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Progress in Neurological Surgery

Jang W Yoon, Wen Jiang, James T Rutka, Yuhui Huang, Betty Y S Kim
Significant advances in the design and understanding of the materials and systems of 1-100 nm have provided unprecedented tools to probe, diagnose, and treat diseases at the molecular level with greater efficiency and accuracy. In particular, optical and chemical properties of nanomaterials are being exploited to improve the effectiveness of neuro-oncological and neurosurgical interventions. Modern nanotechnology-driven clinical applications may have significant impact on management of brain tumors.
2018: Progress in Neurological Surgery
Eric T Wong, Edwin Lok, Kenneth D Swanson
Alternating electric fields of intermediate frequencies, also known as Tumor Treating Fields (TTFields or TTF) is a novel anticancer treatment modality that disrupts tumor cell mitosis at the metaphase-anaphase transition, leading to mitotic catastrophe, aberrant mitotic exit, and/or cell death. It is realized through alteration of the cytokinetic cleavage furrow by interference of proteins possessing large dipole moments, like septin heterotrimer complex and α/β-tubulin, and that results in disordered membrane contraction and failed cytokinesis...
2018: Progress in Neurological Surgery
David R Santiago-Dieppa, David D Gonda, Vincent J Cheung, Jeffery A Steinberg, Bob S Carter, Clark C Chen
Normal and pathologic cells secrete extracellular vesicles (EV), which are defined as 30-2,000 nm spherical organelles. It has been found that EV mediate various biological functions including cellular remodeling and export of biomolecules, extracellular communication, immune stimulation and suppression, and modulation of the cellular microenvironment. EV secreted by human glioma cells contain a wealth of tumor-specific proteins and nucleic acids that can be isolated from patients with these neoplasms. Thus, EV contribute to the development of biomarkers, and additionally have certain therapeutic potential for possible use in neuro-oncology and neurosurgery...
2018: Progress in Neurological Surgery
Iddo Paldor, Kaisorn L Chaichana, Henry Brem, Betty M Tyler
Systemic chemotherapy of malignant brain tumors has failed to achieve sufficient drug concentrations at the neoplasm site and frequently results in severe toxicities. Therefore, the local application of several anticancer agents, oncolytic viruses and vectors for gene therapy, immune-modifying preparations, and angiogenesis inhibitors has been investigated widely. Various modes of their administration were introduced, including intratumoral injections, implantation of reservoirs or pumps, convection-enhanced delivery, and use of nanocarriers, thermoreversible gels, microchips, and drug-loaded polymers...
2018: Progress in Neurological Surgery
Sujit S Prabhu
Convection-enhanced delivery (CED) is a novel method of bypassing the blood-brain barrier for administration of therapeutic agents directly into brain with a potential to provide concentrations that cannot be achieved with systemic drug delivery. This technique has grown significantly over the last 20 years with better understanding of the biomechanics of infusion and of the delivery process. Though clinical trials of CED in malignant brain tumors have not yielded the desired results, a number of new biologically active compounds and pharmaceutical preparations, their carriers, modes of delivery, and improved catheter designs are continually being tested, which hold promise for the future...
2018: Progress in Neurological Surgery
Brittany C Parker Kerrigan, Anwar Hossain, Shinji Yamashita, Frederick F Lang
Stem cells (SC) are the seeds of tissue repair and regeneration that have been extensively investigated as tumor-tropic vectors for gene delivery to solid cancers. SC have an inherent glioma tropism that supports their use as reliable vehicles to deliver therapeutic gene products to brain neoplasms. Several types of adult SC (ASC) have been used to carry antiglioma agents, and neural SC (NSC) and mesenchymal SC (MSC) are the most studied. The therapeutic cargoes that have been tested include secreted proteins, converting enzyme/prodrug suicide combinations, oncolytic viruses, antibodies, and nanoparticles...
2018: Progress in Neurological Surgery
Julius W Kim, Alan L Chang, J Robert Kane, Jacob S Young, Jian Qiao, Maciej S Lesniak
Despite many recent advances in the management of gliomas, such as aggressive surgical resection, chemoradiotherapy, antiangiogenic therapy, and molecular targeted therapy, the survival of patients with high-grade neoplasms remains dismal. Gene therapy and oncolytic virotherapy have emerged as highly promising strategies for treatment of malignant brain tumors due to recent progress in understanding of the underlying cancer biology as well as improved techniques for genetic modification of potential therapeutics...
2018: Progress in Neurological Surgery
Eiichi Ishikawa, Yoshihiro Muragaki, Tetsuya Yamamoto, Tadao Ohno, Akira Matsumura
Multiple phase II clinical trials on the use of tumor vaccines in cases of high-grade gliomas (HGG), in particular autologous formalin-fixed tumor vaccine (AFTV), demonstrated the safety and potential efficacy of such therapy. There is evidence that maximal resection of neoplasm provides optimal conditions for enhancement of the tumor-specific immune reactions induced by vaccine administration, and thus aggressive surgery may be an important prerequisite for treatment success. Irradiation and chemotherapy may also enhance the effectiveness of vaccines, particularly through modulation of the tumor microenvironment...
2018: Progress in Neurological Surgery
Richard G Everson, Joseph P Antonios, Linda M Liau
Current cell-based immunotherapeutic strategies attempt to produce and maintain an immune response against glioma cells by artificially stimulating the immune system using passive and/or active approaches. Cellular immunotherapy is taken to mean the administration of live immune cells that either have immune effector capabilities themselves (passive immunotherapy) or engender a downstream antitumor response (active immunotherapy). Passive cellular immunotherapy most often takes the form of the adoptive transfer of a range of cell types, whereby antitumor immune cells from a patient (or allogeneic donor) are created, activated, and/or expanded ex vivo and subsequently administered back to the patient to directly attack the neoplasm...
2018: Progress in Neurological Surgery
Kenichiro Iwami, Atsushi Natsume, Toshihiko Wakabayashi
Cytokines are a heterogeneous group of soluble small polypeptides or glycoproteins, which exert pleiotropic and redundant effects that promote growth, differentiation, and activation of cells. Cytokine production plays a profound role in the modulation of the tumor microenvironment, including the host of heterogeneous neoplastic cells, immune cells, and extracellular matrix, which is essential for progression of the neoplasm. Depending on specific conditions, the cytokines can either upregulate or downregulate anti-inflammatory and immunosuppressive activities...
2018: Progress in Neurological Surgery
Nicholas Butowski
Multiple alterations in the expression levels of genes or proteins have been identified in gliomas, including activation of oncogenes and silencing of tumor suppressor genes. Illuminating these molecular mechanisms of tumorigenesis and treatment resistance is necessary for the development of new therapies. With the promise of better effectiveness and less toxicity, the emphasis in drug development has moved from cytotoxic, non-specific chemotherapies to molecular targeted agents. However, despite progress in other areas of oncology, targeted therapy success stories in cases of brain tumors remain all but absent...
2018: Progress in Neurological Surgery
Stephanie E Combs
In comparison to photon irradiation, particle therapy of cancer performed either with protons or with carbon ions, offers the advantage of their distinct physical characteristics, and through delivery of high linear energy transfer (LET) particles, exploits greater relative biological effectiveness (RBE). There is strong rationale for applying such treatment in patients with intracranial gliomas. In cases of low-grade tumors, the main benefits may be related to potential decrease of long-term morbidity, whereas in cases of high-grade neoplasms, the use of modalities with greater RBE may lead to better tumor control and improve patient survival...
2018: Progress in Neurological Surgery
Shin-Ichi Miyatake, Shinji Kawabata, Ryo Hiramatsu, Toshihiko Kuroiwa, Minoru Suzuki, Koji Ono
Boron neutron capture therapy (BNCT) is a promising modality for biochemically targeted, highly selective radiation treatment of various cancers, including malignant gliomas. Currently available results demonstrate the beneficial effect of such therapy on survival of patients with both recurrent and newly diagnosed glioblastomas. The main drawback of BNCT in cases of previously irradiated neoplasms is high rates of symptomatic pseudoprogression and radiation necrosis. For prevention of these complications, concurrent administration of bevacizumab may be helpful...
2018: Progress in Neurological Surgery
Ryan D Alkins, Todd G Mainprize
Ultrasound in clinical medicine is most commonly associated with imaging, but can be harnessed to yield an array of biological effects, including thermal ablation of brain tumors. Therapeutic ultrasound has been studied for many years, but only within the last decade has the technology reached a point where it is safe and practical for clinical adoption. Using large, multi-element arrays, ultrasound can be focused through the skull, and combined with MRI for image guidance and real-time thermometry, to create lesions in the brain with millimeter accuracy...
2018: Progress in Neurological Surgery
Boris V Martynov, Andrey I Kholyavin, Vladimir B Nizkovolos, Valery E Parfenov, Gennady E Trufanov, Dmitry V Svistov
Surgical resection of gliomas affecting functionally important brain structures is associated with high risk of permanent postoperative neurological deficit and deterioration of the patient's quality of life. The availability of modern neuroimaging and neuronavigation permits the application of minimally invasive stereotactic cryodestruction of the tumor in such cases. The authors used this treatment in 88 patients with supratentorial gliomas of various WHO histopathological grades not suitable for microsurgical resection...
2018: Progress in Neurological Surgery
Ioannis Karampelas, Andrew E Sloan
Laser-induced interstitial thermotherapy (LITT) is a modern minimally invasive treatment modality applied for management of a variety of diseases. Recent developments of techniques for precise targeting of the lesion, accurate delivery of the prescribed therapeutically effective thermal doses, and real-time visualization of the induced tissue damage during the procedure by means of intraoperative MR thermometry have stimulated a number of clinical studies testing LITT in cases of different brain pathologies, including gliomas...
2018: Progress in Neurological Surgery
Sadao Kaneko, Shin Fujimoto, Hideshi Yamaguchi, Toru Yamauchi, Tetsuya Yoshimoto, Koichi Tokuda
Recently, the clinical applications of photodynamic therapy (PDT) in the management of malignant brain tumors have attracted significant attention. Meta-analysis of the observational studies on this treatment in high-grade gliomas (Eljamel, 2010) included more than 1,000 patients and reported median survival in cases of newly diagnosed and recurrent glioblastoma multiforme (GBM) of 16.1 and 10.3 months, respectively. In some series, increase in the long-term survival rates was also observed. Few controlled trials demonstrated statistically significant impact of PDT on prolongation of survival in patients with GBM in comparison to conventional management...
2018: Progress in Neurological Surgery
Takashi Komori, Yoshihiro Muragaki, Mikhail F Chernov
Current World Health Organization (WHO) classification of the neuroepithelial tumors is cell lineage-oriented and based on a presumed developmental tree of the central nervous system (CNS). It defines three main groups of gliomas, namely astrocytomas, oligodendrogliomas, and ependymomas, and additionally presumes their 4-tiered histopathological grading (WHO grades I to IV). Nevertheless, the impact of tumor pathology on clinically related parameters may be frequently much better predicted by genetics, than by histological appearance of the lesion...
2018: Progress in Neurological Surgery
Andrea Pace, Veronica Villani
Clinicians dealing with patients affected by malignant brain tumors are frequently involved in providing palliative and supportive care, particularly at the end of life. It requires a multidisciplinary approach by a well-trained specialized neuro-oncology team. Early initiation of palliative care integrated with standard anticancer therapy may be effective for symptom management and results in improvement of the quality of life. However, studies specifically addressing these issues are very limited, thus do not allow the creation of any reliable evidence-based guidelines...
2018: Progress in Neurological Surgery
Julija Andrejeva, Olesya V Volkova
Patients with brain tumor frequently experience a combination of physical, cognitive, and communication deficits. These may cause severe psycho-emotional stress altering biological and mental conditions and complicating the course of the primary disease, and thus necessiate physical and psychological rehabilitation. While existing data on the effectiveness of such treatment in patients with intracranial glioma are limited and inconsistent, it is possible to suggest that systematic and multidisciplinary rehabilitation plays a very important therapeutic role and leads to improvements in functional independence, mental and emotional state, and quality of life...
2018: Progress in Neurological Surgery
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