77 consecutive patients who underwent craniotomy for atypical meningioma between 1990–2010 at Oslo University Hospital (OUH) were reviewed. Results: Median age at surgery was 62.21 [interquartile range (IQR): 22.87] years. Fifty-one patients (66.2%) had neurological deficits at presentation. Fifty-four patients (70.1%) underwent gross total resection (GTR). Thirty-nine patients (50.7%) had improved/stable neurological outcomes at 6–12 months. Twenty-two patients (28.6%) underwent retreatment, of whom 20 (26.0%) were subjected to resection followed by adjuvant radiotherapy. Overall survival (OS) was significantly longer in patients p < 0.001), with preoperative Karnofsky performance scale (KPS) score of ≥ 70 (p = 0.006), and who required no retreatment (p = 0.033). GTR significantly prolonged the retreatment-free survival rate (p < 0.001). STR carried almost a six-fold greater risk of neurological outcome deterioration (p = 0.044). Conclusions: GTR significantly prolonged retreatment-free survival but had no significant impact on OS. STR was a significant risk factor for deteriorated neurological outcome. Age, preoperative KPS, and retreatment were all strong predictors of OS. Median time-to-retreatment (TTR) did not shorten significantly throughout repeated surgeries.
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- 2021
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21. Predictors of Survival in Subtotally Resected WHO Grade I Skull Base Meningiomas
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Michele Da Broi, Paola Borrelli, and Torstein R. Meling
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surgery ,neurosurgery ,brain tumor ,intracranial tumor ,meningioma ,overall survival ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Although gross total resection (GTR) is the goal in meningioma surgery, this can sometimes be difficult to achieve in skull base meningiomas. We analyzed clinical outcomes and predictors of survival for subtotally resected benign meningiomas. Methods: A total of 212 consecutive patients who underwent subtotal resection (STR) for benign skull base meningioma between 1990–2010 were investigated. Results: Median age was 57.7 [IQR 18.8] years, median preoperative Karnofsky performance status (KPS) was 80.0 [IQR 20.0], 75 patients (35.4%) had posterior fossa meningioma. After a median follow-up of 6.2 [IQR 7.9] years, retreatment (either radiotherapy or repeated surgery) rate was 16% at 1-year, 27% at 3-years, 34% at 5-years, and 38% at 10-years. Ten patients (4.7%) died perioperatively, 9 (3.5%) had postoperative hematomas, and 2 (0.8%) had postoperative infections. Neurological outcome at final visit was improved/stable in 122 patients (70%). Multivariable analysis identified advanced age and preoperative KPS < 70 as negative predictors for overall survival (OS). Patients who underwent retreatment had no significant reduction of OS. Conclusions: Advanced age and preoperative KPS were independent predictors of OS. Retreatments did not prolong nor shorten the OS. Clinical outcomes in STR skull base meningiomas were generally worse compared to cohorts with high rates of GTR.
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- 2021
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22. A 34-Year-Old Woman with Brainstem Cavernous Malformation: The Anterior Transcallosal Transchoroidal Approach and Literature Review
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Sayied Abdol Mohieb Hosainey and Torstein R. Meling
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cavernous malformation ,brainstem cavernoma ,surgical approach ,transcallosal transchoroidal approach ,surgical complications ,brainstem hemorrhage ,Surgery ,RD1-811 ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Mesencephalic cavernous malformations (MeCMs) account for 4 to 35% of the cavernous malformations of the central nervous system and are generally rare. Surgical resection of brainstem cavernomas are high-risk procedures and can be challenging to the neurosurgeon. Several approaches have been described, but the approach must allow for a straight line of sight in which the surgeon, the pial incision, and the MeCM are all collinear. This alignment provides the best view of the lesion while minimizing the need for brainstem retraction. The pial incision should be chosen to minimize the distance to the lesion while avoiding critical nuclei and tracts. In this case report, we present a 34-year-old woman with a MeCM resected by an anterior transcallosal transchoroidal approach with minimal damage to surrounding brain tissue. Although rarely used, it should be considered a valuable alternative to ventrally located brainstem cavernomas.
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- 2014
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23. Evaluation of the precision of navigation-assisted endoscopy according to the navigation tool setup and the type of endoscopes
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Lara Chavaz, Alioucha Davidovic, Torstein R. Meling, Shahan Momjian, Karl Schaller, Philippe Bijlenga, and Julien Haemmerli
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Endoscopes ,Humans ,Endoscopy ,Surgery ,Neurology (clinical) ,Neuronavigation - Abstract
Object Preoperative image-based neuronavigation-assisted endoscopy during intracranial procedures is gaining great interest. This study aimed to analyze the precision of navigation-assisted endoscopy according to the navigation setup, the type of optic and its working angulation. Methods A custom-made box with four screws was referenced. The navigation-assisted endoscope was aligned on the screws (targets). The precision on the navigation screen was defined as the virtual distance-to-target between the tip of the endoscope and the center of the screws. Three modifiers were assessed: (1) the distance D between the box and the reference array (CLOSE 13 cm – MIDDLE 30 cm – FAR 53 cm), (2) the distance between the tip of the endoscope and the navigation array on the endoscope (close 5 cm – middle 10 cm – far 20 cm), (3) the working angulation of the endoscope (0°-endoscope and 30°-endoscope angled at 90° and 45° with the box). Results The median precision was 1.3 mm (Q1: 1.1; Q3: 1.7) with the best setting CLOSE/close. The best setting in surgical condition (CLOSE/far) showed a distance-to-target of 2.3 mm (Q1: 1.9; Q3: 2.5). The distance D was correlated to the precision (Spearman rho = 0.82), but not the distance d (Spearman rho = 0.04). The type of optic and its angulation with the box were also correlated to the precision (Spearman rho = − 0.37). The best setting was the use of a 30°-endoscope angled at 45° (1.4 mm (Q1: 1.0; Q3: 1.9)). Conclusion Navigated-assisted endoscopy is feasible and offers a good precision. The navigation setup should be optimized, reducing the risk of inadvertent perifocal damage.
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- 2022
24. Altered hierarchical auditory predictive processing after lesions to the orbitofrontal cortex
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Olgerta Asko, Alejandro O. Blenkmann, Sabine L. Leske, Maja Dyhre Foldal, Anaïs Llorens, Ingrid Funderud, Torstein R. Meling, Robert T. Knight, Tor Endestad, and Anne-Kristin Solbakk
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Orbitofrontal cortex (OFC) is classically linked to inhibitory control, emotion regulation and reward processing. Recent perspectives propose that the OFC also generates predictions about perceptual events, actions, and their outcomes. We tested the causal involvement of the OFC in detecting violations of prediction at two levels of abstraction (i.e., hierarchical predictive processing) by studying the event-related potentials (ERPs) of patients with focal OFC lesions (n = 12) and healthy controls (n = 14) while they detected deviant sequences of tones in a Local-Global paradigm. The structural regularities of the tones were controlled at two hierarchical levels by rules defined at a local (i.e.,between tones within sequences)and at a global (i.e.,between sequences) level. In OFC patients, ERPs elicited by standard tones were unaffected at both local and global levels compared to controls. However, patients showed an attenuated mismatch negativity (MMN) to local prediction violation, as well as a diminished and delayed MMN/P3a complex to the combined local and global level prediction violation. The subsequent P3b component to conditions involving violations of prediction at the level of global rules was preserved in the OFC group. Comparable effects were absent in patients with lesions restricted to the lateral PFC, which lends a degree of anatomical specificity to the altered predictive processing resulting from OFC lesion. Overall, the altered magnitudes and time courses of MMN/P3a responses after lesions to the OFC indicate fundamental impairments in detecting violation of auditory regularity at two hierarchical levels of stimuli abstraction.HighlightsOrbitofrontal lesions reduce auditory MMN (i.e., prediction error) to unpredicted stimuli at the local level.Orbitofrontal lesions reduce local and global level auditory deviance (i.e., prediction error) response, as manifested by diminished and delayed MMN and P3a.
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- 2023
25. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section Part III: Lower cranial nerve schwannomas, jugular foramen (CN IX, X, XI) and hypoglossal schwannoma (XII)
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Moncef Berhouma, Dimitrios Paraskevopoulos, Henry W. S. Schroeder, Idoya Zazpe, Pierre-Hugues Roche, Torstein R. Meling, Mahmoud Messerer, Roy Thomas Daniel, Sébastien Froelich, Marcos Tatagiba, Jan Frederick Cornelius, Michaël Bruneau, Emmanuel Jouanneau, Luigi Maria Cavallo, Jarnail Bal, Surgical clinical sciences, Neuroprotection & Neuromodulation, and Neurosurgery
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Adult ,Skull Base ,medicine.medical_specialty ,Hypoglossal Schwannoma ,business.industry ,medicine.medical_treatment ,General surgery ,Cranial Nerves ,Radiosurgery ,Part iii ,Skull ,medicine.anatomical_structure ,Jugular Foramen Schwannoma ,Jugular Foramina ,otorhinolaryngologic diseases ,medicine ,Humans ,Cranial Nerve Neoplasms ,Surgery ,Neurology (clinical) ,Neurosurgery ,business ,Neurilemmoma ,Jugular foramen ,Neuroradiology - Abstract
BACKGROUND: Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogenous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS: A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the third of a three-part series describing non-vestibular schwannomas (IX, X, XI, XII). RESULTS: A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to preoperative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management. CONCLUSION: This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management paradigm is shifting towards the compromise between function preservation and progression free survival.
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- 2021
26. Novel human melanoma brain metastasis models in athymic nude fox1 nu mice: Site‐specific metastasis patterns reflecting their clinical origin
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Vigdis Nygaard, Jens Pahnke, Siril G. Rogne, Stein Waagene, Gunhild Mari Mælandsmo, Torstein R. Meling, Øystein Fodstad, Siri Juell, Eirik Helseth, Hege G. Russnes, and Henrik A Svendsen
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Cancer Research ,Cerebellum ,Pathology ,medicine.medical_specialty ,site specificity ,Metastasis ,030207 dermatology & venereal diseases ,03 medical and health sciences ,brain metastasis model ,0302 clinical medicine ,medicine ,Human melanoma ,Radiology, Nuclear Medicine and imaging ,neoplasms ,RC254-282 ,tissue‐specific metastasis ,Athymic nude fox1nu mice ,medicine.diagnostic_test ,business.industry ,Cerebrum ,Melanoma ,Site specificity ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Magnetic resonance imaging ,Brain metastasis model ,medicine.disease ,nervous system diseases ,ddc:616.8 ,3. Good health ,athymic nude fox1nu mice ,medicine.anatomical_structure ,nervous system ,Oncology ,Cell culture ,030220 oncology & carcinogenesis ,Tissue- specific metastasis ,business ,human melanoma ,Brain metastasis - Abstract
Background: Malignant melanomas frequently metastasize to the brain, but metastases in the cerebellum are underrepresented compared with metastases in the cerebrum. Methods: We established animal models by injecting intracardially in athymic nude fox1nu mice two human melanoma cell lines, originating from a cerebral metastasis (HM19) and a cerebellar metastasis (HM86). Results: Using magnetic resonance imaging (MRI), metastases were first detected after a mean of 34.5 days. Mean survival time was 59.6 days for the mice in the HM86 group and significantly shorter (43.7 days) for HM19-injected animals (p < 0.001). In the HM86 group, the first detectable metastasis was located in the cerebellum in 15/55 (29%) mice compared with none in the HM19 group (p < 0.001). At sacrifice, cerebellar metastases were found in 34/55 (63%) HM86- injected mice compared with 1/53 (2%) in the HM19-injected (p < 0.001) mice. At that time, all mice in both groups had detectable metastases in the cerebrum. Comparing macroscopic and histologic appearances of the brain metastases with their clinical counterparts, the cell line-based tumors had kept their original morphologic characteristics. Conclusions: The present work demonstrates that human brain-metastatic melanoma cells injected intracardially in mice had retained inherent characteristics also in reproducing interaction with subtle microenvironmental brain tissue compartment-specific features. The models offer new possibilities for investigating tumor- and host-associated factors involved in determining tissue specificity of brain metastasis.
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- 2021
27. The 'STARS-CASCADE' Study: Virtual Reality Simulation as a New Training Approach in Vascular Neurosurgery
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Enrico Gambatesa, Paolo Ferroli, Chiara Caggiano, Torstein R. Meling, Andrea Saladino, Claudia Fanizzi, Luca Mattei, Francesco Prada, Chiara Benedetta Rui, Roberta Ayadi, Alessandro Perin, Francois Yves Legninda Sop, Francesco Acerbi, Francesco DiMeco, Giovanni Carone, and Tommaso Francesco Galbiati
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Adult ,Male ,Models, Anatomic ,3d planning ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Decision-Making ,education ,Neurosurgery ,Virtual reality ,3d simulation ,Subspecialty ,Neurosurgical Procedures ,Vascular neurosurgery ,User-Computer Interface ,Aneurysm ,Surveys and Questionnaires ,medicine ,Training ,Humans ,Medical physics ,cardiovascular diseases ,Postoperative Period ,Surgical Theater ,Simulation Training ,Aged ,business.industry ,Debriefing ,Virtual Reality ,Internship and Residency ,Intracranial Aneurysm ,Clipping (medicine) ,Middle Aged ,medicine.disease ,ddc:616.8 ,surgical procedures, operative ,Neurosurgeons ,cardiovascular system ,Rehearsal ,Female ,Surgery ,Clinical Competence ,Neurology (clinical) ,business ,Vascular Surgical Procedures ,Simulation - Abstract
Objective Surgical clipping has become a relatively rare procedure in comparison to endovascular exclusion of cerebral aneurysms. Consequently, there is a declining number of cases where young neurosurgeons can practice clipping. For this reason, we investigated the application of a new 3-dimensional (3D) simulation and rehearsal device, Surgical Theater, in vascular neurosurgery. Methods We analyzed data of 20 patients who underwent surgical aneurysm clipping. In 10 cases, Surgical Theater was used to perform the preoperative 3D planning (CASCADE group), while traditional imaging was used in the other cases (control group). Preoperative 3D simulation was performed by 4 expert and 3 junior neurosurgeons (1 fellow, 2 residents). During postoperative debriefings, expert surgeons explained the different aspects of the operation to their younger colleagues in an interactive way using the simulator. Questionnaires were given to the surgeons to get qualitative feedback about the simulator, and the junior surgeons' performance at simulator was also analyzed. Results There were no differences in surgery outcomes, complications, and surgical duration (P > 0.05) between the 2 groups. Senior neurosurgeons performed similarly when operating at the simulator as compared with in the operating room, while junior neurosurgeons improved their performance at the simulator after the debriefing session (P Conclusions Surgical Theater proved to be realistic in replicating vascular neurosurgery scenarios for rehearsal and simulation purposes. Moreover, it was shown to be useful for didactic purposes, allowing young neurosurgeons to take full advantage and learn from senior colleagues to become familiar with this demanding neurosurgical subspecialty.
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- 2021
28. Early Extubation After Elective Infratentorial Craniotomy: Results of the International PRICE Survey
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John G. Gaudet, Camille S. Levy, Lien Jakus, Nicolai Goettel, Torstein R. Meling, and Hervé Quintard
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Anesthesiology and Pain Medicine ,Surgery ,Neurology (clinical) - Published
- 2022
29. How I do it: the trans-laminar, facet-joint sparing minimal invasive approach for ventral dural repair in spontaneous intracranial hypotension—a 2-dimensional operative video
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Torstein R. Meling and Marco Vincenzo Corniola
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musculoskeletal diseases ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Microsurgery ,Neurology ,medicine.medical_treatment ,Intracranial Hypotension ,Zygapophyseal Joint ,Facet joint ,Subdural hematoma ,Minimally invasive surgery ,medicine ,otorhinolaryngologic diseases ,Spontaneous Intracranial Hypotension ,Humans ,Neuroradiology ,medicine.diagnostic_test ,business.industry ,Spontaneous idiopathic hypotension ,Interventional radiology ,musculoskeletal system ,How I Do it - Spine - Other ,humanities ,Spine ,Surgery ,ddc:616.8 ,medicine.anatomical_structure ,Neurology (clinical) ,Neurosurgery ,Dura Mater ,business - Abstract
Background We describe the minimally invasive, facet-sparing postero-lateral approach to the thoracic spine for a ventral dural repair in a patient with intracranial hypotension secondary to a spontaneous dural breach. Methods We performed a minimally invasive approach using a short paramedian posterior skin incision followed by a 10 × 10 mm targeted trans-laminar approach, to achieve a microsurgical repair of a symptomatic ventral dural defect causing severe disability. Conclusion The facet-sparing postero-lateral approach is safe and effective in the surgical management of thoracic dural tears, even in the most anterior ones, and avoids the traditional costotransversectomy.
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- 2021
30. Natural history and treatment options of radiation-induced brain cavernomas: a systematic review
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Gildas Patet, Torstein R. Meling, and Andrea Bartoli
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medicine.medical_specialty ,Pediatrics ,business.industry ,Incidence (epidemiology) ,General Medicine ,Cochrane Library ,Cavernous malformations ,medicine.disease ,Asymptomatic ,Natural history ,03 medical and health sciences ,0302 clinical medicine ,Systematic review ,030220 oncology & carcinogenesis ,medicine ,Surgery ,Neurology (clinical) ,Neurosurgery ,medicine.symptom ,Complication ,business ,030217 neurology & neurosurgery - Abstract
Radiation-induced cavernous malformations (RICMs) are delayed complications of brain irradiation during childhood. Its natural history is largely unknown and its incidence may be underestimated as RCIMS tend to develop several years following radiation. No clear consensus exists regarding the long-term follow-up or treatment. A systematic review of Embase, Cochrane Library, PubMed, Google Scholar, and Web of Science databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Based on our inclusion/exclusion criteria, 12 articles were included, totaling 113 children with RICMs, 86 were treated conservatively, and 27 with microsurgery. We were unable to precisely define the incidence and natural history from this data. The mean age at radiation treatment was 7.3 years, with a slight male predominance (54%) and an average dose of 50.0 Gy. The mean time to detection of RICM was 9.2 years after radiation. RICM often developed at distance from the primary lesion, more specifically frontal (35%) and temporal lobe (34%). On average, 2.6 RICMs were discovered per child. Sixty-seven percent were asymptomatic. Twenty-one percent presented signs of hemorrhage. Clinical outcome was favorable in all children except in 2. Follow-up data were lacking in most of the studies. RICM is most often asymptomatic but probably an underestimated complication of cerebral irradiation in the pediatric population. Based on the radiological development of RICMs, many authors suggest a follow-up of at least 15 years. Studies suggest observation for asymptomatic lesions, while surgery is reserved for symptomatic growth, hemorrhage, or focal neurological deficits.
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- 2021
31. Opportunities and challenges for the development of 'core outcome sets' in neuro-oncology
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Christopher P Millward, Terri S Armstrong, Heather Barrington, Andrew R Brodbelt, Helen Bulbeck, Anthony Byrne, Linda Dirven, Carrol Gamble, Paul L Grundy, Abdurrahman I Islim, Mohsen Javadpour, Sumirat M Keshwara, Sandhya T Krishna, Conor L Mallucci, Anthony G Marson, Michael W McDermott, Torstein R Meling, Kathy Oliver, Barry Pizer, Puneet Plaha, Matthias Preusser, Thomas Santarius, Nisaharan Srikandarajah, Martin J B Taphoorn, Colin Watts, Michael Weller, Paula R Williamson, Gelareh Zadeh, Amir H Zamanipoor Najafabadi, Michael D Jenkinson, and Neurology
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Adult ,Cancer Research ,Consensus ,Delphi Technique ,Clinical Trials and Supportive Activities ,Oncology and Carcinogenesis ,effectiveness ,core outcome set ,meningioma ,6.9 Resources and infrastructure (treatment evaluation) ,Rare Diseases ,Clinical Research ,glioma ,Meningeal Neoplasms ,Humans ,Oncology & Carcinogenesis ,Child ,Cancer ,Neurosciences ,clinical trial ,Brain Disorders ,Brain Cancer ,Treatment Outcome ,Oncology ,Research Design ,Neurology (clinical) ,Generic health relevance ,Meningioma - Abstract
Core Outcome Sets (COS) define minimum outcomes to be measured and reported in clinical effectiveness trials for a particular health condition/health area. Despite recognition as critical to clinical research design for other health areas, none have been developed for neuro-oncology. COS development projects should carefully consider: scope (how the COS should be used), stakeholders involved in development (including patients as both research partners and participants), and consensus methodologies used (typically a Delphi survey and consensus meeting), as well as dissemination plans. Developing COS for neuro-oncology is potentially challenging due to extensive tumor subclassification (including molecular stratification), different symptoms related to anatomical tumor location, and variation in treatment options. Development of a COS specific to tumor subtype, in a specific location, for a particular intervention may be too narrow and would be unlikely to be used. Equally, a COS that is applicable across a wider area of neuro-oncology may be too broad and therefore lack specificity. This review describes why and how a COS may be developed, and discusses challenges for their development, specific to neuro-oncology. The COS under development are briefly described, including: adult glioma, incidental/untreated meningioma, meningioma requiring intervention, and adverse events from surgical intervention for pediatric brain tumors.
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- 2022
32. Development of 'Core Outcome Sets' for Meningioma in Clinical Studies (The COSMIC Project)
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Christopher P, Millward, Terri S, Armstrong, Heather, Barrington, Sabrina, Bell, Andrew R, Brodbelt, Helen, Bulbeck, Anna, Crofton, Linda, Dirven, Theo, Georgious, Paul L, Grundy, Abdurrahman I, Islim, Mohsen, Javadpour, Sumirat M, Keshwara, Shelli D, Koszdin, Anthony G, Marson, Michael W, McDermott, Torstein R, Meling, Kathy, Oliver, Puneet, Plaha, Matthias, Preusser, Thomas, Santarius, Nisaharan, Srikandarajah, Martin J B, Taphoorn, Carole, Turner, Colin, Watts, Michael, Weller, Paula R, Williamson, Gelareh, Zadeh, Amir H, Zamanipoor Najafabadi, Michael D, Jenkinson, Viktor, Zherebitskiy, and Neurology
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Consensus ,Delphi Technique ,Clinical Trials and Supportive Activities ,Clinical Sciences ,BIMS ,BNOS ,core outcome set ,meningioma ,SNO ,and Brain Tumour Foundation of Canada ,EANO ,Clinical Research ,International Brain Tumour Alliance ,Meningeal Neoplasms ,Humans ,TBTC ,Brainstrust ,Cancer ,Other Medical and Health Sciences ,SBNS ,Neurosciences ,clinical trial ,General Medicine ,Brain Disorders ,Treatment Outcome ,Research Design ,ICOM ,RANO-PRO ,Public Health and Health Services ,EORTC BTG ,Meningioma ,Systematic Reviews as Topic - Abstract
IntroductionMeningioma is the most common primary intracranial tumour in adults. The majority are non-malignant, but a proportion behave more aggressively. Incidental/minimally symptomatic meningioma are often managed by serial imaging. Symptomatic meningioma, those that threaten neurovascular structures, or demonstrate radiological growth, are usually resected as first-line management strategy. For patients in poor clinical condition, or with inoperable, residual or recurrent disease, radiotherapy is often used as primary or adjuvant treatment. Effective pharmacotherapy treatments do not currently exist. There is heterogeneity in the outcomes measured and reported in meningioma clinical studies. Two ‘Core Outcome Sets’ (COS) will be developed: (COSMIC: Intervention) for use in meningioma clinical effectiveness trials and (COSMIC: Observation) for use in clinical studies of incidental/untreated meningioma.Methods and analysisTwo systematic literature reviews and trial registry searches will identify outcomes measured and reported in published and ongoing (1) meningioma clinical effectiveness trials, and (2) clinical studies of incidental/untreated meningioma. Outcomes include those that are clinician reported, patient reported, caregiver reported and based on objective tests (eg, neurocognitive tests), as well as measures of progression and survival. Outcomes will be deduplicated and categorised to generate two long lists. The two long lists will be prioritised through two, two-round, international, modified eDelphi surveys including patients with meningioma, healthcare professionals, researchers and those in caring/supporting roles. The two final COS will be ratified through two 1-day online consensus meetings, with representation from all stakeholder groups.Ethics and disseminationInstitutional review board (University of Liverpool) approval was obtained for the conduct of this study. Participant eConsent will be obtained prior to participation in the eDelphi surveys and consensus meetings. The two systematic literature reviews and two final COS will be published and freely available.Trial registration numberCOMET study ID 1508
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- 2022
33. Neurosurgical Evidence and Randomized Trials: The Fragility Index
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Victor Volovici, Valerie I. Vogels, Ruben Dammers, Torstein R. Meling, and Neurosurgery
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Sample Size ,Humans ,Surgery ,Neurology (clinical) ,Neurosurgical Procedures ,Randomized Controlled Trials as Topic - Abstract
Background: Neurosurgical randomized controlled trials (RCTs) are difficult to carry out due to the low incidence of certain diseases, heterogeneous disease phenotypes, and ethical issues. This results in a weak evidence base in terms of both the number of trials and their robustness. The fragility index (FI) measures the robustness of an RCT and is the minimum number of patients in a trial whose status would have to change from a nonevent to an event to change a statistically significant result to a nonsignificant result. The smaller the FI, the more fragile the trial's outcome. Methods: RCTs that have influenced neurosurgical practice were included in this analysis. Simulations were run to calculate the FI. To determine associations with a high or low FI, multivariable logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals adjusting for baseline confounders. Results: Of 2975 papers screened, 74 were included. The median FI was 4.5 (interquartile range: 1.5–10). RCTs included a median of 165 patients (interquartile range: 75–330), with a maximum of 10,008. A total of 38 trials had lost to follow-up patients that might have impacted the robustness of the results (51%). Conclusion: Results of neurosurgical RCTs on which we base our clinical decision-making and treatment guidelines are often fragile. Improved methodologies, international collaboration, and cooperation between specialties might improve the evidence base in the future.
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- 2022
34. The 'STARS' study: advanced pre-operative rehearsal and intraoperative navigation in neurosurgical oncology
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Alessandro, Perin, Enrico, Gambatesa, Chiara B, Rui, Giovanni, Carone, Claudia, Fanizzi, Francesca M, Lombardo, Tommaso F, Galbiati, Donatella, Sgubin, Paolo, Cappabianca, Torstein R, Meling, and Francesco, Dimeco
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Surgery ,Neurology (clinical) - Abstract
Neurosurgical 3D visualizers and simulators are innovative devices capable of defining a surgical strategy in advance and possibly making neurosurgery safer by rehearsing the phases of the operation beforehand. The aim of this study is to evaluate Surgical Theater™, a new 3D neurosurgical planning, simulation, and navigation system, and qualitatively assess its use in the operating room.Clinical data were collected from 30 patients harbouring various types of brain tumours; Surgical Theater™ was used for the preoperative planning and intraoperative 3D navigation. Preoperative and postoperative questionnaires were completed by first and second operators to get qualitative feedback on the system's functionality. Furthermore, we measured and compared the impact of this technology on surgery duration.Neurosurgeons were overall satisfied when using this rehearsal and navigation tool and found it efficient and easy to use; interestingly, residents considered this device more useful as compared to their more senior colleagues (with significantly higher scores, p0.05), possibly because of their limited anatomical experience and spatial/surgical rehearsal ability. The length of the surgical procedure was not affected by this technology (p0.05).Surgical Theater™ system was found to be clinically useful in improving anatomical understanding, surgical planning and intraoperative navigation, especially for younger and less experienced neurosurgeons.
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- 2022
35. Petroclival meningiomas: update of current treatment and consensus by the EANS skull base section
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Torstein R. Meling, Takanori Fukushima, Mahmoud Messerer, Lorenzo Giammattei, P di Russo, Jan Frederick Cornelius, Vladimír Beneš, Marcos Tatagiba, Kenji Ohata, Takeo Goto, Giulia Cossu, Daniele Starnoni, Ossama Al-Mefty, Emmanuel Jouanneau, Michael Bruneau, Roy Thomas Daniel, Volker Seifert, Idoya Zazpe, Dimitrios Paraskevopoulos, Luigi Maria Cavallo, T Passeri, Henry W. S. Schroeder, Sébastien Froelich, and Moncef Berhouma
- Subjects
Counseling ,medicine.medical_specialty ,Clinical Decision-Making ,Computed tomography ,Radiosurgery ,Posterior Fossa Meningiomas ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Meningeal Neoplasms ,medicine ,Humans ,Multimodal treatment ,Medical physics ,Skull Base ,medicine.diagnostic_test ,Task force ,business.industry ,Optimal management ,Skull ,medicine.anatomical_structure ,Section (archaeology) ,Retrosigmoid approach ,Surgery ,Neurology (clinical) ,Meningioma ,business ,030217 neurology & neurosurgery - Abstract
The optimal management of petroclival meningiomas (PCMs) continues to be debated along with several controversies that persist. A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the management of these tumors. To achieve this, the task force reviewed in detail the literature in this field and had formal discussions within the group. The constituted task force dealt with the existing definitions and classifications, pre-operative radiological investigations, management of small and asymptomatic PCMs, radiosurgery, optimal surgical strategies, multimodal treatment, decision-making, and patient’s counselling. This article represents the consensually derived opinion of the task force with respect to the management of PCMs.
- Published
- 2021
36. Unruptured Arteriovenous Malformations
- Author
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Torstein R. Meling, Ruben Dammers, Joost W. Schouten, Peter Vajkoczy, and Victor Volovici
- Subjects
Intracranial Arteriovenous Malformations ,medicine.medical_specialty ,Clinical Decision-Making ,Context (language use) ,law.invention ,External validity ,Randomized controlled trial ,law ,Prevalence ,Medicine ,Humans ,Stroke ,Cerebral Hemorrhage ,Advanced and Specialized Nursing ,Rupture ,Medical treatment ,business.industry ,General surgery ,Bayes Theorem ,medicine.disease ,Clinical Practice ,Clinical equipoise ,Intraventricular hemorrhage ,Treatment Outcome ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Brain arteriovenous malformations (bAVMs) are vascular lesions that carry significant morbidity and mortality risk upon rupture. bAVM rupture causes either intracerebral or intraventricular hemorrhage, or both. In 2014, the first results of the ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) were published in The Lancet , causing a paradigm shift in clinical practice and suggesting the superiority of medical treatment in terms of mortality or stroke compared with any intervention designed to obliterate the AVM. In 2020, the final results of the ARUBA trial were published. In this Viewpoint, we critically review the clinical equipoise behind the trial, highlight issues regarding external validity, and place the results of the trial in the context of other results in scientific literature of bAVMs using Bayesian inference. ARUBA is a trial of decision-making, and only proper knowledge of the nuances of its interpretation within the broader context of bAVM research can lead to proper decision-making when confronted with patients with unruptured bAVMs.
- Published
- 2021
37. Functional outcome and quality of life after meningioma surgery: a systematic review
- Author
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Marco Vincenzo Corniola and Torstein R. Meling
- Subjects
Adult ,Male ,medicine.medical_specialty ,Barthel index ,Extent of resection ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Meningeal Neoplasms ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,business.industry ,Recovery of Function ,General Medicine ,medicine.disease ,Surgery ,Neurology ,Functional disability ,Quality of Life ,Female ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery - Abstract
Assessment of long-term functional outcomes after meningioma surgery is important. We systematically reviewed the literature on health-related quality of life (HrQoL) and functional disability (FD) of patients after surgery for intracranial meningiomas. Using PRISMA 2015 guidelines, we screened 289 abstracts and 43 titles were retained for full-paper screening. 15 articles did not present enough data to meet the inclusion criteria and 7 articles failed to assess functional assessment and HrQoL. Twenty-two articles were included in our review. HrQol was assessed in N = 18 publications, most frequently using SF-36 (N = 10), followed by EQ5D-5L (N = 4), EORTC-QLQ (N = 4), and the FACT questionnaire (N = 2). The assessment of FD was reported in N = 11 publications, mostly using the KPS (N = 8). The Barthel index was used in N = 2 publications. Follow-up was reported in N = 12 publications, ranging from 6 months to 9 years. Scientific publications assessing long-term postoperative HrQol and FD in patients undergoing meningioma surgery are scarce and the data are heterogeneously reported, using various scales and follow-up protocols. Efforts should be undertaken to uniformly assess long-term post-operative functional outcomes in meningioma patients.
- Published
- 2021
38. Foramen magnum meningiomas: a systematic review and meta-analysis
- Author
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Luca Paun, Torstein R. Meling, Renato Gondar, and Paola Borrelli
- Subjects
Male ,medicine.medical_specialty ,Review ,Neurosurgical Procedures ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Epidemiology ,Meningeal Neoplasms ,Medicine ,Humans ,RC346-429 ,Grading (tumors) ,Outcome ,Retrospective Studies ,Foramen magnum ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Classification ,Surgery ,Meta-analysis ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,Systematic review ,Quality of Life ,Female ,Neurology. Diseases of the nervous system ,Neurology (clinical) ,Neurosurgery ,Neoplasm Recurrence, Local ,business ,030217 neurology & neurosurgery - Abstract
Foramen magnum meningiomas (FMMs) account for 1.8–3.2% of all meningiomas. With this systematic review and meta-analysis, our goal is to detail epidemiology, clinical features, surgical aspects, and outcomes of this rare pathology. Using PRISMA 2015 guidelines, we reviewed case series, mixed series, or retrospective observational cohorts with description of surgical technique, patient and lesion characteristics, and pre- and postoperative clinical status. A meta-analysis was performed to search for correlations between meningioma characteristics and rate of gross total resection (GTR). We considered 33 retrospective studies or case series, including 1053 patients, mostly females (53.8%), with a mean age of 52 years. The mean follow-up was of 51 months (range 0–258 months). 65.6% of meningiomas were anterior, and the mean diameter was of 29 mm, treated with different surgical approaches. Postoperatively, 17.2% suffered complications (both surgery- and non-surgery-related) and 2.5% had a recurrence. The Karnofsky performance score improved in average after surgical treatment (75 vs. 81, p < 0.001). Our meta-analysis shows significant rates of GTR in cohorts with a majority of posterior and laterally located FMM (p = 0.025) and with a mean tumor less than 25 mm (p < 0.05). FMM is a rare and challenging pathology whose treatment should be multidisciplinary, focusing on quality of life. Surgery still remains the gold standard and aim at maximal resection with neurological function preservation. Adjuvant therapies are needed in case of subtotal removal, non-grade I lesions, or recurrence. Specific risk factors for recurrence, other than Simpson grading, need further research.
- Published
- 2021
39. Work Related Musculoskeletal Disorders in Spine Surgeons
- Author
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Georgios Mavrovounis, Torstein R Meling, Jesus Lafuente, Kostas N Fountas, and Andreas K Demetriades
- Subjects
Orthopedics and Sports Medicine ,Surgery ,Neurology (clinical) - Published
- 2023
40. Critical Appraisal of Randomized Controlled Trials on Unruptured Brain Arteriovenous Malformations
- Author
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Anastasia Tasiou, Alexandros G. Brotis, Christos Tzerefos, Xanthoula Lambrianou, Theodosios Spiliotopoulos, Cargill H. Alleyne, Edoardo Boccardi, Bengt Karlsson, Neil Kitchen, Torstein R. Meling, Robert F. Spetzler, Christos M. Tolias, and Kostas N. Fountas
- Subjects
Intracranial Arteriovenous Malformations ,Brain ,Humans ,Surgery ,Neurology (clinical) ,Reference Standards ,Nervous System Malformations ,Randomized Controlled Trials as Topic - Abstract
Brain arteriovenous malformations management remains controversial despite the numerous, available treatment options. Randomized controlled trials (RCTs) theoretically provide the strongest evidence for the assessment of any therapeutic intervention. However, poorly designed RCTs may be associated with biases, inaccuracies, and misleading conclusions. The purpose of our study is to assess reporting transparency and methodological quality of the existing RCTs.A search was performed in the PubMed, Scopus, Embase, clinicaltrials.gov, and Cochrane databases. The search was limited to English literature. We included all published RCTs reporting on the management of unruptured brain arteriovenous malformations. The eligible studies were evaluated by 5 blinded raters with the CONsolidated Standards of Reporting Trials 2010 statement and the risk-of-bias 2 tool. The inter-rater agreement was assessed with the Fleiss' Kappa.A randomized trial of unruptured brain arteriovenous malformations (ARUBA) and treatment of brain arteriovenous malformations (TOBAS) trials were evaluated. ARUBA achieved high CONsolidated standards of reporting trials compliance, while TOBAS showed a moderate one. In ARUBA the introduction, discussion, and other information sections reached the highest compliance rate (80%-86%). The lowest rates were recorded in the results and the methods (62% and 73%, respectively). The inter-rater agreement was moderate to substantial (54.1% to 78.4%). All the examined studies demonstrated a high risk of bias, mainly related to ill-defined intended interventions, missing outcome data, and selection of the reported results.Our study confirmed the high risk of bias mainly attributed to several protocol violations, deviations, minimal external validity and selection, attrition, and allocation biases of the ARUBA trial. Analysis of the TOBAS trial revealed a moderate overall reporting clarity and a high risk of bias.
- Published
- 2022
41. Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults
- Author
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Torstein R. Meling, John K. Hald, and Sayied Abdol Mohieb Hosainey
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VP shunt ,Adult ,medicine.medical_specialty ,Complications ,Survival ,medicine.medical_treatment ,Population ,Neurosurgery ,Brain tumor ,Ventriculoperitoneal Shunt ,medicine ,Humans ,Vp shunt ,education ,Craniotomy ,Retrospective Studies ,education.field_of_study ,Brain Neoplasms ,business.industry ,General Medicine ,medicine.disease ,ddc:616.8 ,Hydrocephalus ,Surgery ,Shunting ,Treatment Outcome ,Neurology (clinical) ,business ,Shunt (electrical) - Abstract
Risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus after craniotomies for brain tumors are largely unknown. The purpose of this study was to determine the overall timing of VP shunting and its failure after craniotomy for brain tumors in adults. The authors also wished to explore risk factors for early VP shunt failure (within 90 days). A population-based consecutive patient cohort of all craniotomies for intracranial tumors leading to VP shunt dependency in adults (> 18 years) from 2004 to 2013 was studied. Patients with pre-existing VP shunts prior to craniotomy were excluded. The survival time of VP shunts, i.e., the shunt longevity, was calculated from the day of shunt insertion post-craniotomy for a brain tumor until the day of shunt revision requiring replacement or removal of the shunt system. Out of 4774 craniotomies, 85 patients became VP shunt-dependent (1.8% of craniotomies). Median time from craniotomy to VP shunting was 1.9 months. Patients with hydrocephalus prior to tumor resection (N = 39) had significantly shorter time to shunt insertion than those without (N = 46) (p
- Published
- 2022
42. Neuroimaging Precision Tools and Augmented Reality
- Author
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Torstein R. Meling and Maria-Isabel Vargas
- Published
- 2022
43. Contributors
- Author
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Maria V. Alexiou, Panagiotis E. Antoniou, Alkinoos Athanasiou, Bakopoulou Athina, Panagiotis D. Bamidis, Petros Bangeas, Alexandros Brotis, Hadjichristou Christina, Angelos Daniilidis, Efterpi Demiri, Dimitrios Dionyssiou, Konstantinos Fountas, Kleanthis E. Giannoulis, Grigoris F. Grimbizis, Ion-Anastasios Karolos, Ioannis Magras, Bousnaki Maria, Torstein R. Meling, Alessandro Moiraghi, Koidis Petros, Christos Pikridas, Constantine P. Spanos, Marianna P. Spanos, Georgia-Alexandra Spyropoulou, Theodoros D. Theodoridis, Andreas I. Tooulias, Antonios Tsimponis, Vassilios Tsioukas, Georgios Tsoulfas, and Lazaros Tzounis
- Published
- 2022
44. Proposal of a new grading system for meningioma resection:the Copenhagen Protocol
- Author
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Jane Skjøth-Rasmussen, Frantz Rom Poulsen, Morten Ziebell, David Scheie, Lars Poulsgaard, Tiit Mathiesen, Andrea Daniela Maier, Jeppe Haslund-Vinding, Torstein R. Meling, Petter Förander, Kaare Fugleholm, Jiri Bartek, Thomas Santarius, Christian Mirian, Bjarne Winther Kristensen, Ian Law, and Vibeke Andrée Larsen
- Subjects
medicine.medical_specialty ,business.industry ,Neurooncology ,Neurosurgery ,Gold standard (test) ,medicine.disease ,Meningioma ,Neuroradiology ,Radiological weapon ,Adjuvant therapy ,Medicine ,Surgery ,Neurology (clinical) ,Radiology ,business ,Grading (education) ,Neuropathology - Abstract
Introduction: The extent of meningioma resection is the most fundamental risk factor for recurrence, and exact knowledge of extent of resection is necessary for prognostication and for planning of adjuvant treatment. Currently used classifications are the EANO-grading and the Simpson grading. The former comprises radiological imaging with contrast-enhanced MRI and differentiation between “gross total removal” and “subtotal removal,” while the latter comprises a five-tiered differentiation of the surgeon’s impression of the extent of resection. The extent of resection of tumors is usually defined via analyses of resection margins but has until now not been implemented for meningiomas. PET/MRI imaging with 68Ga-DOTATOC allows more sensitive and specific imaging than MRI following surgery of meningiomas. Objective: To develop an objective grading system based on microscopic analyses of resection margins and sensitive radiological analyses to improve management of follow-up, adjuvant therapy, and prognostication of meningiomas. Based on the rationale of resection-margin analyses as gold standard and superior imaging performance of 68Ga DOTATOC PET, we propose “Copenhagen Grading” for meningiomas. Results: Copenhagen Grading was described for six pilot patients with examples of positive and negative findings on histopathology and DOTATOC PET scanning. The grading could be traceably implemented and parameters of grading appeared complementary. Copenhagen Grading is prospectively implemented as a clinical standard at Rigshospitalet, Copenhagen. Conclusion: Copenhagen Grading provided a comprehensive, logical, and reproducible definition of the extent of resection. It offers promise to be the most sensitive and specific imaging modality available for meningiomas. Clinical and cost-efficacy remain to be established during prospective implementation.
- Published
- 2022
45. 3D printing in neurosurgery
- Author
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Alessandro Moiraghi, Alexandros G. Brotis, Torstein R. Meling, Konstantinos Fountas, Panagiotis D. Bamidis, Alkinoos Athanasiou, and Ioannis Magras
- Subjects
medicine.medical_specialty ,Engineering ,business.industry ,Specialty ,medicine ,Medical physics ,Neurosurgery ,business ,Biomedical technology - Abstract
Three-dimensional (3D) printing (3DP) has seen spectacular progress in recent years, making it widely available to consumers and researchers, but it has also been steadily expanding its capabilities while becoming more and more affordable. This progress has allowed 3DP technology to be seriously tested in various fields of Medicine and Biomedical Technology. Neurological Surgery is widely considered to be among the most demanding and intricate medical specialties, as it concerns fine and highly critical neural and vascular elements even during standard interventions or the most common pathological conditions. As such, advances in 3DP were quick to be applied to neurosurgical practice (depicting brain aneurysms), research and development (spine and disc models), and neurosurgical education. In the past years, we have seen progress in four main distinct directions for the use of 3DP technologies within the prism of Neurological Surgery, where we also envision future progress: (a) neurovascular physiological anatomy and its associated disorders, (b) complex central nervous system tumors and neuroanatomy, (c) spine instrumentation, deformities, and biomechanical implications, and (d) educational purposes, prototyping of implants, devices, and equipment. In this chapter, we critically review the progress of 3DP technology within each of these described directions and discuss the impact it can possibly have on specific diseases and on the Neurosurgical Specialty as a whole in the years to come.
- Published
- 2022
46. Orbital Tumors
- Author
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Torstein R. Meling
- Published
- 2022
47. Visual field restoration after Simpson grade I resection of symptomatic occipital lobe meningioma: illustrative case and review of the literature
- Author
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Torstein R. Meling, Marco Vincenzo Corniola, Maria Vargas, and Walid Bouthour
- Subjects
medicine.medical_specialty ,Neurology ,medicine.diagnostic_test ,business.industry ,Interventional radiology ,medicine.disease ,030218 nuclear medicine & medical imaging ,Visual field ,Lesion ,Meningioma ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Surgery ,Neurology (clinical) ,Radiology ,Neurosurgery ,medicine.symptom ,business ,Occipital lobe ,030217 neurology & neurosurgery ,Neuroradiology - Abstract
Intracranial meningiomas mostly affect patients in their fifth decade and beyond, raising pertinent questions regarding the risk of surgery, particularly in the elderly. Here, we describe the case of a septuagenarian patient with occipital meningioma causing severe visual field cuts that experienced full recovery of the visual function after a Simpson I resection of the lesion. This case illustrates the potential of recovery of the brain, even in the case of severely impaired function in elderly patients. To complete the picture, we review the literature on occipital meningiomas, advocating for systematic reports and increase data collection on post-operative neurological recovery in the elderly.
- Published
- 2020
48. Ergonomics and musculoskeletal disorders in neurosurgery: a systematic review
- Author
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Torstein R. Meling, Andreas K. Demetriades, Alexandre Lavé, and Renato Gondar
- Subjects
Review Article - Neurosurgery general ,Neuro-endoscopy ,medicine.medical_specialty ,Posture ,Population ,Intervertebral Disc Degeneration ,Wrist ,Musculoskeletal disorders ,03 medical and health sciences ,Spine surgery ,0302 clinical medicine ,Quality of life ,medicine ,Humans ,030212 general & internal medicine ,Carpal tunnel syndrome ,education ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Neurosurgical practice ,Human factors and ergonomics ,Interventional radiology ,medicine.disease ,Carpal Tunnel Syndrome ,Low back pain ,Occupational Diseases ,Neurosurgeons ,medicine.anatomical_structure ,Systematic review ,Physical therapy ,Surgery ,Ergonomics ,Neurology (clinical) ,Neurosurgery ,medicine.symptom ,business ,Low Back Pain ,Intervertebral Disc Displacement ,030217 neurology & neurosurgery - Abstract
Background Work-related musculoskeletal disorders (WMSDs) are a growing and probably undervalued concern for neurosurgeons and spine surgeons, as they can impact their quality of life and career length. This systematic review aims to ascertain this association and to search for preventive measures. Methods We conducted a PRISMA-P-based review on ergonomics and WMSDs in neurosurgery over the last 15 years. Twelve original articles were included, of which 6 focused on spine surgery ergonomics, 5 cranio-facial surgery (mainly endoscopic), and one on both domains. Results We found a huge methodological and content diversity among studies with 5 surveys, 3 cross-sectional studies, 2 retrospective cohorts, and 2 technical notes. Spine surgeons have sustained neck flexion and neglect their posture during surgery. In a survey, low back pain was found in 62% of surgeons, 31% of them with a diagnosed lumbar disc herniation, and 23% of surgery rate. Pain in the neck (59%), shoulder (49%), finger (31%), and wrist (25%) are more frequent than in the general population. Carpal tunnel syndrome showed a linear relationship with increasing cumulative hours of spine surgery practice. Among cranial procedures, endoscopy was also significantly related to shoulder pain while pineal region surgery received some attempts to optimize ergonomics. Conclusions Ergonomics in neurosurgery remains underreported and lack attention from surgeons and authorities. Improvements shall target postural ergonomics, equipment design, weekly schedule adaptation, and exercise.
- Published
- 2020
49. The role of EC-IC bypass in ICA blood blister aneurysms—a systematic review
- Author
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Torstein R. Meling and Gildas Patet
- Subjects
Adult ,Carotid Artery Diseases ,Male ,Middle Cerebral Artery ,medicine.medical_specialty ,External carotid artery ,Neurosurgery ,Aneurysm, Ruptured ,Neurosurgical Procedures ,Young Adult ,Extracranial-to-intracranial bypass ,Aneurysm ,Modified Rankin Scale ,medicine.artery ,medicine ,Humans ,Prospective Studies ,Radial artery ,Aged ,Aged, 80 and over ,Cerebral Revascularization ,business.industry ,Intracranial Aneurysm ,General Medicine ,Middle Aged ,Superficial temporal artery ,medicine.disease ,Short Review ,Temporal Arteries ,Surgery ,Bypass surgery ,Radial Artery ,Middle cerebral artery ,Systematic review ,cardiovascular system ,Female ,Neurology (clinical) ,Internal carotid artery ,business ,Blood blister–like aneurysm ,Carotid Artery, Internal - Abstract
To perform a systematic review of extracranial-to-intracranial (EC-IC) bypass surgery with parent vessel trapping for blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) according to PRISMA guidelines. Search of PubMed using “bypass” [all fields] and “ICA” [all fields] or “internal carotid artery” [all fields] and (“blood blister–like aneurysm” [MeSH terms]. Thirty-four original articles were identified, of which 21 were excluded (treatment not including bypass or insufficient details on complications or clinical outcomes). Thirteen articles published between 2008 and 2019 were included, totaling 98 patients, with a median of 7.5 patients per article (range 1–17). Mean age was 53.3 years (range 23–80). The main techniques were external carotid artery to middle cerebral artery (ECA-MCA) in 81% and superficial temporal artery to MCA (STA-MCA) in 19%. The most common grafts were radial artery (74%) and STA (19%). The risk of intraoperative rupture varied from 0 to 75%, with a mean of 12%. With respect to clinical outcomes, the modified Rankin Scale (mRS) was not stated in 30% of the cases. When stated, mRS was ≤ 2 in 79%, mRS was 3–5 in 10%, and 4% had mRS 6 (death). We identified only 13 articles, with no prospective studies. Outcomes were better than generally reported for ruptured aneurysms, both with respect to poor outcome (mRS > 2) and in-hospital mortality, perhaps reflecting a selection bias. In general, the data reporting quality was low, precluding any firm conclusions, but EC-IC bypass with ICA trapping may be a valid treatment option for ruptured ICA BBAs.
- Published
- 2020
50. Improved prognostication of glioblastoma beyond molecular subtyping by transcriptional profiling of the tumor microenvironment
- Author
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Sverre Heim, Torstein R. Meling, Anita Sveen, Lina Cekaite, Petter Brandal, Marine Jeanmougin, Ragnhild A. Lothe, David Scheie, Annette Bentsen Håvik, Guro Elisabeth Lind, and Trude H. Ågesen
- Subjects
0301 basic medicine ,Male ,Cancer Research ,Kaplan-Meier Estimate ,CD8-Positive T-Lymphocytes ,infiltration ,Cohort Studies ,0302 clinical medicine ,Databases, Genetic ,Tumor Microenvironment ,Research Articles ,Oligonucleotide Array Sequence Analysis ,Aged, 80 and over ,B-Lymphocytes ,Brain Neoplasms ,General Medicine ,Middle Aged ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Prognosis ,Subtyping ,Gene Expression Regulation, Neoplastic ,Killer Cells, Natural ,Oncology ,030220 oncology & carcinogenesis ,Multigene Family ,Molecular Medicine ,Female ,Infiltration (medical) ,Research Article ,Adult ,Stromal cell ,In silico ,Biology ,lcsh:RC254-282 ,survival ,03 medical and health sciences ,Immune system ,stratification ,Glioma ,Genetics ,medicine ,Humans ,Computer Simulation ,Aged ,Proportional Hazards Models ,Tumor microenvironment ,Mesenchymal stem cell ,glioblastoma ,medicine.disease ,microenvironment ,Survival Analysis ,030104 developmental biology ,Multivariate Analysis ,Cancer research ,Stromal Cells ,Transcriptome - Abstract
Glioblastoma (GBM), the most aggressive form of brain cancer, is characterized by a high level of molecular heterogeneity, and infiltration by various immune and stromal cell populations. Important advances have been made in deciphering the microenvironment of GBMs, but its association with existing molecular subtypes and its potential prognostic role remain elusive. We have investigated the abundance of infiltrating immune and stromal cells in silico, from gene expression profiles. Two cohorts, including in‐house normal brain and glioma samples (n = 70) and a large sample set from TCGA (n = 393), were combined into a single exploratory dataset. A third independent cohort (n = 124) was used for validation. Tumors were clustered based on their microenvironment infiltration profiles, and associations with known GBM molecular subtypes and patient outcome were tested a posteriori in a multivariable setting. We identified a subset of GBM samples with significantly higher abundances of most immune and stromal cell populations. This subset showed increased expression of both immune suppressor and immune effector genes compared to other GBMs and was enriched for the mesenchymal molecular subtype. Survival analyses suggested that tumor microenvironment infiltration pattern was an independent prognostic factor for GBM patients. Among all, patients with the mesenchymal subtype with low immune and stromal infiltration had the poorest survival. By combining molecular subtyping with gene expression measures of tumor infiltration, the present work contributes with improving prognostic models in GBM., This work combined molecular subtyping of glioblastomas (GBMs) with gene expression measures of tumor infiltration and identified a subset of GBMs with high abundances of most immune and stromal cell populations. Survival analyses suggested that tumor microenvironment infiltration was an independent prognostic factor for GBM patients. Among all, patients with the mesenchymal subtype and low infiltration had the poorest survival.
- Published
- 2020
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