EPIDEMIOLOGY, IMAGING, DIAGNOSIS, CLINICAL PRESENTATIONS AND TREATMENT OF PRIMARY GLIOBLASTOMA IN RELATION TO PROGNOSIS: A CLINICAL CASE STUDY

GBM is the most common primary intracranial malignancy. Previous studies found its incidence varying substantially by age, sex, race and ethnicity and survival also varies by country, ethnicity and treatment. There is slight predominance in males, incidence increases with age. The standard approach of therapy is the newly diagnosed setting include surgery followed by concurrent radiotherapy with temozolomide. The recently revised classi?cation of GBM is based on molecular pro?ling notably isocitrate dehydrogenase mutation status. Our study included only patients who had undergone surgery in our institute in the past 1 year and diagnosed with grade IV astrocytoma as per biopsy report. We have excluded patients with other high grade tumors. We have used non-invasive brain imaging techniques such as CT scan and MRI for visualising tumors. We have included 32 patients, 22 men and 10 women, who were diagnosed with glioblastoma in our institute in the past 1 year . The median age of diagnosis among men is 50 years and that of women is 46 years. All of our patients were from Eastern India. Among these, 8 men and 2 women expired within 3 months of undergoing surgery before radiotherapy and chemotherapy. Thus, the mortality rate was nearly 31% during our study. We have found most of the patients presenting with headache, nausea, vomiting, seizure and hemiparesis. Extent of resection has varied from patient to patient thus leading to differences in outcome, morbidity and mortality. Outcome depends on performance status, advanced age, eloquent location, extent of resection and availability of chemo-radiotherapy.

Demographic study of brain tumour in a neurosurgical department in Terengganu, Malaysia

@#patients, families as well as the surrounding communities,especially the healthcare services. It can be classified intoeither a benign slow growing tumour (non-cancerous) andmalignant tumour (cancerous). The purpose of this studywas to determine the incidence and pattern of brain tumouradmitted to the Neurosurgery Department in HospitalSultanah Nurzahirah (HSNZ), Terengganu, Malaysia.Methods: This is a retrospective study of incidence andpattern of BT admitted to the Neurosurgery Department inHSNZ. Data was collected from the yearly census of BTregistered from 2013 to 2018.Results: A total number of 386 new cases of primary BT wereregistered. The number of cases of BT was found to belowest among children (0 to 10 years old) with only 4.4% butat peak among elderly aged between 51 to 60 years old(26.2%). As for gender, males constituted about 44.5%(n=172) whereas females accounted for 55.5% (n= 214) of thecases. In total, meningioma was found to have the highestincidence (27.2%) followed by metastases brain tumour(18.1%) and glioma (17.4%). Conclusions: This study has shown that the incidence of BTwas led by meningioma which had a high prevalence amongthe elderly population, followed by metastasis BT andgliomas.

Deep Vein Thrombosis and the Neurosurgical Patient

@#Background: Neurosurgical patients are varied, encompassing cranial and spinal diseases and trauma, and are admitted under both elective and emergency settings. In all settings, neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT). We conducted a study to identify the factors associated with DVT among neurosurgical patients, and the overall rate of occurrence at our centre. We aimed to also compare our results to the incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis was undertaken. We also included the Well’s score to validate its usefulness in screening for DVT in our local setting. Methods: All patients admitted into our centre were screened for eligibility and those who underwent surgery from September 2016 to September 2017 had a D-dimer screening after surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant therapy was not influenced by this study, and observation of the use was in keeping with usual practices in our centre was done. Results: A total number of 331 patients were recruited in this study, however, after the inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate analysis, the Well’s score and the number of days in bed remained statistically significant, after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT prophylaxis with an adjusted odd’s ratio, and a confidence interval of 95%, and P < 0.05 for each. Conclusion: Well’s scoring and number of days in bed were independent factors affecting the rate of DVT in patients undergoing neurosurgical procedures in our centre.

Arteriovenous malformation masking associated anaplastic ganglioglioma in an adolescent / Malformación arteriovenosa asociada enmascara un ganglioglioma anaplásico multifocal en un adolescente

Abstract Grade III anaplastic ganglioglioma is an aggressive, rare, and radiosensitive central nervous system (CNS) tumour. It is more common in males, with a ratio of 1.3 to 1. Its peak incidence is in the third decade of life. Only 10 cases were recorded in children in Colombia from 2000 to 2014, with a fatal outcome in spite of radiation therapy. This is a case of an adolescent, who began having headaches, with warning signs related to an arteriovenous malformation hindering the diagnosis of this rare tumour. This presented in its aggressive, multi-focus form. Knowledge of clinical manifestations of space-occupying intracranial lesions facilitates the assessment and treatment of affected children.

Resumen El ganglioglioma anaplásico grado III es un tumor del sistema nervioso central (SNC) agresivo, infrecuente y radiosensible. Afecta más a hombres en una relación 1,3 a 1. Su pico de incidencia se encuentra en la tercera década de la vida. Existen solo 10 casos registrados en niños en Colombia desde el 2000 al 2014, con desenlace fatal a pesar de la radioterapia. Se presenta un caso de un adolescente que debutó con cefalea con signos de alarma asociado a una malformación arteriovenosa que dificultó el diagnóstico de este raro tumor, cuya presentación fue la más agresiva: la forma multicéntrica. El conocer las manifestaciones clínicas de lesiones intracraneales ocupantes de espacio facilita la evaluación y tratamiento a los niños afectados.

An Improved Classification System for Brain Tumours Using Wavelet Transform and Neural Network / Un sistema de clasificación mejorado para los tumores cerebrales usando la transformada de ondeletas y la red neuronal

ABSTRACT This paper presents an improved classification system for brain tumours using wavelet transform and neural network. The anisotropic diffusion filter was used for image denoising, and the performance of the oriented rician noise reducing anisotropic diffusion (ORNRAD) filter was validated. The segmentation of the denoised image was carried out by fuzzy c-means clustering. The features were extracted using symlet and coiflet wavelet transforms, and the Levenberg-Marquardt algorithm based neural network was used to classify the magnetic resonance (MR) images. This classification technique of MR images was tested and analysed with existing methods, and its performance was found to be satisfactory with a classification accuracy of 93.24%. The developed system could assist physicians in classifying MR images for better decision-making.

RESUMEN Este artículo presenta un sistema de clasificación mejorado para los tumores de cerebro usando la transformada de ondeletas (transformada wavelet) y la red neuronal. El filtro de difusión anisotrópica fue utilizado para la eliminación del ruido de la imagen, y se validó el funcionamiento del filtro de difusión anisotrópica orientado a reducir el ruido riciano (ORNRAD, siglas en inglés). La segmentación de la imagen 'desruidizada ' (denoised) fue realizada mediante el agrupamiento difuso c-means fuzzy. Las características fueron extraídas usando las transformadas de ondeletas symlet y coiflet, y la red neuronal basada en el algoritmo de Levenberg-Marquardt fue utilizada para clasificar las imágenes de resonancia magnética (RM) imágenes. Esta técnica de clasificación de imágenes de RM fue probada y analizada con métodos existentes, y se halló que su rendimiento era satisfactorio con una precisión de clasificación de 93.24%. El sistema desarrollado podría ayudar a los médicos a clasificar imágenes de RM para una mejor toma de decisiones.

Glioblastoma multiforme outcomes of 107 patients treated in two Singapore institutions

<p><b>INTRODUCTION</b>Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults. Although the survival rate for GBM has improved with recent advancements in treatment, the prognosis remains generally poor.</p><p><b>METHODS</b>We conducted a retrospective review of GBM patients seen in National University Hospital, Singapore, and Tan Tock Seng Hospital, Singapore, from January 2002 to December 2011. Data on disease and treatment factors was collected and correlated with survival.</p><p><b>RESULTS</b>Data on a total of 107 GBM patients was analysed. Their median survival time was 15.1 months and the two-year survival rate was 23.5%, which is comparable with data published in other series. The factors associated with improved median survival time were radiotherapy dose > 50 Gy (16.1 months vs. 8.7 months, p = 0.01) and adjuvant concurrent chemotherapy (16.4 months vs. 9.2 months, p = 0.003).</p><p><b>CONCLUSION</b>GBM confers a poor prognosis. Adjuvant radiotherapy and chemotherapy are associated with improved survival. Ethnicity may be a contributing factor to differences in GBM incidence and prognosis.</p>

Glioblastoma Multiforme Metastasizing to Humerus and Craniospinal Axis.

Glioblastoma multiforme (GBM) is the most common malignant brain tumour. GBM metastasizing to humerus has never been reported. This is the first such case of recurrent GBM to be reported in medical literature with both extracranial and cerebrospinal dissemination. Our case amply demonstrated the need to keep vigil and high index of suspicion while interpreting the clinical and radiological findings in GBM wih a risk of CSF spread and systemic metastases.

A swelling on the fore head- the tip of the iceberg.

An epidermoid cyst is a benign cyst usually found on the skin, developing out of ectodermal tissue. These are relatively uncommon benign cysts or tumors to arise over the surface of the brain. They are mostly intra dural and few percentages are located in the diploic space. We are reporting a case of 51 years old lady presenting with a swelling over forehead which was diagnosed to be an intradiploic epidermoid cyst of the frontal bone with an intracranial extension which is an unusual presentation causing clinical dilemma. Radiological findings led to a correct diagnosis and with complete removal patient is doing well.

The prevalence of human cytomegalovirus DNA in gliomas of Brazilian patients

Members of the Herpesviridae family have been implicated in a number of tumours in humans. At least 75% of the human population has had contact with cytomegalovirus (HCMV). In this work, we screened 75 Brazilian glioma biopsies for the presence of HCMV DNA sequences. HCMV DNA was detected in 36% (27/75) of the biopsies. It is possible that HCMV could be a co-factor in the evolution of brain tumours.