Frailty is associated with mortality in brain tumor patients.

Frailty represents a state of vulnerability that increases the risk of adverse health outcomes. In the last years, frailty has emerged as a good indicator of patient's functional reserve and it seems to be a predictor of negative outcomes in oncological patients. In this work, we analyzed the clinical utility of frailty as preoperative risk assessment tool in a brain tumor cohort from Donostia University Hospital (Spain). For that, we used several frailty tools consisting of questionnaires based on frailty phenotype (FRAIL scale), evaluating functional performance (Gait Speed) and a self-report questionnaire that includes variables related to the physical, cognitive and psychosocial domains of frailty (Tilburg Frailty Indicator). We identified a higher percentage of patients in vulnerable situation prior to surgery when using frailty tools compared to routine scales such as Karnosfky score and Barthel Index. Remarkably, patients diagnosed with malignant tumors were frailer and presented significant less six-month survival than patients with benign tumors by all the frailty scales abovementioned. In line with this, the vast majority of patients that became pre-frail or frail after neurosurgery (by FRAIL scale) harbored a malignant tumor. Moreover, frailty status significantly correlated with patient's mortality and autonomy, but not with the presence of postoperative outcomes in our cohort. Taken together, our results show that frailty measurement, mainly by FRAIL scale, is a useful tool to evaluate preoperative risk in brain tumor patients as well as patient's prognosis after neurosurgery.

Trigeminal root massage in microsurgical treatment of trigeminal neuralgia patients without arterial compression: When, how and why / Masaje de la raíz trigeminal en el tratamiento quirúrgico de la neuralgia de trigémino sin contacto neurovascular arterial: cuándo, cómo y porqué

BACKGROUND: During the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call "trigeminal root massage" (TRM). METHODS: 52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. RESULTS: All 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. CONCLUSIONS: The described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don't find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as "nerve combing". Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression

INTRODUCCIÓN Y OBJETIVOS: Durante la exploración microquirúrgica de la raíz trigeminal en el ángulo pontocerebeloso en pacientes con neuralgia del trigémino (NT) primaria sin una evidente compresión arterial, el cirujano se encuentra en una situación comprometida, ya que no existe una estrategia quirúrgica establecida. El objetivo de este estudio es la de describir en esos casos una maniobra quirúrgica que llamamos «masaje de la raíz trigeminal» (MRT). MÉTODOS: Se revisan un total de 52 pacientes consecutivos con NT primaria a quienes se ha realizado una exploración de la raíz trigeminal por vía suboccipital retrosigmoidea. Entre ellos hemos encontrado 10 pacientes sin una evidente compresión arterial durante la exploración microquirúrgica. En 8 de los 10 casos ha existido un contacto venoso de la raíz trigeminal a lo largo de su trayectoria cisternal, procediendo a la coagulación y sección de la/s vena/s. En los 10 casos se ha procedido, finalmente, a un suave masaje de la raíz trigeminal sin interposición de ningún material. RESULTADOS: Los 10 pacientes experimentaron una inmediata desaparición de la neuralgia y el curso postoperatorio fue favorable excepto por un caso de complicación severa con edema cerebeloso, meningitis e hidrocefalia. La recidiva fue del 40%. Seis pacientes obtuvieron una desaparición completa de la neuralgia, sin medicación específica, en un seguimiento medio de 5 años. No ha habido mortalidad ni anestesia dolorosa postoperatoria. CONCLUSIONES: La maniobra quirúrgica descrita es una alternativa útil y sencilla en casos donde, durante la exploración microquirúrgica de la raíz trigeminal, no encontramos una clara compresión arterial, con resultados similares a otras posibilidades como la rizotomía parcial o más laboriosas como la llamada nerve combing. En cualquier caso, un 40% de recidiva dolorosa a los 5 años significa que, aunque es una buena alternativa, no es una técnica definitiva en la curación de todos los enfermos con NT sin conflicto arterial

Trigeminal root massage in microsurgical treatment of trigeminal neuralgia patients without arterial compression: When, how and why.

BACKGROUND: During the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call "trigeminal root massage" (TRM). METHODS: 52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. RESULTS: All 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. CONCLUSIONS: The described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don't find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as "nerve combing". Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression.

PR-LncRNA signature regulates glioma cell activity through expression of SOX factors.

Long non-coding RNAs (LncRNAs) have emerged as a relevant class of genome regulators involved in a broad range of biological processes and with important roles in tumor initiation and malignant progression. We have previously identified a p53-regulated tumor suppressor signature of LncRNAs (PR-LncRNAs) in colorectal cancer. Our aim was to identify the expression and function of this signature in gliomas. We found that the expression of the four PR-LncRNAs tested was high in human low-grade glioma samples and diminished with increasing grade of disease, being the lowest in glioblastoma samples. Functional assays demonstrated that PR-LncRNA silencing increased glioma cell proliferation and oncosphere formation. Mechanistically, we found an inverse correlation between PR-LncRNA expression and SOX1, SOX2 and SOX9 stem cell factors in human glioma biopsies and in glioma cells in vitro. Moreover, knock-down of SOX activity abolished the effect of PR-LncRNA silencing in glioma cell activity. In conclusion, our results demonstrate that the expression and function of PR-LncRNAs are significantly altered in gliomagenesis and that their activity is mediated by SOX factors. These results may provide important insights into the mechanisms responsible for glioblastoma pathogenesis.

Therapeutic strategies targeting glioblastoma stem cells.

Glioblastoma is the most common, aggressive and lethal brain tumor in adults. However, current therapeutic protocols have low success rates and average overall survival is less than 15 months. The resistance to therapy is largely a result of the remarkable cellular and phenotypical heterogeneity that characterizes this type of tumor. The discovery of a subpopulation of cells exhibiting stem cell properties within the tumor bulk has profound implications for therapy as increasing evidence indicates that these cells, glioblastoma stem cells (GSCs), are responsible for the origin, maintenance and recurrence of the glioblastomas. These findings highlight the need to characterize GSCs in order to find novel treatments directly targeted specifically against them. In this review, we summarize the current knowledge regarding this issue, including some recent and relevant patents.

Funciones y organización de un comité de neurooncología en un hospital con servicio de neurocirugía / Functions and organisation of a neuro-oncology committee in hospitals with a neurosurgery service

El Grupo de Trabajo de Neurooncología (GTNO) de la SENEC ha encargado a los miembros del comité de neurooncología del Hospital Universitario Donostia de San Sebastián (España) la elaboración del presente documento, para que sirva como Guía del consenso establecido en el seno del GTNO y recomendación propuesta en todos los hospitales, públicos o privados, que manejan esta patología. Es obligado la constitución y funcionamiento normalizado de comités de neurooncología en todos los centros con servicio de neurocirugía, y lo expuesto a continuación debe contemplarse a la luz de las condiciones particulares de los mismos, con las variaciones pertinentes según los recursos diagnósticos y terapéuticos. Nos presentan a continuación el ejemplo de la constitución, funcionamiento y experiencia que han contraído en más de 8 años de trabajo multidisciplinar en pacientes con tumores cerebrales (AU)

The Neuro-Oncology Study Group (NOSG) at SENEC has commissioned the elaboration of the present document to the Neuro-Oncology Committee at Donostia University Hospital. It is intended to serve as a NOSG Consensus Guide and a proposed recommendation for the management of his pathological conditionatallSpanishHospitals,bothpublicandprivate.Neuro-Oncology Committees must be established and active at all centres with a Neurosurgery Service, taking into account the specific diagnostic and therapeutic capacity available. The work presents an example of the constitution, functioning and experience of such a Committee, drawing on 8 years of multidisciplinary work with brain tumour patients (AU)

[Functions and organisation of a neuro-oncology committee in hospitals with a neurosurgery service]. / Funciones y organización de un comité de neurooncología en un hospital con servicio de neurocirugía.

The Neuro-Oncology Study Group (NOSG) at SENEC has commissioned the elaboration of the present document to the Neuro-Oncology Committee at Donostia University Hospital. It is intended to serve as a NOSG Consensus Guide and a proposed recommendation for the management of this pathological condition at all Spanish Hospitals, both public and private. Neuro-Oncology Committees must be established and active at all centres with a Neurosurgery Service, taking into account the specific diagnostic and therapeutic capacity available. The work presents an example of the constitution, functioning and experience of such a Committee, drawing on 8 years of multidisciplinary work with brain tumour patients.

Trochlear nerve palsy after repeated percutaneous balloon compression for recurrent trigeminal neuralgia: case report and pathogenic considerations.

OBJECTIVE AND IMPORTANCE: Repeated percutaneous balloon compression for the treatment of idiopathic trigeminal neuralgia is infrequent. When a second procedure is performed, the outcome is unknown. A patient developed an isolated trochlear nerve palsy after undergoing percutaneous trigeminal ganglion balloon compression for a second time. The mechanism of diplopia and the complications associated with this technique were studied. CLINICAL PRESENTATION: The patient was a 67-year-old woman with a history of medically refractory idiopathic trigeminal neuralgia involving all three divisions of the right trigeminal nerve. INTERVENTION: Percutaneous balloon compression was performed. Despite initial total relief from pain without complications, the patient again displayed manifestations of trigeminal neuralgia 3 months after the procedure. The pain disappeared after she underwent a second balloon compression procedure, but she developed an isolated trochlear nerve palsy, which spontaneously resolved in 2 months. CONCLUSION: Isolated trochlear nerve palsy is a rare and reversible complication after percutaneous balloon compression for trigeminal neuralgia. This case illustrates that the mechanism of injury to the fourth nerve is the result of an erroneous technique: excessive penetration of the Fogarty catheter in Meckel's cave beyond the porus trigemini and compression of the cisternal segment of the trochlear nerve when the inflated balloon is pushed against the tentorium.