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BACKGROUND: In light of the recently updated World Health Organization (WHO) 2021 central nervous system tumor classifications, the aim of the present study was to establish the effect of the resection extent on overall survival (OS) and progression-free survival (PFS) for patients who met the current diagnostic criteria for glioblastoma, isocitrate dehydrogenase (IDH)–wild-type (WT), WHO grade 4. METHODS: A systematic literature search was performed using the following databases: PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews and ClinicalTrials.gov to identify studies that had compared OS and PFS after gross total resection (GTR) versus subtotal resection (STR) or biopsy for glioblastoma IDH-WT. RESULTS: We identified 1439 studies, of which 9 met the inclusion and/or exclusion criteria. Of the 2023 patients, 788 had undergone GTR. The meta-analysis showed a significant increase in the OS and PFS duration after GTR for glioblastoma IDH-WT, with a median OS of 20 months (95% confidence interval [CI], 17–25) after GTR versus 12 months (95% CI, 9–15) after STR (P < 0.0001). The median PFS was 11 months (95% CI, 9–12) after GTR versus 7 months (95% CI, 5–7) after STR (P < 0.0001). GTR was associated with a 51% reduction in the mortality risk (hazard ratio, 0.49; 95% CI, 0.36–0.65) and a 42% reduction in the progression risk (hazard ratio, 0.58; 95% CI, 0.39–0.88) compared with STR. CONCLUSIONS: The results from our systematic review suggest that GTR is associated with improved OS and PFS compared with STR for glioblastoma, IDH-WT, WHO grade 4 (WHO 2021). However, our findings were limited by the various study designs and significant clinical and methodologic heterogeneity among the studies.

Laser interstitial thermal therapy (LITT) is an emerging treatment modality for both primary brain tumors and metastases. We report initial outcomes after LITT for metastatic brain tumors across 3 sites at our institution and discuss potential strategies for optimal patient selection and outcomes.International Classification of Diseases, Ninth Revision and Tenth Revision codes were used to identify patients with malignant brain tumors treated via LITT across all 3 Mayo Clinic sites with at least 6 months follow-up. Local control was based on radiologic and clinical evidence. Overall survival was measured from time of receiving LITT until death or end of the study period.Twenty-three patients were treated for progression of a single (n = 21) or multiple (n = 2) previously radiated metastatic lesions and/or radiation necrosis. Median age was 56 years (interquartile range, 47-66.5 years). LITT achieved local control of the lesion in most patients with metastatic tumors or radiation necrosis (n = 18; 81.8%) for the duration of follow-up. One patient did not have local control data available. Thirteen (56.5%) patients remained alive at the end of the study period. No other patients died of their treated disease during the study period; 5 of 10 deaths were attributable to central nervous system progression outside the treated lesion. Although median survival for this cohort has not yet been reached, the current median survival is 16 months (interquartile range, 12-48.5 months) after LITT for metastatic/radiation necrosis lesions.LITT was associated with sustained local control in 81.8% of patients treated for radiographic progression of metastatic central nervous system disease.

Introduction Pilocytic astrocytoma is a classically benign tumor that most often affects pediatric patients. Rarely, it occurs during adulthood. We present a case series and systematic literature review of adult pilocytic astrocytoma (APA) to examine the clinical presentation, extent of resection, and recurrence rate associated with this tumor in this population. Materials and Methods Our institutional records were retrospectively reviewed for cases of pilocytic astrocytoma in adults. A PubMed search identified English-language studies of pathology-proven APA. A meta-analysis was performed to determine the relationship between extent of tumor resection and recurrence. Results Forty-six patients with APA were diagnosed at our institution (mean age 33.6 ± 13.3; 24 [52%] female). Twenty-four patients (52%) underwent gross total resection, 11 (24%) subtotal resection, 4 (9%) near total resection, 4 (9%) observation after biopsy, and 3 (6%) radiotherapy alone. Tumors recurred or progressed in 6 (13%) patients, of whom 4 were treated by STR and 2 were treated by radiotherapy alone. Thirty-nine (95%) patients were still alive at last follow-up. A systematic literature review identified 415 patients with APA in 38 studies. Including our case series, 7 studies reported extent of resection, follow-up, and recurrence. Of 254 patients with a weighted mean follow-up of 77.7 ± 49.6 (31–250) months, 129 (51%) were treated with gross total resection, and 125 (49%) underwent subtotal resection. Tumor recurred in 79 (31%) patients, 22 (27%) after gross total resection and 57 (73%) after subtotal resection (P Conclusions Pilocytic astrocytoma rarely presents during adulthood. Overall, prognosis is favorable and survival rates are high. APA recurrence is more likely after STR, and the goal of surgery should always be GTR when feasible.

Postoperative seizures after surgical resection of intracranial meningiomas will negatively affect the quality of life of patients. The aim of the present meta-analysis was to pool the current data and identify the independent predictors of postoperative seizures to better guide postoperative surveillance.Searches of 4 electronic databases from inception to February 2019 were conducted using the preferred reporting items for systematic reviews and meta-analyses guidelines. We identified 430 reports for screening. The hazard ratios (HRs) of the preoperative and postoperative parameters from ≥3 separate multivariate regression analyses were pooled using a meta-analysis of the proportions.Of the 430 reports, 12 satisfied the criteria for inclusion in the present study. The pooled population of 5681 patients with meningioma had a median age of 56 years (range, 50-61) and a median proportion of World Health Organization grade I of 91% (range, 66-100). From these data, 4 statistically significant, independent predictors of postoperative seizures were identified: 1) preoperative seizure history (HR, 3.53; P0.01), 2) non-skull base location (HR, 2.35; P0.01), 3) postoperative complications (HR, 3.95; P0.01), and 4) meningioma recurrence (HR, 3.69; P0.01). However, the certainty of these results ranged from low to moderate.We identified 4 significant independent predictors of postoperative seizures after meningioma resection. These parameters should be considered in the follow-up of these patients to ensure optimal seizure surveillance, although ultimate validation by prospective studies is still required.

To determine the rate of surgical site infection (SSI) after resection of an intracranial neoplasm using the American College of Surgeons National Surgical Quality Improvement Program data set and to identify potential risk factors associated with SSI.The National Surgical Quality Improvement Program Participant Use Data File was queried during the period 2006-2013 for patients who underwent a resection for an intracranial neoplasm. Multivariable logistic regression analysis was used to identify risk factors associated with SSI.Inclusion criteria were met by 12,021 patients. SSI occurred at a rate of 2.04%. SSI was significantly associated with increased rates of return to the operating room (56.1% vs. 4.0%, P0.001) and postoperative lengths of stay30 days (5.3% vs. 1.3%, P0.001) on unadjusted bivariate analysis. On multivariable analysis, age (odds ratio [OR] = 0.991, 95% confidence interval [CI] = 0.982-0.999) and female sex (OR = 0.697, 95% CI = 0.538-0.902) were associated with a reduction in the odds of SSI. Preoperative wound infections (OR = 3.833, 95% CI = 1.834-8.0011) and operative times4 hours (OR = 1.891, 95% CI = 1.298-2.756) were associated with an increased odds of SSI. Among cases with available chemotherapy data (n = 3504), recent chemotherapy (OR = 3.007, 95% CI = 1.460-6.196) was associated with an increased odds of SSI.This study identified patient risk factors that may assist clinical decision making regarding patient risk stratification, timing of surgery, and preoperative antibiotic prophylaxis for patients with an intracranial neoplasm undergoing craniotomy.

Background Central nervous system lymphoma (CNSL) is typically treated with chemotherapy and external beam radiation therapy (EBRT). Optimal management of recurrent CNSL is poorly defined. Objective We aim to determine the effectiveness of stereotactic radiosurgery in the treatment of recurrent CNSL. Methods We performed a retrospective analysis of patients having stereotactic radiosurgery (SRS) for recurrent intracranial CNSL between 1999 and 2011. Results Fourteen patients (20 tumors) underwent SRS. The median patient age was 71 years (range, 18–82 years). Seven patients (50%) had primary CNSL. All had received prior chemotherapy, and nine patients (64%) had undergone prior whole brain radiotherapy (WBRT) with a median dose of 40 Gy in 25 fractions. The median preoperative Karnofsky Performance Score was 80. The median tumor volume was 6.7 cm 3 (range, 0.5–37.7); the median margin dose was 15.5 Gy (range, 10–18). Eleven patients (79%) had tumor regression ( n = 11) shown on MRI after SRS. The median overall survival after SRS was 9.5 months. No patient had a major radiation-related complication. Conclusion Stereotactic radiosurgery for patients with recurrent CNSL is well tolerated and has a high rate of radiographic response. A marginal dose of 15.5 Gy or greater, a Karnofsky score of 80 or greater, and the absence of pre-SRS WBRT were associated with significantly longer overall survival. Stereotactic radiosurgery may be beneficial as an initial salvage therapy in the treatment of recurrent CNSL for properly selected patients.

Background Awake craniotomy and electrophysiologic mapping (EPM) is an established technique to facilitate the resection of near eloquent cortex. Intraoperative magnetic resonance imaging (iMRI) is increasingly used to aid in the resection of intracranial lesions. Standard draping protocols in high-field iMRI units make awake craniotomies challenging, and only two groups have previously reported combined EPM and high-field iMRI. Methods We present an illustrative case describing a simple technique for combining awake craniotomy and EPM with high-field iMRI. A movable platter is used to transfer the patient from the operating table to a transport trolley and into the adjacent MRI and still maintaining the patient's surgical position. This system allows excess drapes to be removed, facilitating awake craniotomy. Results A 57-year-old right-handed man presented with new onset seizures. Magnetic resonance imaging demonstrated a large left temporal mass. The patient underwent an awake, left frontotemporal craniotomy. The EPM demonstrated a single critical area for speech in his inferior frontal gyrus. After an initial tumor debulking, the scalp flap was loosely approximated, the wound was covered with additional drapes, and the excess surrounding drapes were trimmed. An iMRI was obtained. The image-guidance system was re-registered and the patient was redraped. Additional resection was performed, allowing extensive removal of what proved to be an anaplastic astrocytoma. The patient tolerated this well without any new neurological deficits. Conclusions Standard protocols for positioning and draping in high-field iMRI units make awake craniotomies problematic. This straightforward technique for combined awake EPM and iMRI may facilitate safe removal of large lesions in eloquent cortex.