Publications by authors named "Alexander Hulsbergen"
Objective: The incidence of leptomeningeal disease (LMD) has increased as treatments for brain metastases (BMs) have improved and patients with metastatic disease are living longer. Sample sizes of individual studies investigating LMD after surgery for BMs and its risk factors have been limited, ranging from 200 to 400 patients at risk for LMD, which only allows the use of conventional biostatistics. Here, the authors used machine learning techniques to enhance LMD prediction in a cohort of surgically treated BMs.
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- * Out of 170 patients, 43.5% experienced a second local recurrence at a median of 7 months post-surgery.
- * Key risk factors for a poorer outcome were found to be subtotal resection of the initial BM and the location of the tumor in the infratentorial region.
Article Synopsis
- This meta-analysis investigated the impact of smoking on overall survival (OS) and progression-free survival (PFS) in patients with lung cancer brain metastases (BM).
- Analysis included 15 studies with 2,915 patients, indicating that smokers had a 34% higher risk of worse survival outcomes compared to non-smokers.
- The findings suggest a strong association between smoking and decreased survival among lung carcinoma BM patients, highlighting the need for more standardized reporting of smoking status in future research.
Article Synopsis
- Current models for predicting survival in brain metastasis (BM) patients mainly rely on data from those receiving radiotherapy, which raises questions about their relevance for surgical patients.
- Researchers aimed to create and validate a machine learning model that predicts 6-month survival after BM resection, using data from 1,062 patients.
- The best-performing model was a logistic regression that achieved an AUC of 0.71 and accurately stratified patients by risk, with the tool being accessible via a web application for further use and validation.*
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- The study investigates the varying practices of steroid dosing and tapering schedules among neurosurgeons treating brain tumors, as there is little evidence on the best approach.
- An electronic survey with 27 questions was distributed to neurosurgeons worldwide, receiving 175 responses spread across 55 countries, with a high percentage prescribing perioperative steroids.
- Results showed a wide range of steroid doses and schedules, primarily using dexamethasone, highlighting the need for future research to establish standardized guidelines for optimal dosing practices.
Article Synopsis
- - Leptomeningeal disease (LMD) is a severe complication of brain metastases, leading to a poor prognosis with a median survival of only 2-4 months, and this study aimed to identify risk factors associated with LMD after surgery for brain metastases.
- - The meta-analysis included 13 studies with over 2,100 patients, finding that 16.1% developed LMD, with significant risk factors such as tumor size, location, surgical methods, and specifically, breast cancer as the primary tumor type and multiple brain metastases being key contributors.
- - The research emphasized the need to consider various risk factors, as breast cancer origins and having multiple brain metastases notably increase the likelihood of developing
Article Synopsis
- The study examines the effectiveness of routine postoperative imaging after pediatric ventricular shunt revisions, questioning its necessity in asymptomatic patients.
- Out of 387 shunt revisions, 77% had postoperative imaging, mainly routine, but only 0.8% of cases changed clinical management based on these images.
- The findings suggest that routine imaging may not significantly impact outcomes, and clinical monitoring could be a more appropriate approach for managing these patients.
Background: In patients with locally recurrent brain metastases (LRBMs), the role of (repeat) craniotomy is controversial. This study aimed to analyze long-term oncological outcomes in this heterogeneous population.
Methods: Craniotomies for LRBM were identified from a tertiary neuro-oncological institution.
Article Synopsis
- Immune checkpoint inhibitors (ICI) are beneficial for cancer patients, including those with brain metastases (BMs), but the interaction with steroids is unclear.
- A systematic literature review analyzed data from 15 studies involving 1102 BM patients, with 32.1% using steroids, revealing worse overall survival (OS) and progression-free survival (PFS) for the steroid group compared to those not using steroids.
- The findings highlight the need for further research on how steroids affect treatment outcomes in BM patients receiving ICI, particularly regarding dosage and timing.
The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain.
View Article and Find Full Text PDFNeurosurgical guidelines are fundamental for evidence-based practice and have considerably increased both in number and content over the last decades. Yet, guidelines in neurosurgery are not without limitations, as they are overwhelmingly based on low-level evidence. Such recommendations have in the past been occasionally overturned by well-designed randomized controlled trials (RCTs), demonstrating the volatility of poorly underpinned evidence.
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- The COVID-19 pandemic forces healthcare workers, including neurosurgeons, to make tough decisions about patient treatment due to limited resources.
- This article outlines key ethical principles to guide the triage process, focusing on four main considerations: helping the worst off, maximizing overall benefits, ensuring equal treatment, and recognizing the value of certain patients based on their potential contribution.
- It serves as a toolkit for neurosurgeons from the European Association of Neurosurgical Societies, offering guidance for navigating ethical dilemmas when resources are scarce.
Programmed Death Receptor Ligand One Expression May Independently Predict Survival in Patients With Non-Small Cell Lung Carcinoma Brain Metastases Receiving Immunotherapy.
Int J Radiat Oncol Biol Phys
September 2020
Article Synopsis
- PD-L1 expression in non-small cell lung cancer (NSCLC) is believed to help predict patient response to PD-1/PD-L1 inhibitors, but its effect on patients with brain metastases (BMs) was unclear before this study.
- This research analyzed 48 patients with NSCLC-BMs who were treated with these inhibitors, finding that positive PD-L1 expression correlated with improved overall survival (OS). Specifically, higher percentages of PD-L1 expression linked to better survival outcomes.
- However, the study revealed that PD-L1 expression did not predict intracranial progression-free survival (IC-PFS), suggesting that while it may have a role in overall survival, its impact on disease progression within the brain is less certain.
Article Synopsis
- Glioblastoma has a median survival of 15 months, prompting the need for new treatment strategies; this study reviews the impact of beta-blockers on glioma growth based on existing literature.* -
- The systematic search yielded 10 preclinical studies and 1 clinical study, revealing that beta-blockers may reduce glioma cell proliferation, migration, and enhance drug sensitivity, though results on migration were inconsistent.* -
- While preclinical evidence suggests potential mechanisms for beta-blockers against glioma, the single clinical study found no survival benefit, highlighting the need for further research to determine their effectiveness in clinical outcomes.*
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- Eccrine carcinoma affecting the central nervous system (CNS) is rare and poorly understood in terms of treatment and prognosis, with only 23 reported cases.
- A study of 3 patients (ages 60-79) revealed varying outcomes; one had a successful treatment response with pembrolizumab due to a NOTCH1 mutation, surviving 39 months after CNS diagnosis.
- The other two patients faced rapid decline and hospice care within a month, highlighting the need for genomic testing to improve understanding and treatment strategies for this disease.
Article Synopsis
- - The study examines breast cancer brain metastases (BCBM) and found that approximately 36.3% of patients showed discordance in hormonal or HER2 receptor expression compared to their original tumors; this includes significant discordance rates for estrogen (16.7%) and progesterone (25.2%).
- - About 22.8% of patients experienced changes in their cancer subtype, with 37.5% of those who were initially hormone receptor-positive (HR+) showing subtype switching, and some patients even gained HER2 status.
- - Loss of receptor expression generally led to worse survival outcomes, particularly with estrogen loss, while gaining HER2 status indicated a slight, non-significant improvement in survival; these findings suggest that
Article Synopsis
- The study aimed to evaluate the patterns of postoperative systemic therapy (ST) use and its impact on patient outcomes after surgically removing a solitary breast cancer brain metastasis (BCBM).
- A review of 44 patients indicated that those receiving ST had significantly longer progression-free survival (PFS) and overall survival (OS), particularly ER+ patients who benefited from hormonal therapy.
- Results showed that more patients experienced intracranial progression rather than extracranial, and HER2-targeted therapy did not provide a survival advantage in HER2+ patients, highlighting the need for further research with larger groups.
Objective: Outcome prediction in severe traumatic brain injury (sTBI) has been studied using clinical and radiographic measurements and by using biomarkers such as glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, and tau. Routine blood tests are regularly performed in patients with sTBI and could be used to predict outcomes. This study aims to investigate whether routine blood tests on admission can be predictive of outcome in patients with sTBI.
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- Passive data is generated without active involvement of individuals, like GPS and phone metadata, yet poses ethical issues in healthcare applications.
- A systematic review highlighted major ethical concerns around privacy, consent, and data security, along with access equity and patient ownership issues.
- There's no established ethical framework to balance innovation with patient integrity, and future discussions should address conflicts in ethical and technical values for safe passive data use in healthcare.
Objectives: Major spinal corrective surgeries can be associated with critical intra-operative blood loss. The objective of this systematic review and meta-analysis was to assess the safety and efficacy of tranexamic acid (TXA), a commonly used antifibrinolytic agent, in adult spinal deformity (ASD) surgery, defined as fusion of five or more levels.
Methods: Articles from PubMed, Embase, Cochrane, and clinicaltrials.
Article Synopsis
- This study aimed to compare the long-term effectiveness of two methods for repairing intracranial aneurysms: surgical clipping and endovascular treatment (EVT), focusing on outcomes like recurrence and rebleeding.
- A meta-analysis involving 11 studies and over 4500 patients revealed that coiling (a type of EVT) had significantly higher risks for aneurysm recurrence, retreatment, and rebleeding compared to surgical clipping.
- The findings suggest that surgical clipping may offer better long-term durability for aneurysm repair, highlighting the importance of considering these risks when choosing a treatment approach.
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- The study reviews literature on the dosage and schedule of dexamethasone (DXM) and its impact on clinical outcomes for patients with malignant brain tumors, highlighting the need for evidence-based practices.
- A systematic search revealed 15 relevant studies, indicating that a common dose of 16 mg (4 mg four times a day) is used, but differences among studies prevented a comprehensive analysis.
- Findings indicate that higher DXM doses may lead to more adverse effects without improving patient outcomes, suggesting that lower doses might be just as effective, though further research is urgently needed, particularly with the rise of immunotherapy treatments.
Background: In patients with breast cancer brain metastases (BCBM), time between primary tumor diagnosis and appearance of brain metastases varies widely. Despite being a readily available clinical parameter, it remains unclear whether brain metastasis-free interval (BMFI) carries prognostic value among breast cancer patients. The aim of this study was to compare characteristics and overall survival among patients with varying BMFIs and to assess the prognostic role, if any, for BMFI.
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