Glioma outcome

Glioma outcome

In order to set up a reliable prediction system for the tumor grade and glioma outcome, Li et al. clarified the complicated crosstalk of Annexin A2 (ANXA2) with Glypican 1 (GPC1) and demonstrate whether combined indexes of ANXA2 and GPC1 could improve the prognostic evaluation for glioma patients. Li et al. found that ANXA2-induced glioma cell proliferation in a c-Myc-dependent manner. ANXA2 increased the expression of GPC1 via c-Myc and the upregulated GPC1 further promoted the c-Myc level, forming a positive feedback loop, which eventually led to enhanced proliferation of glioma cells. Both mRNA and protein levels of ANXA2 were upregulated in glioma tissues and coincided with the overexpression of GPC1. Besides, they utilized tissue microarrays (TMAs) and immunohistochemistry to demonstrate that glioma patients with both high expressions of ANXA2 and GPC1 tended to have a higher rate of tumor recurrence and shorter overall survival (OS). In conclusion, the overexpression of ANXA2 promotes proliferation of glioma cells by forming a GPC1/c-Myc positive feedback loop, and ANXA2 together with its downstream target GPC1 could be a potential “combination biomarker” for predicting the prognosis of glioma patients 1).

see Glioma Quality of Life.


The ability to resume professional activities following brain tumor surgery is an important patient-oriented outcome parameter. Senft et al. found that the majority of patients with gliomas were able to return to work following surgical and adjuvant treatment. Preservation of neurological function is of utmost relevance for individual patients quality of life 2)


Patients with IDH and TERTp glioma mutations have the best prognosis, and only IDH mutation patients and only TERTp mutation patients have the worst prognosis. Moreover, the molecular classification of gliomas by mutations of IDH and TERTp is not suitable for pediatric patients 3).

Also the O6 methylguanine DNA methyltransferase (MGMT) promoter methylation status seem to be the most important predictors of survival.


Infiltrative gliomas invade the brain, relentlessly recur, transform into higher-grade gliomas, and are invariably lethal 4) 5) 6). , mostly due to the poor glioblastoma outcome (Grade IV glioma).

Gliomas are considered incurable due to recurrence as demonstrated in a series of five patients who underwent hemispherectomies in 1928 7).

The prognosis improves as the amount of glioma removed increases 8) 9) 10) 11) 12).

Older age (>40 years), high pathological grade, invasion of the corpus callosum and high levels of Ki67 expression were risk factors associated with the intracranial dissemination of gliomas 13).


1)

Li X, Nie S, Lv Z, Ma L, Song Y, Hu Z, Hu X, Liu Z, Zhou G, Dai Z, Song T, Liu J, Wang S. Overexpression of Annexin A2 promotes proliferation by forming a Glypican 1/c-Myc positive feedback loop: prognostic significance in human glioma. Cell Death Dis. 2021 Mar 12;12(3):261. doi: 10.1038/s41419-021-03547-5. PMID: 33712571.
2)

Senft C, Behrens M, Lortz I, Wenger K, Filipski K, Seifert V, Forster MT. The ability to return to work: a patient-centered outcome parameter following glioma surgery. J Neurooncol. 2020 Sep 22. doi: 10.1007/s11060-020-03609-2. Epub ahead of print. PMID: 32960402.
3)

Qu CX, Ji HM, Shi XC, Bi H, Zhai LQ, Han DW. Characteristics of the isocitrate dehydrogenase gene and telomerase reverse transcriptase promoter mutations in gliomas in Chinese patients. Brain Behav. 2020 Mar 8:e01583. doi: 10.1002/brb3.1583. [Epub ahead of print] PubMed PMID: 32146731.
4)

DeAngelis LM (2001) Brain tumors. N Engl J Med 344:114–123.
5)

Wen PY, Kesari S (2008) Malignant gliomas in adults. N Engl J Med 359:492–507.
6)

Behin A, Hoang-Xuan K, Carpentier AF, et al.(2003) Primary brain tumours in adults. Lancet 361:323–331.
7)

Dandy WE. Removal of right cerebral hemisphere for certain tumors with hemiplegia: preliminary report. JAMA. 1928;90:823–825.
8)

Chan-Seng E, Moritz-Gasser S, Duffau H. Awake mapping for low-grade gliomas involving the left sagittal stratum: Anatomofunctional and surgical considerations. J Neurosurg. 2014;120:1069–1077. doi: 10.3171/2014.1.JNS132015.
9)

Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery. 2008;62:753–764. doi: 10.1227/01.neu.0000318159.21731.cf.
10)

Han SJ, Sughrue ME. The rise and fall of ‘biopsy and radiate’: A history of surgical nihilism in glioma treatment. Neurosurg Clin N Am. 2012;23:207–214. doi: 10.1016/j.nec.2012.02.002.
11)

Giussani C, Roux FE, Ojemann J, Sganzerla EP, Pirillo D, Papagno C. Is preoperative functional magnetic resonance imaging reliable for language areas mapping in brain tumor surgery? Review of language functional magnetic resonance imaging and direct cortical stimulation correlation studies. Neurosurgery. 2010;66:113–120. doi: 10.1227/01.NEU.0000360392.15450.C9.
12)

Choi BD, Mehta AI, Batich KA, Friedman AH, Sampson JH. The use of motor mapping to aid resection of eloquent gliomas. Neurosurg Clin N Am. 2012;23:215–225. doi: 10.1016/j.nec.2012.01.013.
13)

Cai X, Qin JJ, Hao SY, Li H, Zeng C, Sun SJ, Yu LB, Gao ZX, Xie J. Clinical characteristics associated with the intracranial dissemination of gliomas. Clin Neurol Neurosurg. 2018 Feb 1;166:141-146. doi: 10.1016/j.clineuro.2018.01.038. [Epub ahead of print] PubMed PMID: 29427894.

Idiopathic normal pressure hydrocephalus outcome

Idiopathic normal pressure hydrocephalus outcome

Mild preoperative Idiopathic normal pressure hydrocephalus severity, shorter preoperative symptom duration, good tap test response, and complete disproportionately enlarged subarachnoid space hydrocephalus (DESH) were associated with good short-term postoperative outcome at 1 year. These positive factors may be useful for prediction of short-term surgical outcome in iNPH patients 1)


Comorbid conditions interfere with the ability to assess progression of iNPH and the effectiveness of the shunt. Patient caregivers play a large role in decision-making and clinical course, and should be included when counseling patients 2).

A 2001 meta-analysis of outcomes reported the Idiopathic normal pressure hydrocephalus treatment to have a 29% rate of significant improvement and a 6% significant complication rate 3).

A study in 2005 revealed greater improvements, with 75% of patients (n = 132) seeing postoperative improvements within 24 months of surgery 4), 68% of patients experiencing “very good” or “good” outcomes in a prospective study 5), and 69%–84% of patients seeing improvements by 1 year after surgery in a prospective multicenter study 6).

Studies that have established fixed protocols for follow-up have shown that short- and long-term periods after shunting are determined by many factors. Whereas short-term results were more likely to be influenced by shunt-associated risks, long-term results were independent of factors inherent to the shunt procedure and shunt complications, i.e., death and morbidity related to concomitant cerebrovascular and vascular diseases 7).

In 2013 a total of 64 studies of 3,063 patients were reviewed. Positive improvement following shunt insertion was reported in an average of 71 % of patients with an average 1 % mortality. Results from studies published in the last 5 years showed 82 % improvement following shunt insertion, mortality of 0.2 %, and combined common complications rate of 8.2 % 8).

Analysis of the efficacy of shunts for possible iNPH conducted in Japan indicated a significant improvement in the mRS grade between baseline and outcome within 1 year, regardless of the surgical technique, and shunt intervention was found to be effective 9).


Clinically, patients presenting with early or severe dementia have worse outcome, while those with a primary gait disturbance feature have better results 10) 11).


Clinical improvement of patients with iNPH can be sustained for 5-7 years in some patients, even if shunt revision surgery is needed multiple times. With earlier diagnosis and treatment and the increasing lifespan of the ageing population, the need for long-term follow-up after shunt surgery may be greater than it was in the past. Monitoring, identification and treatment of shunt obstruction is a key management principle 12).

Gait and Incontinence

Postoperative improvement of Gait and Urinary incontinence is obtained at an early stage 13) 14). In contrast, Dementia tends to improve gradually from after the third postoperative month. The family satisfaction increases as the symptom of Dementia improve. The satisfaction of the medical personnel tends to remain high after the first postoperative month 15).

Independent predictors

Independent predictors of improvement are the presence of gait impairment as the dominant symptom and shorter duration of symptoms 16).

see Caregiver burden in idiopathic normal pressure hydrocephalus.


1)

Kimura T, Yamada S, Sugimura T, Seki T, Miyano M, Fukuda S, Takeuchi M, Miyata S, Tucker A, Fujita T, Hashizume A, Izumi N, Kawasaki K, Nakagaki A, Sako K. Preoperative Predictive Factors of Short-Term Outcome in Idiopathic Normal Pressure Hydrocephalus (iNPH). World Neurosurg. 2021 Apr 22:S1878-8750(21)00596-9. doi: 10.1016/j.wneu.2021.04.055. Epub ahead of print. PMID: 33895373.
2)

Subramanian HE, Mahajan A, Sommaruga S, Falcone GJ, Kahle KT, Matouk CC. The subjective experience of patients undergoing shunt surgery for idiopathic normal pressure hydrocephalus. World Neurosurg. 2018 Jul 4. pii: S1878-8750(18)31425-6. doi: 10.1016/j.wneu.2018.06.209. [Epub ahead of print] PubMed PMID: 29981467.
3)

Hebb AO, Cusimano MD: Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186, 2001
4) , 16)

McGirt MJ, Woodworth G, Coon AL, Thomas G, Williams MA, Rigamonti D. Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005 Oct;57(4):699-705; discussion 699-705. PubMed PMID: 16239882.
5)

Meier U, Kiefer M, Neumann U, Lemcke J: On the optimal opening pressure of hydrostatic valves in cases of idiopathic normal-pressure hydrocephalus: a prospective randomized study with 123 patients. Acta Neurochir Suppl 96:358–363, 2006
6)

Wikkelsø C, Hellström P, Klinge PM, Tans JT: The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 84:562–568, 2013
7)

Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PM. Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery. 2005 Sep;57(3 Suppl):S40-52; discussion ii-v. Review. PubMed PMID: 16160428.
8)

Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien). 2013 Oct;155(10):1977-80. doi: 10.1007/s00701-013-1835-5. Epub 2013 Aug 23. Review. PubMed PMID: 23975646.
9)

Nakajima M, Miyajima M, Ogino I, Akiba C, Kawamura K, Kurosawa M, Kuriyama N, Watanabe Y, Fukushima W, Mori E, Kato T, Sugano H, Karagiozov K, Arai H. Shunt Intervention for Possible Idiopathic Normal Pressure Hydrocephalus Improves Patient Outcomes: A Nationwide Hospital-Based Survey in Japan. Front Neurol. 2018 Jun 7;9:421. doi: 10.3389/fneur.2018.00421. eCollection 2018. PubMed PMID: 29942280; PubMed Central PMCID: PMC6004916.
10)

Bugalho P, Alves L, Ribeiro O. Normal pressure hydrocephalus: a qualitative study on outcome. Arq Neuropsiquiatr. 2013 Nov;71(11):890-5. doi: 10.1590/0004-282×20130173. PubMed PMID: 24394877.
11)

Poca MA, Mataró M, Matarín M, Arikan F, Junqué C, Sahuquillo J. Good outcome in patients with normal-pressure hydrocephalus and factors indicating poor prognosis. J Neurosurg. 2005 Sep;103(3):455-63. PubMed PMID: 16235677.
12)

Pujari S, Kharkar S, Metellus P, Shuck J, Williams MA, Rigamonti D. Normal pressure hydrocephalus: long-term outcome after shunt surgery. J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1282-6. doi: 10.1136/jnnp.2007.123620. Epub 2008 Mar 20. PubMed PMID: 18356257.
13)

Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M: Five-year outcome of normal pressure hydrocephalus with or without a shunt: predictive value of the clinical signs, neuropsychological evaluation and infusion test. Acta Neurochir (Wien) 144:515–523, 2002
14) , 15)

Takeuchi T, Goto H, Izaki K, Tamura S, Sasanuma Z, Maeno K, Kikuchi Y, Tomii M, Koizumi Z, Watanabe Z, Numazawa S, Ito Y, Ohara H, Kowada M, Watanabe K. Postoperative patterns of improvement of symptoms and degrees of satisfaction in families of patients after operations for definite idiopathic normal pressure hydrocephalus: a long-term follow-up study]. No Shinkei Geka. 2007 Aug;35(8):773-9. Japanese. PubMed PMID: 17695775.

Skull base meningioma outcome

Skull base meningioma outcome

Peritumoral edema (PTE) in skull base meningiomas correlates to the absence of an arachnoid plane and difference in outcome.

A subset of benign (WHO grade I) skull base meningiomas shows early progression/recurrence (P/R) in the first years after surgical resection.


Though various predictors of adverse postoperative outcomes among meningioma patients have been established, research has yet to develop a method for consolidating these findings to allow for predictions of adverse healthcare outcomes for patients diagnosed with skull base meningiomas.


The objective of a study was to develop three predictive algorithms that can be used to estimate an individual patient’s probability of extended length of stay (LOS), experiencing a nonroutine discharge disposition, or incurring high hospital charges following surgical resection of a skull base meningioma.

The study utilized data from patients who underwent surgical resection for skull base meningiomas at a single academic institution between 2017-2019. Multivariate logistic regression analysis was used to predict extended LOS, nonroutine discharge, and high hospital charges, and 2000 bootstrapped samples were used to calculate an optimism-corrected c-statistic. The Hosmer-Lemeshow test was used to assess model calibration, and p<0.05 was considered statistically significant.

A total of 245 patients were included in our analysis. Our cohort was majority female (77.6%) and Caucasian (62.4%). Our models predicting extended LOS, nonroutine discharge, and high hospital charges had optimism-corrected c-statistics of 0.768, 0.784, and 0.783, respectively. All models demonstrated adequate calibration (p>0.05), and were deployed an open-access, online calculator: https://neurooncsurgery3.shinyapps.io/high_value_skull_base_calc/.

Following external validation, these predictive models have the potential to aid clinicians in providing patients with individualized risk-estimation for healthcare outcomes following meningioma surgery 1).


Ko et al. retrospectively investigated the preoperative CT and MR imaging features for the prediction of P/R in skull base meningiomas, with emphasis on quantitative ADC values. Only patients had postoperative MRI follow-ups for more than 1 year (at least every 6 months) were included. From October 2006 to December 2015, total 73 patients diagnosed with benign (WHO grade I) skull base meningiomas were included (median follow-up time 41 months), and 17 (23.3%) patients had P/R (median time to P/R 28 months). Skull base meningiomas with spheno-orbital location, adjacent bone invasion, high DWI, and lower ADC value/ratio were significantly associated with P/R (P < 0.05). The cut-off points of ADC value and ADC ratio for prediction of P/R are 0.83 × 10- 3 mm2/s and 1.09 respectively, with excellent area under curve (AUC) values (0.86 and 0.91) (P < 0.05). In multivariate logistic regression, low ADC values (< 0.83 × 10- 3 mm2/s) and adjacent bone invasion are high-risk factors of P/R (P < 0.05), with odds ratios of 31.53 and 17.59 respectively. The preoperative CT and MRI features for prediction of P/R offered clinically vital information for the planning of treatment in skull base meningiomas 2).


1)

Jimenez AE, Khalafallah AM, Lam S, Horowitz MA, Azmeh O, Rakovec M, Patel P, Porras JL, Mukherjee D. Predicting High-Value Care Outcomes Following Surgery for Skull Base Meningiomas. World Neurosurg. 2021 Feb 7:S1878-8750(21)00188-1. doi: 10.1016/j.wneu.2021.02.007. Epub ahead of print. PMID: 33567369.
2)

Ko CC, Lim SW, Chen TY, Chen JH, Li CF, Shiue YL. Prediction of progression in skull base meningiomas: additional benefits of apparent diffusion coefficient value. J Neurooncol. 2018 Jan 20. doi: 10.1007/s11060-018-2769-9. [Epub ahead of print] PubMed PMID: 29353434.
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