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A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Surgical Oncology".

Deadline for manuscript submissions: closed (31 May 2022) | Viewed by 33815

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Special Issue Editor

Dr. Soichi Oya

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Guest Editor

Department of Neurosurgery, Saitama Medical Center/University, Saitama 350-8550, Japan
Interests: brain tumor; craniopharyngioma; endoscopic surgery; glioma; intraventricular tumor; meningioma; pediatric brain tumor; skull base tumor; surgical resection
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Special Issue Information

Dear Colleagues,

The surgical treatment of brain tumors has been continuously refined. To enhance the safety and efficacy of surgery, our understanding of pathophysiology and the knowledge regarding recent advancements in imaging technology and surgical devices need to be updated and incorporated into surgical procedures. For this Special Issue, we welcome manuscripts focusing on recent advancements in the surgical resection of any type of brain tumors. The choice of suitable frameworks is quite flexible; for example, malignant/benign brain tumors, intraventricular tumors, skull base tumors, pediatric tumors, intraoperative monitoring, etc. We hope that this Special Issue will contribute to furthering understanding of the recent advancements and future perspectives regarding surgery for brain tumors.

Dr. Soichi Oya
Guest Editor

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Keywords

brain tumor
endoscopic surgery
exoscopic surgery
imaging technology
intraoperative monitoring
robotic surgery
skull base tumor
surgical device
surgical resection
surgical simulation

Published Papers (17 papers)

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Editorial

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Open AccessEditorial

Recent Advancements in the Surgical Treatment of Brain Tumors

Soichi Oya

Curr. Oncol. 2023, 30(9), 8424-8425; https://doi.org/10.3390/curroncol30090612 - 14 Sep 2023

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Abstract

The surgical removal of brain tumors is essential for improving patient quality of life and survival [...] Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

Research

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Open AccessArticle

Intraoperative Flow Cytometry for the Evaluation of Meningioma Grade

George A. Alexiou

Georgios S. Markopoulos

Evrysthenis Vartholomatos

Athanasios P. Kyritsis

Spyridon Voulgaris

and

George Vartholomatos

Curr. Oncol. 2023, 30(1), 832-838; https://doi.org/10.3390/curroncol30010063 - 07 Jan 2023

Cited by 1 | Viewed by 1435

Abstract

Meningiomas are the most frequent central nervous system tumors in adults. The majority of these tumors are benign. Nevertheless, the intraoperative identification of meningioma grade is important for modifying surgical strategy in order to reduce postoperative complications. Here, we set out to investigate the role of intraoperative flow cytometry for the differentiation of low-grade (grade 1) from high-grade (grade 2–3) meningiomas. The study included 59 patients. Intraoperative flow cytometry analysis was performed using the ‘Ioannina Protocol’ which evaluates the G0/G1 phase, S-phase, mitosis and tumor index (S + mitosis phase fraction) of a tumor sample. The results are available within 5 min of sample receipt. There were 41 grade 1, 15 grade 2 and 3 grade 3 meningiomas. High-grade meningiomas had significantly higher S-phase fraction, mitosis fraction and tumor index compared to low-grade meningiomas. High-grade meningiomas had significantly lower G0/G1 phase fraction compared to low-grade meningiomas. Thirty-eight tumors were diploids and twenty-one were aneuploids. No significant difference was found between ploidy status and meningioma grade. ROC analysis indicated 11.4% of tumor index as the optimal cutoff value thresholding the discrimination between low- and high-grade meningiomas with 90.2% sensitivity and 72.2% specificity. In conclusion, intraoperative flow cytometry permits the detection of high-grade meningiomas within 5 min. Thus, surgeons may modify tumor removal strategy. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessFeature PaperArticle

Evaluation of a Navigated 3D Ultrasound Integration for Brain Tumor Surgery: First Results of an Ongoing Prospective Study

Marco Maria Fontanella

Christian Rainer Wirtz

Andrej Pala

and

Jan Coburger

Curr. Oncol. 2022, 29(9), 6594-6609; https://doi.org/10.3390/curroncol29090518 - 15 Sep 2022

Cited by 1 | Viewed by 1584

Abstract

The aim of the study was to assess the quality, accuracy and benefit of navigated 2D and 3D ultrasound for intra-axial tumor surgery in a prospective study. Patients intended for gross total resection were consecutively enrolled. Intraoperatively, a 2D and 3D iUS-based resection was performed. During surgery, the image quality, clinical benefit and navigation accuracy were recorded based on a standardized protocol using Likert’s scales. A total of 16 consecutive patients were included. Mean ratings of image quality in 2D iUS were significantly higher than in 3D iUS (p < 0.001). There was no relevant decrease in rating during the surgery in 2D and 3D iUS (p > 0.46). The benefit was rated 2.2 in 2D iUS and 2.6 in 3D iUS (p = 0.08). The benefit remained stable in 2D, while there was a slight decrease in the benefit in 3D after complete tumor resection (p = 0.09). The accuracy was similar in both (mean 2.2 p = 0.88). Seven patients had a small tumor remnant in intraoperative MRT (mean 0.98 cm³) that was not appreciated with iUS. Crucially, 3D iUS allows for an accurate intraoperative update of imaging with slightly lower image quality than 2D iUS. Our preliminary data suggest that the benefit and accuracy of 2D and 3D iUS navigation do not undergo significant variations during tumor resection. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Combined Exoscopic and Endoscopic Two-Step Keyhole Approach for Intracranial Meningiomas

and

Curr. Oncol. 2022, 29(8), 5370-5382; https://doi.org/10.3390/curroncol29080426 - 29 Jul 2022

Cited by 3 | Viewed by 1625

Abstract

The advantages of neuroendoscopic surgery are the wide viewing angle and the freedom of an axis of view with minimal surgical trauma. With the advent of the exoscope, which has similar advantages to endoscopy, such as a small body and ergonomically superior heads-up surgery, it has become possible to add a field of view that is similar to that of microsurgery to endoscopic surgery. By taking advantage of the features of these scopes, we report the usefulness of the minimally invasive combined exoscopic and endoscopic two-step keyhole approach (EEKA) for various types of meningiomas. We reviewed data from 34 consecutive cases of EEKA for various types of intracranial meningiomas compared with that of conventional microsurgery. All of the tumors were resected as planned without severe complications. Significantly better outcome data were obtained in terms of the blood loss and the surgical time in the EEKA group, in addition to the craniotomy size. The well-illuminated fine vision in the deep corners by the endoscope enabled radical resection of the tumors with minimum burden on the patients. This technique has the potential for minimally invasive surgery in intracranial meningioma patients, including the older population. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Increased MIB-1 Labeling Index Is Associated with Abducens Nerve Morbidity in Primary Sporadic Petroclival Meningioma Surgery: Beyond Location and Approach

and

Curr. Oncol. 2022, 29(7), 5026-5041; https://doi.org/10.3390/curroncol29070398 - 16 Jul 2022

Cited by 1 | Viewed by 1297

Abstract

Abducens nerve palsy is a severe dysfunction after petroclival meningioma (PC MNG) surgery. The objective of this investigation was to analyze abducens nerve outcomes in patients who underwent the retrosigmoid approach in relation to the MIB-1 index. Thirty-two patients with primary sporadic PC MNG were retrospectively analyzed. Mean follow-up was 28.0 months. Analysis of the MIB-1 index was performed to evaluate the abducens nerve outcome. An optimal MIB-1 index cut-off value (<4/≥4) in the association with postoperative CN VI palsy was determined by ROC analysis (AUC: 0.74, 95% CI: 0.57–0.92). A new-onset CN VI palsy was present in 7 cases (21.88%) and was significantly associated with an increased MIB-1 index (≥4%, p = 0.025) and a peritumoral edema in the brachium pontis (p = 0.047) which might be caused by the increased growth rate. Tumor volume, cavernous sinus infiltration, auditory canal invasion, and Simpson grading were not associated with new CN VI deficits. Six (85.7%) of the 7 patients with both an increased MIB-1 index (≥4%) and new abducens nerve palsy still had a CN VI deficit at the 12-month follow-up. A peritumoral edema caused by a highly proliferative PC MNG with an elevated MIB-1 index (≥4%) is associated with postoperative abducens nerve deficits. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

Cristine Klatt-Cromwell

and

Curr. Oncol. 2022, 29(7), 4914-4922; https://doi.org/10.3390/curroncol29070390 - 12 Jul 2022

Cited by 1 | Viewed by 1628

Abstract

Pituitary tumor apoplexy (PTA) classically comprises sudden-onset headache, loss of vision, ophthalmoparesis, and decreased consciousness. It typically results from hemorrhage and/or infarction within a pituitary adenoma. Presentation is heterologous, and optimal management is debated. The time course of recovery of cranial nerve deficits (CNDs) and headaches is not well established. In this study, a retrospective series of consecutive patients with PTA managed at a single academic institution over a 22-year period is presented. Headaches at the time of surgery were more severe in the early and subacute surgical cohort and improved significantly within 72 h postoperatively (p < 0.01). At one year, 90% of CNDs affecting cranial nerves (CNs) 3, 4, and 6 had recovered, with no differences between early (<4 d), subacute (4–14 d), and delayed (>14 d) time-to-surgery cohorts. Remarkably, half recovered within three days. In total, 56% of CN2 deficits recovered, with the early surgery cohort including more severe deficits and recovering at a lower rate (p = 0.01). No correlation of time-to-surgery and rapidity of recovery of CNDs was observed (p = 0.65, 0.72). Surgery for PTA is associated with rapid recovery of CNDs in the early, subacute, and delayed time frames, and with rapid headache improvement in the early and subacute time frames in 50% or more of patients. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

The Role of Stereotactic Frame-Based Biopsy for Brainstem Tumors in the Era of Molecular-Based Diagnosis and Treatment Decisions

and

Curr. Oncol. 2022, 29(7), 4558-4565; https://doi.org/10.3390/curroncol29070360 - 28 Jun 2022

Cited by 1 | Viewed by 1539

Abstract

Stereotactic frame-based brain tumor biopsy (SFB) is a potent diagnostic tool considering its minimal invasiveness, though its diagnostic power and safety for brainstem lesions remain to be discussed. Here, we aimed to examine the usefulness of SFB for brainstem tumors. Twenty-two patients with brainstem tumors underwent 23 SFBs at our institution during 2002–2021. We retrospectively analyzed patient characteristics, tumor pathology, surgical procedures, and outcomes, including surgery-related complications and the diagnostic value. Seven (32%) tumors were located from the midbrain to the pons, eleven (50%) in the pons only, and four (18%) from the pons to the medulla oblongata. The target lesions were in the middle cerebellar peduncles in sixteen procedures (70%), the cerebellum in four (17%), the inferior cerebellar peduncles in two (9%), and the superior cerebellar peduncles in one (4%). A definitive diagnosis was made in 21 patients (95%) at the first SFB. The diagnoses were glioma in seventeen (77%) cases, primary central nervous system lymphoma in four (18%), and a metastatic brain tumor in one (5%). The postoperative complications (cranial nerve palsy in three [13%] cases, ataxia in one [4%]) were all transient. SFB for brainstem tumors yields a high diagnostic rate with a low risk of morbidity. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

DTI Abnormalities Related to Glioblastoma: A Prospective Comparative Study with Metastasis and Healthy Subjects

and

Curr. Oncol. 2022, 29(4), 2823-2834; https://doi.org/10.3390/curroncol29040230 - 16 Apr 2022

Cited by 1 | Viewed by 1850

Abstract

(1) Background: Glioblastoma multiforme (GBM) shows complex mechanisms of spreading of the tumor cells, up to remote areas, and little is still known of these mechanisms, thus we focused on MRI abnormalities observable in the tumor and the brain adjacent to the lesion, up to the contralateral hemisphere, with a special interest on tensor diffusion imaging informing on white matter architecture; (2) Material and Methods: volumes, macroscopic volume (MV), brain-adjacent-tumor (BAT) volume and abnormal color-coded DTI volume (aCCV), and region-of-interest samples (probe volumes, ipsi, and contra lateral to the lesion), with their MRI characteristics, apparent diffusion coefficient (ADC), fractional anisotropy (FA) values, and number of fibers (DTI fiber tracking) were analyzed in patients suffering GBM (n = 15) and metastasis (n = 9), and healthy subjects (n = 15), using ad hoc statistical methods (type I error = 5%) (3) Results: GBM volumes were larger than metastasis volumes, aCCV being larger in GBM and BAT ADC was higher in metastasis, ADC decreased centripetally in metastasis, FA increased centripetally either in GBM or metastasis, MV and BAT FA values were higher in GBM, ipsi FA values of GBM ROIs were higher than those of metastasis, and the GBM ipsi number of fibers was higher than the GBM contra number of fibers; (4) Conclusions: The MV, BAT and especially the aCCV, as well as their related water diffusion characteristics, could be useful biomarkers in oncology and functional oncology. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Laser Interstitial Thermal Therapy in Grade 2/3 IDH1/2 Mutant Gliomas: A Preliminary Report and Literature Review

and

Curr. Oncol. 2022, 29(4), 2550-2563; https://doi.org/10.3390/curroncol29040209 - 08 Apr 2022

Cited by 2 | Viewed by 2033

Abstract

Laser interstitial thermal therapy (LITT) has become an increasingly utilized alternative to surgical resection for the treatment of glioma in patients. However, treatment outcomes in isocitrate dehydrogenase 1 and 2 (IDH1/2) mutant glioma, specifically, have not been reported. The objective of this study was to characterize a single institution’s cohort of IDH1/2 mutant grade 2/3 glioma patients treated with LITT. We collected data on patient presentation, radiographic features, tumor molecular profile, complications, and outcomes. We calculated progression-free survival (PFS) and tested factors for significant association with longer PFS. Overall, 22.7% of our cohort experienced progression at a median follow up of 1.8 years. The three- and five-year estimates of PFS were 72.5% and 54.4%, respectively. This is the first study to characterize outcomes in patients with IDH1/2 mutant glioma after LITT. Our results suggest that LITT is an effective treatment option for IDH1/2 mutant glioma. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Quantitative Evaluation of Proliferative Potential Using Flow Cytometry Reveals Intratumoral Heterogeneity and Its Relevance to Tumor Characteristics in Vestibular Schwannomas

and

Curr. Oncol. 2022, 29(3), 1594-1604; https://doi.org/10.3390/curroncol29030134 - 03 Mar 2022

Viewed by 1810

Abstract

This study sought to explore the existence and clinical significance of intratumoral heterogeneity of proliferative potential in vestibular schwannoma (VS). Rapid intraoperative flow cytometry was utilized with raw samples to measure the proliferative ability of VS. The proliferation index (PI) was defined as the ratio of the number of cells with greater than normal DNA content to the total number of cells. A total of 66 specimens (26 from the intrameatal portion and 40 from the cisternal portion) were obtained from 34 patients with VS. There was a moderate correlation between the PI and MIB-1 labelling index values (R = 0.57, p < 0.0001). In contrast, the patterns of heterogeneity, represented by the proportion of intrameatal PI to cisternal PI, were associated with tumor size (p = 0.03). In addition, preoperative hearing tended to be poor in cases where the intrameatal PI was higher than the cisternal PI (p = 0.06). Our data demonstrated the presence of intratumoral heterogeneity of proliferative potential in VS and its relationship with tumor characteristics. The results of this study may advocate the resection of the intrameatal portion of large VSs treated with planned subtotal resection, especially in cases of poor preoperative hearing function. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas

Andrej Pala

Andreas Knoll

Max Schneider

Gwendolin Etzrodt-Walter

Georg Karpel-Massler

Christian Rainer Wirtz

and

Michal Hlavac

Curr. Oncol. 2022, 29(1), 392-401; https://doi.org/10.3390/curroncol29010035 - 17 Jan 2022

Cited by 2 | Viewed by 2166

Abstract

The surgical treatment of recurrent adenomas can be challenging. Intraoperative magnetic resonance imaging (iMRI) can improve the orientation and increase the safe extent of resection. We conducted a quantitative and qualitative retrospective analysis of recurrent adenomas treated by endoscopic or microscopic iMRI-assisted transsphenoidal surgery. A total number of 59 resections were selected. Detailed volumetric measurements, tumor characteristics, and MRI features of intraoperative remnants were evaluated. Intraoperative MRI increased the gross total resection (GTR) rate from 33.9% to 49.2%. Common locations of tumor remnants after iMRI were the clivus, the wall of the cavernous sinus or the perforation of the diaphragm. Increasing tumor volume and the microscopic technique were significantly associated with further resection after iMRI in the univariate analysis (p = 0.004, OR 1.6; p = 0.009, OR 4.4). Only the increasing tumor volume was an independent predictor for further resection (p = 0.007, OR 1.5). A significantly higher proportion of GTRs was achieved with the endoscopic technique (p = 0.001). Patients with a large recurrent pituitary adenoma who underwent microscopic transsphenoidal resection were the most likely to benefit from iMRI regarding the extent of resection. Occult invasions of the cavernous sinus and/or the clivus were the most common findings leading to further resection of tumor remnants after iMRI. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Changes in Brain Energy and Membrane Metabolism in Glioblastoma following Chemoradiation

Lisa Maria Walchhofer

Malik Galijašević

Julian Mangesius

Martha Nowosielski

Christian Franz Freyschlag

Johannes Kerschbaumer

and

Elke Ruth Gizewski

Curr. Oncol. 2021, 28(6), 5041-5053; https://doi.org/10.3390/curroncol28060424 - 01 Dec 2021

Cited by 5 | Viewed by 2164

Abstract

Brain parenchyma infiltration with glioblastoma (GB) cannot be entirely visualized by conventional magnetic resonance imaging (MRI). The aim of this study was to investigate changes in the energy and membrane metabolism measured with phosphorous MR spectroscopy (31P-MRS) in the presumably “normal-appearing” brain following chemoradiation therapy (CRT) in GB patients in comparison to healthy controls. Twenty (seven female, thirteen male) GB patients underwent a 31P-MRS scan prior to surgery (baseline) and after three months of standard CRT (follow-up examination. The regions of interest “contrast-enhancing (CE) tumor” (if present), “adjacent to the (former) tumor”, “ipsilateral distant” hemisphere, and “contralateral” hemisphere were compared, differentiating between patients with stable (SD) and progressive disease (PD). Metabolite ratios PCr/ATP, Pi/ATP, PCr/Pi, PME/PDE, PME/PCr, and PDE/ATP were investigated. In PD, energy and membrane metabolism in CE tumor areas have a tendency to “normalize” under therapy. In different “normal-appearing” brain areas of GB patients, the energy and membrane metabolism either “normalized” or were “disturbed”, in comparison to baseline or controls. Differences were also detected between patients with SD and PD. 31P-MRS might contribute as an additional imaging biomarker for outcome measurement, which remains to be investigated in a larger cohort. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessArticle

Combined Exoscopic and Endoscopic Technique for Craniofacial Resection

and

Curr. Oncol. 2021, 28(5), 3945-3958; https://doi.org/10.3390/curroncol28050336 - 04 Oct 2021

Cited by 8 | Viewed by 1963

Abstract

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Review

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Open AccessReview

Surgical Management of Brain Tumors with Focused Ultrasound

Yusuf Mehkri

Kevin Pierre

Samuel Joel Woodford

Caroline Grace Davidson

and

Curr. Oncol. 2023, 30(5), 4990-5002; https://doi.org/10.3390/curroncol30050377 - 13 May 2023

Cited by 1 | Viewed by 1473

Abstract

Focused ultrasound is a novel technique for the treatment of aggressive brain tumors that uses both mechanical and thermal mechanisms. This non-invasive technique can allow for both the thermal ablation of inoperable tumors and the delivery of chemotherapy and immunotherapy while minimizing the risk of infection and shortening the time to recovery. With recent advances, focused ultrasound has been increasingly effective for larger tumors without the need for a craniotomy and can be used with minimal surrounding soft tissue damage. Treatment efficacy is dependent on multiple variables, including blood–brain barrier permeability, patient anatomical features, and tumor-specific features. Currently, many clinical trials are currently underway for the treatment of non-neoplastic cranial pathologies and other non-cranial malignancies. In this article, we review the current state of surgical management of brain tumors using focused ultrasound. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessReview

Focused Delivery of Chemotherapy to Augment Surgical Management of Brain Tumors

Mohammad Reza Hosseini Siyanaki

Mohammed Azab

and

Brandon Lucke-Wold

Curr. Oncol. 2022, 29(11), 8846-8861; https://doi.org/10.3390/curroncol29110696 - 17 Nov 2022

Cited by 3 | Viewed by 2064

Abstract

Chemotherapy as an adjuvant therapy that has largely failed to significantly improve outcomes for aggressive brain tumors; some reasons include a weak blood brain barrier penetration and tumor heterogeneity. Recently, there has been interest in designing effective ways to deliver chemotherapy to the tumor. In this review, we discuss the mechanisms of focused chemotherapies that are currently under investigation. Nanoparticle delivery demonstrates both a superior permeability and retention. However, thus far, it has not demonstrated a therapeutic efficacy for brain tumors. Convection-enhanced delivery is an invasive, yet versatile method, which appears to have the greatest potential. Other vehicles, such as angiopep-2 decorated gold nanoparticles, polyamidoamine dendrimers, and lipid nanostructures have demonstrated efficacy through sustained release of focused chemotherapy and have either improved cell death or survival in humans or animal models. Finally, focused ultrasound is a safe and effective way to disrupt the blood brain barrier and augment other delivery methods. Clinical trials are currently underway to study the safety and efficacy of these methods in combination with standard of care. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessEditor’s ChoiceReview

Current Advances in the Management of Adult Craniopharyngiomas

Montserrat Lara-Velazquez

Daryoush Tavanaiepour

and

Gazanfar Rahmathulla

Curr. Oncol. 2022, 29(3), 1645-1671; https://doi.org/10.3390/curroncol29030138 - 04 Mar 2022

Cited by 6 | Viewed by 4546

Abstract

Craniopharyngiomas (CPs) are slow growing, histologically benign intracranial tumors located in the sellar–suprasellar region. Although known to have low mortality, their location and relationship to the adjacent neural structures results in patients having significant neurologic, endocrine, and visual comorbidities. The invasive nature of this tumor makes complete resection a challenge and contributes to its recurrence. Additionally, these tumors are bimodally distributed, being treated with surgery, and are followed by other adjuncts, such as focused radiation therapy, e.g., Gamma knife. Advances in surgical techniques, imaging tools, and instrumentations have resulted in the evolution of surgery using endoscopic techniques, with residual components being treated by radiotherapy to target the residual tumor. Advances in molecular biology have elucidated the main pathways involved in tumor development and recurrence, but presently, no other treatments are offered to patients, besides surgery, radiation, and endocrine management, as the disease and tumor evolve. We review the contemporary management of these tumors, from the evolution of surgical treatments, utilizing standard open microscopic approaches to the more recent endoscopic surgery, and discuss the current recommendations for care of these patients. We discuss the developments in radiation therapy, such as radiosurgery, being used as treatment strategies for craniopharyngioma, highlighting their beneficial effects on tumor resections while decreasing the rates of adverse outcomes. We also outline the recent chemotherapy modalities, which help control tumor growth, and the immune landscape on craniopharyngiomas that allow the development of novel immunotherapies. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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Open AccessReview

The Role of Surgical Approaches in the Multi-Modal Management of Adult Craniopharyngiomas

Christopher S. Hong

and

Sacit Bulent Omay

Curr. Oncol. 2022, 29(3), 1408-1421; https://doi.org/10.3390/curroncol29030118 - 24 Feb 2022

Cited by 6 | Viewed by 2324

Abstract

Craniopharyngiomas are rare, benign primary brain tumors that arise from remnants of the craniopharyngeal duct epithelium within the sellar and suprasellar region. Despite their benign biology, they may cause significant morbidity, secondary to involvement of nearby eloquent neural structures, such as the pituitary gland, hypothalamus, and optic apparatus. Historically, aggressive surgical resection was the treatment goal to minimize risk of tumor recurrence via open transcranial midline, anterolateral, and lateral approaches, but could lead to clinical sequela of visual, endocrine, and hypothalamic dysfunction. However, recent advances in the endoscopic endonasal approach over the last decade have mostly supplanted transcranial surgery as the optimal surgical approach for these tumors. With viable options for adjuvant radiation therapy, targeted medical treatment, and alternative minimally invasive surgical approaches, the management paradigm for craniopharyngiomas has shifted from aggressive open resection to more minimally invasive but maximally safe resection, emphasizing quality of life issues, particularly in regards to visual, endocrine, and hypothalamic function. This review provides an update on current multi-modal approaches for craniopharyngiomas, highlighting the modern surgical treatment paradigm for this disease entity. Full article

(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)

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