Increased sensitivity to traumatic axonal injury on postconcussion diffusion tensor imaging scans in National Football League players by using premorbid baseline scans.

Objective: Statistical challenges exist when using diffusion tensor imaging (DTI) to assess traumatic axonal injury (TAI) in individual concussed athletes. The authors examined active professional American football players over a 6-year time period to study potential TAI after concussion and assess optimal methods to analyze DTI at the individual level.

Methods: Active American professional football players recruited prospectively were assessed with DTI, conventional MRI, and standard clinical workup.

Glioblastoma spheroids produce infiltrative gliomas in the rat brainstem.

Purpose: Diffuse intrinsic pontine glioma (DIPG) is universally fatal without proven therapy other than radiation therapy for palliation. Representative animal models will play an essential role in the preclinical stage of future therapy development. To address the shortage of representative models, we created a novel infiltrative brainstem glioma model in rats based on glioblastoma spheroids.

Volumetric response to radiosurgery for brain metastasis varies by cell of origin.

Object: The aim of this study was to evaluate the imaging response of brain metastases after radiosurgery and to correlate the response with tumor type and patient survival.

Methods: The authors conducted a retrospective review of patients who had undergone Gamma Knife radiosurgery for brain metastases from non-small cell lung cancer (NSCLC), breast cancer, or melanoma. The imaging volumetric response by tumor type was plotted at 3-month intervals and classified as a sustained decrease in tumor volume (Type A), a transient decrease followed by a delayed increase in tumor volume (Type B), or a sustained increase in tumor volume (Type C).

The potential of theragnostic ¹²⁴I-8H9 convection-enhanced delivery in diffuse intrinsic pontine glioma.

Background: Reasons for failure in prior human glioma convection-enhanced delivery (CED) clinical trials remain unclear. Concentration-dependent volume of distribution (Vd) measurement of CED-infused agents in the human brain is challenging and highlights a potential technical shortcoming. Activity of iodine isotope 124 ((124)I ) in tissue can be directly measured in vivo with high resolution via PET.

Predicting tumor control after resection bed radiosurgery of brain metastases.

Background: Stereotactic radiosurgery (SRS) to the resection bed of a brain metastasis is an important treatment option.

Objective: To identify factors associated with tumor progression after SRS of the resection bed of a brain metastasis and to evaluate patterns of failure for patients who eventually had tumor progression.

Methods: We performed a retrospective analysis of 120 patients who underwent tumor bed radiosurgery after an initial gross total resection.

Motor function after stereotactic radiosurgery for brain metastases in the region of the motor cortex.

Object: The authors sought to better define the clinical response of patients who underwent stereotactic radiosurgery (SRS) for brain metastases located in the region of the motor cortex.

Methods: A retrospective analysis was performed in 2026 patients with brain metastasis who underwent SRS with the Gamma Knife between 2002 and 2012, and multiple factors that affect motor function before and after SRS were evaluated. Ninety-four patients with tumors ≥ 1.

Comparison of navigated versus non-navigated pedicle screw placement in 260 patients and 1434 screws: screw accuracy, screw size, and the complexity of surgery.

Objective: Computer 3D navigation (3D NAV) techniques in spinal instrumentation can theoretically improve screw placement accuracy and reduce injury to critical neurovascular structures, especially in complex cases. In this series, we analyze the results of 3D NAV in pedicle screw placement accuracy, screw outer diameter, and case complexity in comparison with screws placed with conventional lateral fluoroscopy.

Methods: Pedicle screws placed in the cervical, thoracic, or lumbar spine using either standard lateral fluoroscopy or 3D NAV using isocentric fluoroscopy were retrospectively analyzed.

B7-H3, a potential therapeutic target, is expressed in diffuse intrinsic pontine glioma.

Diffuse intrinsic pontine glioma (DIPG) is a brain cancer with a median survival of only 1 year. Lack of molecular characterization of this tumor impedes the development of novel therapies. Membrane protein B7-H3, aka CD276, involved in interactions with host defenses in certain cancers, has been shown to be over-expressed in the majority of malignant neuroectodermal tumors including adult high-grade glioma.

The value of intraoperative electrocorticography in surgical decision making for temporal lobe epilepsy with normal MRI.

Purpose: We hypothesized that acute intraoperative electrocorticography (ECoG) might identify a subset of patients with magnetic resonance imaging (MRI)-negative temporal lobe epilepsy (TLE) who could proceed directly to standard anteromesial resection (SAMR), obviating the need for chronic electrode implantation to guide resection.

Methods: Patients with TLE and a normal MRI who underwent acute ECoG prior to chronic electrode recording of ictal onsets were evaluated. Intraoperative interictal spikes were classified as mesial (M), lateral (L), or mesial/lateral (ML).

Interstitial infusion of glioma-targeted recombinant immunotoxin 8H9scFv-PE38.

Monoclonal antibodies have the potential to target therapy for high-grade gliomas. Monoclonal antibody 8H9 is specific for membrane protein B7H3 and is reactive with most human high-grade gliomas. We tested the 8H9scFv-PE38 recombinant Pseudomonas immunotoxin in a preclinical model of high-grade glioma.

Subarachnoid dissemination of intraventricular tumors following simultaneous endoscopic biopsy and third ventriculostomy.

Object: Endoscopic biopsy with concomitant third ventriculostomy (ETV) is a well-established diagnostic and therapeutic maneuver in patients presenting with noncommunicating hydrocephalus resulting from a tumor of the pineal region or posterior third ventricle. Fenestration of the floor of the third ventricle theoretically provides a conduit for the subarachnoid dissemination of an intraventricular tumor. The aim of this study was to ascertain the rate of leptomeningeal dissemination following this surgical procedure.

Interstitial infusion of erlotinib in the rodent brain.

A critical need exists for the development of novel forms of treatment for high-grade glioma. Molecular characterization of high-grade glioma has shown overexpression of the epidermal growth factor receptor, antagonists to which, including erlotinib, may prevent tumor growth. Interstitial infusion is a mode of local delivery which bypasses the blood-brain barrier and utilizes a pressure-dependent gradient to enhance drug uniformity and volume of distribution.

Intraparenchymal and intratumoral interstitial infusion of anti-glioma monoclonal antibody 8H9.

Objective: Interstitial infusion, a form of local delivery that bypasses the blood-brain barrier, has been shown to afford high regional concentrations of a therapeutic molecule while avoiding systemic exposure. The distribution of monoclonal antibodies administered via interstitial infusion has not been characterized, and this is salient in light of the potential sequestration by epitopes expressed by targeted tissue. Interstitial delivery of murine immunoglobulin G1 monoclonal antibody (MAb) 8H9 was investigated in a rodent model for the potential treatment of infiltrative gliomas.

Giant cell tumor of the spine.

Giant cell tumors are benign but locally aggressive neoplasms that typically affect the extremities. When involving the spine, the tumors occur predominantly in the sacrum. Gross total resection of the tumor with wide margins yields good results in terms of survival.

Endoscopic resection of solid intraventricular brain tumors.

Object: Endoscopic removal of intraventricular brain tumors is well established for cystic tumors such as colloid cysts. Aspiration followed by removal or ablation of the membranous wall is possible given the constituent features of these tumors. It is generally expected that endoscopic removal of solid brain tumors from the intraventricular compartment would impose additional technical demands.

Novel low-grade glioneuronal neoplasm presenting in an octogenarian: case report and review of the literature.

Glioneuronal neoplasms are rare tumors that typically affect patients in the first three decades of life. Since the publication of the World Health Organization (WHO) 2000 classification of tumors, further variants of these tumors have been reported. We present an 83-year-old gentleman who presented with a history of ataxia and weight loss.

Correlation of endoscopic biopsy with tumor marker status in primary intracranial germ cell tumors.

We retrospectively analyzed the results of eight patients who underwent endoscopic biopsy of a newly diagnosed primary intracranial germ cell tumor (GCT), and correlated tumor pathology with serum and cerebrospinal fluid (CSF) tumor markers and treatment outcome in order to determine the reliability of GCT sampling by this method. A biopsy diagnosis was made in each patient, and the tumor histology correlated with tumor marker measurements for all six patients diagnosed with germinoma and for one with a yolk sac tumor. One biopsy revealed only mature teratoma, an inconclusive result since the patient's serum and CSF tumor markers were elevated.

Intracranial nasal natural killer/T-cell lymphoma: immunopathologically-confirmed case and review of literature.

Advances in immunophenotypic profiling now permit characterization of natural killer/T-cell (NK/T-cell) lymphoma as distinct from other extranodal T- and B-cell Non-Hodgkin's lymphomas. NK/T-cell lymphoma presents most commonly in the nasal cavity. Disease progression to the central nervous system (CNS) is a rare phenomenon.

Hemorrhagic sequelae from intracranial neuroendoscopic procedures for intraventricular tumors.

Object: Concern regarding the ability to accomplish adequate hemostasis during intracranial neuroendoscopy is often cited as a potential obstacle for primary endoscopic tumor management. In this study, the rate of clinically significant hemorrhage encountered as a result of endoscopic surgery for an intraventricular brain tumor is examined.

Methods: A total of 86 patients underwent an endoscopic biopsy procedure or resection of an intraventricular tumor.

Neuroendoscopic resection of posterior third ventricular ependymoma. Case report.

The practice of neuroendoscopy in the definitive management of cystic tumors and hydrocephalus has been well established. Resection of solid intraventricular tumors by a primary endoscopic technique, however, has rarely been demonstrated. The authors present the case of a 31-year-old woman in whom endoscopic resection of a posterior third ventricular ependymoma was successfully accomplished.

Multiple primary soft tissue sarcomas.

Background: The synchronous or metachronous development of multiple primary soft tissue sarcomas (STS) of different histopathology has been reported only in isolated case reports.

Methods: The records of patients who developed multiple primary STS and who were treated at a tertiary cancer center between 1982 and 2003 were reviewed.

Results: Nine patients with multiple primary STS were identified, representing 0.