Proposed novel classification of circumscribed Lower-Grade Gliomas (cLGG) vs. infiltrating Lower-Grade Gliomas (iLGG): Correlations of radiological features and clinical outcomes.

Purpose: We hypothesize that lower grade gliomas (LGG) can be identified and classified into two distinct subtypes: radiologically circumscribed Lower-Grade Gliomas (cLGG) and infiltrating Lower-Grade Gliomas (iLGG) based on radiological parameters and that these two different subtypes behave differently in terms of clinical outcomes. Methods: We conducted a retrospective cohort study on surgical patients diagnosed with lower grade glioma over five years. Patient records and MRIs were reviewed, and neurosurgeons classified tumors into cLGG and iLGG groups. Results: From the 165 patients in our cohort, 30 (18.2%) patients were classified as cLGG and 135 (81.8%) patients were classified as iLGG Mean age in cLGG was 31.4 years while mean age in iLGG was 37.9 years (p = 0.004). There was significant difference in mean blood loss between cLGG and iLGG groups (270 and 411 ml respectively, p = 0.020). cLGG had a significantly higher proportion of grade II tumors (p < 0.001). The overall mean survival time for the iLGG group was 14.96 ± 1.23 months, and 18.77 ± 2.72 months for the cLGG group. In univariate cox regression, the survival difference between LGG groups was not significant (HR = 0.888, p = 0.581), however on multivariate regression cLGG showed a significant (aHZ = 0.443, p = 0.015) positive correlation with survival. Intense contrast enhancement (HZ = 41.468, p = 0.018), blood loss (HZ = 1.002, p = 0.049), and moderately high Ki-67 (HZ = 4.589, p = 0.032) were also significant on univariate analyses.Conclusion: cLGG and iLGG are radiologically distinct groups with separate prognoses, surgical experience, and associations.

Recent management trends of subependymal giant cell astrocytoma associated with tuberous sclerosis complex.

Subependymal giant cell astrocytomas (SEGA) are benign cranial tumours typically found in patients with tuberous sclerosis complex (TSC). Surgical resection has been the standard treatment for SEGA, however, medical management through mTOR inhibitors has now predominantly replaced surgery as the primary treatment modality. Additionally, newer treatment modalities have emerged with the hopes of providing safer methods for treating the tumour such as laser interstitial thermal therapy (LITT). However, very few reports have addressed these newer methods and analysed the results.

Intraoperative Seizures During Awake Craniotomy for Brain Tumours.

Awake craniotomy (AC) is becoming increasingly popular for brain tumour surgery. The procedure allows better preservation of eloquent cortex and helps achieve greater tumour resection. However, a potential problem with the procedure is intraoperative seizures (IOS) that may affect the mapping and monitoring of awake patients and may even lead to abandoning of the awake procedure.

Neuropsychiatric disorders after awake craniotomy for brain tumour.

Awake-craniotomy (AC) allows maximum tumour resection while reducing the risk of permanent postoperative neurological deficits without compromising the outcomes of the treatment. AC is a potentially stressful procedure for the patients, which may lead to long-term effects on patients' psychology, and may lead to post-traumatic stress. However, there is a scarcity of data suggesting actual association of any neuropsychiatric conditions after AC. Therefore, we sought to review the neuropsychiatric conditions post awake craniotomy.

Quality of Life in Paediatric Survivors of Medulloblastoma.

Medulloblastoma (MB) is among the most common malignant paediatric brain tumours usually arising in the cerebellum. The treatment is surgical resection followed by craniospinal radiation with or without chemotherapy. We assessed the current literature on survivors of MB and their quality of life (QoL). The QoL of MB survivors is significantly compromised in terms of decreased neurocognitive functions, Intelligence Quotient (IQ), and social functioning. These also lead to a compromised overall performance, school performance, lack of employment, social isolation, and caregiver burden. The survivors often self-reported better performances as compared to objective performance and that rated by the caregivers. The predictors of worse QoL include earlier age at diagnosis, hydrocephalus, shunt placement, altered mental status at diagnosis, incomplete/subtotal resection of the tumour, and metastatic disease.

Endoscopic surgical treatment for primary spinal lesions.

Primary spinal cord tumours are infrequently encountered CNS neoplasms and can be broadly classified into intradural intramedullary and intradural extramedullary lesions. Resection of these lesions was traditionally done via open surgical access almost always with microscope assistance. With the advent of minimally invasive surgical techniques, endoscopic excision of these lesions has been attempted for selected tumours. Available literature mainly deals with retrospective reviews on small number of patients; therefore, extensive research is required to establish safety and efficacy of endoscopic approach for excision of primary spinal tumours.

Quality of Life in Children Treated for Craniopharyngiomas.

Craniopharyngiomas are common but complex paediatric brain lesions that present interesting management challenges. Quality of life is an important consideration while choosing management options. In this review, we have discussed the existing literature on various aspects of quality of life in patients treated for craniopharyngioma, assessed by variety of measurement tools.

Surgical outcomes of intramedullary spinal cord ependymomas.

Intramedullary Spinal Cord Ependymomas (ISCE) are uncommon pathologies that need to be aggressively managed before clinical deterioration sets in. Novel application of different therapeutic strategies is being assessed for improving long-term outcomes in patients presenting with these rare neoplasms. In this review, we have discussed the existing literature on ISCEs, and the role of surgery in determining outcomes in terms of neurological status, progression-free survival (PFS) and overall survival (OS).