Publications by authors named "Adomas Bunevicius"

138 Publications

An International Multicenter Matched Cohort Analysis of Incidental Meningioma Progression During Active Surveillance or After Stereotactic Radiosurgery: The IMPASSE Study.

Neuro Oncol 2021 Jun 9. Epub 2021 Jun 9.

Department of Neurosurgery, University of Liverpool & The Walton Centre NHS Trust, Lower Lane, Liverpool, UK.

Background: The optimal management of patients with an incidental meningiomas remains unclear. The aim of this study was to characterize the radiologic and neurological outcomes of expectant and SRS management of asymptomatic meningioma patients.

Methods: Using data from 14 centers across 10 countries, the study compares SRS outcomes to active surveillance of asymptomatic meningiomas. Local tumor control of asymptomatic meningiomas and development of new neurological deficits attributable to the tumor were evaluated in the SRS and conservatively managed groups.

Results: In unmatched cohorts, 727 meningioma patients underwent SRS and were followed for a mean of 57.2 months. In the conservatively managed cohort, 388 patients were followed for a mean of 43.5 months. Tumor control was 99.0% of SRS and 64.2% of conservatively managed patients (p<0.001; OR 56.860 (95%CI 26.253-123.150))). New neurological deficits were 2.5% in the SRS and 2.8% of conservatively managed patients (p=0.764; OR 0.890 (95% CI 0.416-1.904)). After 1:1 propensity matching for patient age, tumor volume, location, and imaging follow-up, tumor control in the SRS and conservatively managed cohorts was 99.4% and 62.1%, respectively (p<0.001; OR 94.461 (95% CI 23.082-386.568)). In matched cohorts, new neurological deficits were noted in 2.3% of SRS treated and 3.2% of conservatively managed patients (p=0.475; OR 0.700 (95% CI 0.263-1.863)).

Conclusions: SRS affords superior radiologic tumor control compared to active surveillance without increasing the risk of neurological deficits in asymptomatic meningioma patients. While SRS and active surveillance are reasonable options, SRS appears to alter the natural history of asymptomatic meningiomas including tumor progression in the majority of patients treated.
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http://dx.doi.org/10.1093/neuonc/noab132DOI Listing
June 2021

Delayed intracerebral hemorrhage associated with placement of a deep brain stimulating electrode over two years prior.

Int J Surg Case Rep 2021 May 12;83:105969. Epub 2021 May 12.

Department of Neurosurgery, Farber Institute for Neurosciences, Thomas Jefferson University, Philadelphia, PA, USA.

Introduction And Importance: Most severe complications of DBS appear in the perioperative period. There are no published case reports of delayed ICH occurring more than three months from electrode implantation. The pathogenesis of delayed ICH remains unclear.

Case Presentation: We present a 64-year-old male with essential tremor who sustained a delayed intracerebral hemorrhage (ICH) 2.5 years after implantation of a deep brain stimulating electrode.

Discussion: The patient sustained a thalamic-midbrain ICH that may have been related to the positioning of the electrode. An analysis was performed to determine the cause and risk factors that may have contributed. Based on these findings, it is possible that the proximity of the cannula or electrode may have mildly injured the wall of the superior thalamic vein during implantation, or perhaps being in contact with the vein over a longer-term having an effect, which in either of these scenarios can subsequently lead to ICH formation on the sudden rise of intracranial pressure.

Conclusion: It emphasizes the importance of proper surgical navigation planning, image- guidance, and the use of image verification.
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http://dx.doi.org/10.1016/j.ijscr.2021.105969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141757PMC
May 2021

In Regard to Tibbs et al.

Int J Radiat Oncol Biol Phys 2021 Jun;110(2):611-612

Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.

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http://dx.doi.org/10.1016/j.ijrobp.2020.12.059DOI Listing
June 2021

Stereotactic Radiosurgery for Differentiated Thyroid Cancer Brain Metastases: An International, Multicenter Study.

Thyroid 2021 May 11. Epub 2021 May 11.

Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.

Brain metastases (BM) from differentiated thyroid cancer are rare. Stereotactic radiosurgery (SRS) is commonly used for the treatment of BMs; however, the experience with SRS for thyroid cancer BMs remains limited. The goal of this international, multi-centered study was to evaluate the efficacy and safety of SRS for thyroid cancer BMs. From 10 institutions participating in the International Radiosurgery Research Foundation, we pooled patients with established papillary or follicular thyroid cancer diagnosis who underwent SRS for histologically confirmed or radiologically suspected BMs. We investigated patient overall survival (OS), local tumor control, and adverse radiation events (AREs). We studied 42 (52% men) patients who underwent SRS for 122 papillary (83%) or follicular (17%) thyroid cancer BMs. The mean age at SRS was 59.86 ± 12.69 years. The mean latency from thyroid cancer diagnosis to SRS for BMs was 89.05 ± 105.49 months. The median number of BMs per patient was 2 (range: 1-10 BMs). The median SRS treatment volume was 0.79 cm (range: 0.003-38.18 cm), and the median SRS prescription dose was 20 Gy (range: 8-24 Gy). The median survival after SRS for BMs was 14 months (range: 3-58 months). The OS was significantly shorter in patients harboring ≥2 BMs, when compared with patients with one BM (Log-rank = 5.452,  = 0.02). Two or more BMs (odds ratio [OR] = 3.688; confidence interval [CI]: 1.143-11.904;  = 0.03) and lower Karnofsky performance score at the time of SRS (OR = 0.807; CI: 0.689-0.945;  = 0.008) were associated with shorter OS. During post-SRS imaging follow-up of 25.21 ± 30.49 months, local failure (progression and/or radiation necrosis) of BMs treated with SRS was documented in five (4%) BMs at 7.2 ± 7.3 months after the SRS. At the last imaging follow-up, the majority of patients with available imaging data had stable intracranial disease (33%) or achieved complete (26%) or partial (24%) response. There were no clinical AREs. Post-SRS peritumoral T2/fluid attenuated inversion recovery signal hyperintensity was noted in 7% BMs. The SRS allows durable local control of papillary and follicular thyroid cancer BMs in the vast majority of patients. Higher number of BMs and worse functional status at the time of SRS are associated with shorter OS in patients with thyroid cancer BMs. The SRS is safe and is associated with a low risk of AREs.
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http://dx.doi.org/10.1089/thy.2020.0947DOI Listing
May 2021

Influence of Decompressive Craniectomy Post Evacuation of Epidural Hematoma in Comatose Patients.

World Neurosurg 2021 May 1. Epub 2021 May 1.

Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Neurosciences Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background: Epidural hematoma causing brain herniation is a major cause of mortality and morbidity after severe traumatic brain injury, even if surgical treatment is performed quickly. Decompression may be effective in decreasing intracranial pressure, but its effect on outcomes remains unclear.

Methods: A retrospective analysis of deeply comatose patients (Glasgow Coma Scale score 3-5) who underwent surgical treatment during a 12-year period, either via osteoplastic craniotomy (OC) or decompressive craniectomy, was carried out. Patient groups were compared on the basis of demographics, admission clinical state, head computed tomography imaging characteristics, and discharge outcome.

Results: A total of 60 patients were examined. The first group of 31 patients (52%) needed decompression during primary surgery. The second group of 29 patients (48%) underwent OC with evacuation of epidural hematoma without decompression. Both patient groups were similar according to age (40.9 ± 13 vs. 40.6 ± 12.5 years), Glasgow Coma Scale score before surgery (4 [3-5] vs. 4 [3-5]), hematoma thickness (based on computed tomography) (3.44 ± 1 vs. 3.36 ± 1.62 cm), and midline shift (1.42 ± 0.83 vs. 1.36 ± 0.9 cm). Mortality was more evident in the decompression group (45.2% vs. 13.8%; P = 0.008), and the Glasgow Outcome Score was also lower, 2.26 ± 1.5 versus 3.45 ± 1.5 (P = 0.003).

Conclusions: Decompressive craniectomy following the evacuation of an acute epidural hematoma in deeply comatose patients demonstrated inferior outcomes in comparison with OC. Brain injury in the decompressive craniectomy patient group was more severe (concomitant subdural hematoma, early brain ischemia, and early brain herniation), which may have influenced the outcome. Further prospective studies are needed.
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http://dx.doi.org/10.1016/j.wneu.2021.04.109DOI Listing
May 2021

Stereotactic radiosurgery before bilateral adrenalectomy is associated with lowered risk of Nelson's syndrome in refractory Cushing's disease patients.

Acta Neurochir (Wien) 2021 Jul 24;163(7):1949-1956. Epub 2021 Mar 24.

Department of Neurosurgery, University of Virginia, Charlottesville, VA, 22908, USA.

Background: Nelson's syndrome is a rare but challenging sequelae of Cushing's disease (CD) after bilateral adrenalectomy (BLA). We sought to determine if stereotactic radiosurgery (SRS) of residual pituitary adenoma performed before BLA can decrease the risk of Nelson's syndrome.

Methods: Consecutive patients with CD who underwent BLA after non-curative resection of ACTH secreting pituitary adenoma and had at least one follow-up visit after BLA were studied. Nelson's syndrome was diagnosed based on the combination of rising ACTH levels, increasing volume of the pituitary adenoma and/or hyperpigmentation.

Results: Fifty patients underwent BLA for refractory CD, and 43 patients (7 men and 36 women) had at least one follow-up visit after BAL. Median endocrine, imaging, and clinical follow-up were 66 months, 69 months, and 80 months, respectively. Nine patients (22%) were diagnosed with the Nelson's syndrome at median time after BLA at 24 months (range: 0.6-119.4 months). SRS before BLA was associated with reduced risk of the Nelson's syndrome (HR = 0.126; 95%CI [0.022-0.714], p=0.019), while elevated ACTH level within 6 months after BLA was associated with increased risk for the Nelson's syndrome (HR = 9.053; 95%CI [2.076-39.472], p=0.003).

Conclusions: SRS before BLA can reduce the risk for the Nelson's syndrome in refractory CD patients requiring BLA and should be considered before proceeding to BLA. Elevated ACTH concentration within 6 months after BLA is associated with greater risk of the Nelsons' syndrome. When no prior SRS is administered, those with a high ACTH level shortly after BLA may benefit from early SRS.
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http://dx.doi.org/10.1007/s00701-021-04823-1DOI Listing
July 2021

Spontaneous pneumocephalus associated with a melanoma brain metastasis: a Case Report.

J Neurooncol 2021 May 9;152(3):617-619. Epub 2021 Mar 9.

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, USA.

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http://dx.doi.org/10.1007/s11060-021-03728-4DOI Listing
May 2021

Internal carotid artery stenosis and risk of cerebrovascular ischemia following stereotactic radiosurgery for recurrent or residual pituitary adenomas.

Pituitary 2021 Feb 20. Epub 2021 Feb 20.

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.

Purpose: To evaluate the incidence of internal carotid artery (ICA) stenosis and cerebrovascular accident in a series of patients treated with stereotactic radiosurgery (SRS) for recurrent or residual pituitary adenoma.

Methods: All patients treated with single fraction SRS in our institution for recurrent or residual non-functioning-, growth hormone- and ACTH-secreting pituitary adenomas were retrospectively identified and reviewed. A comprehensive literature review to identify studies reporting on ICA steno-occlusive disease following SRS for pituitary adenomas and compare the risks of carotid stenosis and ischemic stroke in the SRS treated group to the general population figures.

Results: 528 patients [312 women and 216 men; median age at SRS 46 years old (range 12-80 years)] treated with SRS at our institution met study inclusion criteria. Mean clinical and radiologic follow-ups were 68.87 (SD ± 43.29) and 55.99 months (SD ± 38.03), respectively, and there were no clinically evident cerebral ischemic events noted. Asymptomatic, post-SRS, ICA stenosis occurred in two patients. A total of eight patients with ICA steno-occlusive disease following pituitary adenoma radiosurgery have been reported. Two of them suffered from ischemic stroke with however excellent recovery.

Conclusion: As compared to the general population, SRS for pituitary adenomas does not seem to confer appreciable increased risk for ICA steno-occlusive disease and ischemic stroke. However, post-SRS radiation vessel injuries do occur and physicians should be aware about this rare event. Prompt identification and management according to current guidelines are essential to prevent ischemic strokes.
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http://dx.doi.org/10.1007/s11102-021-01134-7DOI Listing
February 2021

Intraoperative Magnetic Resonance Imaging for Low-Grade and High-Grade Gliomas: What Is the Evidence? A Meta-Analysis.

World Neurosurg 2021 May 2;149:232-243.e3. Epub 2021 Feb 2.

Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; School of Pharmacy, MCPHS University, Boston, Massachusetts, USA. Electronic address:

Background: The benefit of intraoperative magnetic resonance imaging (iMRI) in gliomas remains unclear. We performed a meta-analysis of outcomes with iMRI-guided surgery in high-grade gliomas (HGGs) and low-grade gliomas (LGGs).

Methods: Databases were searched until November 29, 2018 for randomized controlled trials (RCTs) and observational studies (OBS) comparing iMRI use with conventional neurosurgery. Pooled risk ratios (RRs) or hazard ratios were evaluated with the random-effects model. Outcomes included extent of resection (EOR), gross total resection (GTR), progression-free survival (PFS), overall survival (OS), and length of surgery (LOS), stratified by study design and glioma grade.

Results: Fifteen articles (3 RCTs and 12 OBS) were included. In RCTs, GTR was higher in iMRI compared with conventional neurosurgery (RR, 1.42; 95% confidence interval [CI], 1.17-1.73; I, 7%) overall, for LGGs (1.91; 95% CI, 1.19-3.06), but not HGGs (1.24; 95% CI, 0.89-1.73), with no difference in EOR, PFS, OS, and LOS. For OBS, GTR was higher (RR, 1.65; 95% CI, 1.43-1.90; I, 4%) overall, and for LGGs (1.63; 95% CI, 1.17-2.28; I, 0%) and HGGs (1.62; 95% CI, 1.36-1.92; I, 19%). EOR was greater with iMRI (6%; 95% CI, 4%-8%; I, 44%) overall, in LGGs (5%; 95% CI, 2%-8%; I, 37%) and HGGs (7%; 95% CI, 4%-10%; I, 13%). There was no difference in PFS, OS, and LOS with iMRI.

Conclusions: IMRI use improved GTR in gliomas, including LGGs. However, no PFS and OS benefit was shown in the meta-analysis.
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http://dx.doi.org/10.1016/j.wneu.2021.01.089DOI Listing
May 2021

Stereotactic Radiosurgery for Perioptic Meningiomas: An International, Multicenter Study.

Neurosurgery 2021 03;88(4):828-837

Department of Radiation Oncology, University of Colorado, Denver, Colorado.

Background: Stereotactic radiosurgery (SRS) is increasingly used for management of perioptic meningiomas.

Objective: To study the safety and effectiveness of SRS for perioptic meningiomas.

Methods: From 12 institutions participating in the International Radiosurgery Research Foundation (IRRF), we retrospectively assessed treatment parameters and outcomes following SRS for meningiomas located within 3 mm of the optic apparatus.

Results: A total of 438 patients (median age 51 yr) underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) perioptic meningiomas. Median treatment volume was 8.01 cm3. Median prescription dose was 12 Gy, and median dose to the optic apparatus was 8.50 Gy. A total of 405 patients (93%) underwent single-fraction SRS and 33 patients (7%) underwent hypofractionated SRS. During median imaging follow-up of 55.6 mo (range: 3.15-239 mo), 33 (8%) patients experienced tumor progression. Actuarial 5-yr and 10-yr progression-free survival was 96% and 89%, respectively. Prescription dose of ≥12 Gy (HR: 0.310; 95% CI [0.141-0.679], P = .003) and single-fraction SRS (HR: 0.078; 95% CI [0.016-0.395], P = .002) were associated with improved tumor control. A total of 31 (10%) patients experienced visual decline, with actuarial 5-yr and 10-yr post-SRS visual decline rates of 9% and 21%, respectively. Maximum dose to the optic apparatus ≥10 Gy (HR = 2.370; 95% CI [1.086-5.172], P = .03) and tumor progression (HR = 4.340; 95% CI [2.070-9.097], P < .001) were independent predictors of post-SRS visual decline.

Conclusion: SRS provides durable tumor control and quite acceptable rates of vision preservation in perioptic meningiomas. Margin dose of ≥12 Gy is associated with improved tumor control, while a dose to the optic apparatus of ≥10 Gy and tumor progression are associated with post-SRS visual decline.
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http://dx.doi.org/10.1093/neuros/nyaa544DOI Listing
March 2021

Editorial: Radiosurgical induced malignancy associated with stereotactic radiosurgery.

Acta Neurochir (Wien) 2021 04 6;163(4):969-970. Epub 2021 Jan 6.

Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.

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http://dx.doi.org/10.1007/s00701-020-04667-1DOI Listing
April 2021

Stereotactic radiosurgery for treatment of radiation-induced meningiomas: a multiinstitutional study.

J Neurosurg 2021 Jan 1:1-9. Epub 2021 Jan 1.

1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.

Objective: Radiation-induced meningiomas (RIMs) are associated with aggressive clinical behavior. Stereotactic radiosurgery (SRS) is sometimes considered for selected RIMs. The authors investigated the effectiveness and safety of SRS for the management of RIMs.

Methods: From 12 institutions participating in the International Radiosurgery Research Foundation, the authors pooled patients who had prior cranial irradiation and were subsequently clinically diagnosed with WHO grade I meningiomas that were managed with SRS.

Results: Fifty-two patients underwent 60 SRS procedures for histologically confirmed or radiologically suspected WHO grade I RIMs. The median ages at initial cranial radiation therapy and SRS for RIM were 5.5 years and 39 years, respectively. The most common reasons for cranial radiation therapy were leukemia (21%) and medulloblastoma (17%). There were 39 multiple RIMs (35%), the mean target volume was 8.61 ± 7.80 cm3, and the median prescription dose was 14 Gy. The median imaging follow-up duration was 48 months (range 4-195 months). RIM progressed in 9 patients (17%) at a median duration of 30 months (range 3-45 months) after SRS. Progression-free survival at 5 years post-SRS was 83%. Treatment volume ≥ 5 cm3 predicted progression (HR 8.226, 95% CI 1.028-65.857, p = 0.047). Seven patients (14%) developed new neurological symptoms or experienced SRS-related complications or T2 signal change from 1 to 72 months after SRS.

Conclusions: SRS is associated with durable local control of RIMs in the majority of patients and has an acceptable safety profile. SRS can be considered for patients and tumors that are deemed suboptimal, poor surgical candidates, and those whose tumor again progresses after removal.
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http://dx.doi.org/10.3171/2020.7.JNS202064DOI Listing
January 2021

Gamma Knife radiosurgery associated worsening of superficial siderosis due to a foramen magnum tumor - A case report.

J Radiosurg SBRT 2020 ;7(2):169-172

University of Virginia, Department of Neurological Surgery, Charlottesville, VA, USA.

Superficial siderosis (SS) of the brain results from a chronic iron toxicity due to repeated microscopic leakage of blood products into the subarachnoid space. We report on Gamma Knife Radiosurgery (GKRS) associated worsening of superficial siderosis in a patient with skull-base tumor. A 73 year-old male patient presented with clumsiness and gait ataxia and was diagnosed with foramen magnum meningioma. He was also noted to have superficial siderosis involving the mainly the infratentorial compartment. After a thorough evaluation of craniospinal axis, no other cause of bleeding was identified. Patient was treated with the GKRS. After GKRS, there was an initial radiological and clinical worsening of SS starting at 6 months and peaking at 2 years. The disease stabilized and showed mild reduction at 3 years. GKRS lead to an initial progression of superficial siderosis. However, over a longer period, tumor control and improvement of the siderosis was observed.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717088PMC
January 2020

Magnetic Resonance Perfusion Changes of Arteriovenous Malformations Treated with Stereotactic Radiosurgery.

World Neurosurg 2021 02 20;146:e1003-e1011. Epub 2020 Nov 20.

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA. Electronic address:

Background: The latency period from stereotactic radiosurgery (SRS) to obliteration of arteriovenous malformations (AVM) requires continuous imaging surveillance. Magnetic resonance (MR) perfusion is promising for noninvasive monitoring of AVMs after SRS. We studied longitudinal MR perfusion changes of brain AVMs treated with SRS.

Methods: Consecutive patients treated for brain AVMs using SRS who had MR perfusion imaging studies performed before and at least once after SRS were studied. We estimated ipsilateral/contralateral brain hemisphere ratios of MR perfusion indexes, including regional cerebral blood flow (rCBF) and relative cerebral blood volume (rCBV), in the AVM nidus, perinidal region, and remote anterior and posterior brain regions.

Results: Eleven patients (6 women; median age, 21 years) underwent SRS (median prescription dose, 18 Gy; range, 12-20 Gy) for brain AVMs (median Spetzler-Martin grade 2 and median volume 4.6 mL). Before the SRS, rCBV and rCBF ratios were significantly higher in the AVM nidus compared with other investigated brain regions (P < 0.001). Median time from SRS to the first and last post-SRS MR perfusion studies was 8 and 35 months, respectively. There was a statically significant decrease of rCBV (P = 0.043) and rCBF (P = 0.036) ratios in the AVM nidus, but not other brain regions, during post-SRS follow-up.

Conclusions: There is a gradual decrease of rCBV and rCBF in the AVM nidus after SRS. MR perfusion imaging is promising for monitoring of hemodynamic changes of AVMs after SRS. Larger studies investigating clinical value of MR perfusion imaging for AVMs after SRS are warranted.
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http://dx.doi.org/10.1016/j.wneu.2020.11.075DOI Listing
February 2021

Radiosurgery for Glioblastoma.

Neurosurg Clin N Am 2021 Jan 5;32(1):117-128. Epub 2020 Nov 5.

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA 22908, USA. Electronic address:

Glioblastoma (GBM) is infiltrative neoplasm with limited treatment options and poor overall survival. Stereotactic radiosurgery (SRS) allows spatially precise and conformal delivery of high doses of radiation. Salvage SRS for locally recurrent GBM was shown to improve patient survival and have more favorable safety profile than repeated surgical resection. Boost SRS after fractionated radiation therapy is sometimes attempted; however, Radiation Therapy Oncology Group 93-05 randomized clinical trial did not demonstrate benefits of upfront SRS that was administered before fractionated radiation. Administration of bevacizumab with SRS is associated with improved survival and can allow SRS dose escalation.
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http://dx.doi.org/10.1016/j.nec.2020.08.007DOI Listing
January 2021

Outcomes from treatment of asymptomatic skull base meningioma with stereotactic radiosurgery.

Acta Neurochir (Wien) 2021 01 19;163(1):83-88. Epub 2020 Nov 19.

Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, 22908, USA.

Background: Optimal management of asymptomatic skull base meningiomas is controversial. We evaluated the safety and efficiency of Gamma Knife radiosurgery (GKRS) for the management of asymptomatic skull base meningiomas.

Methods: This retrospective study involved patients managed with GKRS for asymptomatic, skull base meningiomas from 1997 to 2019. Patient clinico-radiologic data, tumor characteristics, and procedural details were analyzed. Favorable outcome was defined as lack of procedure-related mortality or permanent neurologic morbidity and radiologic evidence of tumor control. Tumor progression and regression were defined as an increase or decrease of > 20% in volume from baseline to the last neuroimaging study respectively. Tumor volumes within ± 20% of baseline volume were considered stable.

Results: Thirty-seven patients (30 women), median age 68 years old (range 42-83 months) were managed with a single-session GKRS for 40 asymptomatic, skull base meningiomas. At a median clinical follow-up of 58.5 months (range 14-150 months), no mortality associated with the procedure or the treated tumor was noted. Permanent neurologic morbidity was 2.75%. There was a statistically significant decrease in mean tumor volume (p < 0.001) from 4.04 cc (SD 3.09 cc) prior to radiosurgery to 2.73 cc (SD 2.24 cc) at last follow-up. Higher margin dose was associated with tumor regression at last follow-up (HR = 1.351; 95%CI [1.094-1.669]; p = 0.05).

Conclusion: As compared to natural history studies, GKRS affords long-standing tumor control and neurologic preservation in the vast majority of patients treated for asymptomatic, skull base meningiomas. Further study is necessary to identify the optimal management of asymptomatic skull base meningiomas.
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http://dx.doi.org/10.1007/s00701-020-04648-4DOI Listing
January 2021

Multidimensional Structure of the Alcohol Use Disorders Identification Test: Factorial Validity and Reliability in Patients With Anxiety and Mood Disorders in Lithuania.

Alcohol Alcohol 2021 Jan;56(1):109-115

Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Palanga LT-00135, Lithuania.

Aims: The current study aimed to evaluate the factorial structure of the Lithuanian version of the Alcohol Use Disorders Identification Test (AUDIT) in patients with anxiety and mood disorders (AMD).

Methods: The AUDIT was completed by 199 consecutive outpatients with AMD (21% men, mean age 39 ± 12 years), as defined by AMD criteria in DSM-5. The MINI International Neuropsychiatric Interview was used for current diagnosis of alcohol use disorder (AUD). Sociodemographic and clinical data were also collected.

Results: In patients with AMD, the AUDIT showed high internal consistency (Cronbach's alpha = 0.88) and good psychometric characteristics for identifying current AUD at a cut-off value of ≥9 (positive predictive value = 83.7%, sensitivity = 94.7%, specificity = 95.7%). The confirmatory factor analysis suggested a three-factor ('consumption', 'dependence' and 'related consequences') structure and indicated adequate fit to the model (comparative fit index = 0.966, normed fit index = 0.936, root mean square error of approximation = 0.072).

Conclusions: The findings are in line with increasing evidence suggesting that the AUDIT measures three separate factors related to alcohol misuse level of consumption, dependence and alcohol-related consequences and support the utility of AUDIT as a screening instrument for AUD in AMD patients in Lithuania.
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http://dx.doi.org/10.1093/alcalc/agaa118DOI Listing
January 2021

Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis.

Crit Rev Oncol Hematol 2021 Jan 20;157:103123. Epub 2020 Oct 20.

Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Lithuanian University of Health Sciences, Lithuania; Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. Electronic address:

mHealth can be used to deliver interventions to optimize Health-related quality of life (HRQoL) of cancer patients. In this systematic-review and meta-analysis, we explored the possible impact of health interventions delivered via mHealth tools on HRQoL of cancer patients. The systematic literature search was performed on July 20, 2019, to identify studies that evaluated the impact of mHealth intervention on HRQoL of cancer patients. We identified 25 studies (17 randomized controlled trials and 8 pre-post design studies; 957 patients) that evaluated mHealth interventions. The most commonly studied mHealth interventions included physical activity/ fitness interventions (9 studies), cognitive behavioral therapy (6 studies), mindfulness/ stress management (3 studies). In the majority of studies, mHealth interventions were associated with an improved HRQoL of cancer patients. The meta-analysis of the identified studies supported the positive effect of mHealth interventions for HRQoL of cancer patients. mHealth interventions are promising for improving HRQoL of cancer patients.
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http://dx.doi.org/10.1016/j.critrevonc.2020.103123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574857PMC
January 2021

Validation of the Multidimensional Fatigue Inventory with Coronary Artery Disease Patients.

Int J Environ Res Public Health 2020 10 30;17(21). Epub 2020 Oct 30.

Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, 2100 Palanga, Lithuania.

Background: Fatigue is a common distressing symptom in patients with coronary artery disease (CAD). The Multidimensional Fatigue Inventory (MFI) is used for measuring fatigue in various clinical settings. Nevertheless, its multidimensional structure has not been consistent across studies. Thus, we aimed to psychometrically evaluate the MFI in patients with CAD.

Methods: In sum, 1162 CAD patients completed questionnaires assessing their subjective fatigue level (MFI-20), mental distress symptoms (HADS, STAI), and health-related quality of life (SF-36). Participants also completed exercise capacity (EC) testing.

Results: Confirmatory factor analysis of the four-factor model, showed acceptable fit (CFI = 0.905; GFI = 0.895; NFI = 0.893, RMSEA = 0.077). After eliminating four items, confirmatory factor analysis testing showed improvement in the four-factor model of the MFI-16 (CFI = 0.910; GFI = 0.909; NFI = 0.898, RMSEA = 0.077). Internal consistency values were adequate for the total score and four MFI-16 subscales: General fatigue, physical fatigue, reduced activity, and mental fatigue with Cronbach's α range: 0.60-0.82. The inadequate value (Cronbach's α = 0.43) was received for the subscale of reduced motivation in both MFI-20 and MFI-16. Correlations between the MFI-16 and HADS, STAI, SF-36, and EC measures were statistically significant (all 's < 0.001).

Conclusions: The Lithuanian version of the modified MFI of 16 items showed good factorial structure and satisfactory psychometric characteristics, except for reduced motivation subscale.
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http://dx.doi.org/10.3390/ijerph17218003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662819PMC
October 2020

Depression prevalence based on the Edinburgh Postnatal Depression Scale compared to Structured Clinical Interview for DSM DIsorders classification: Systematic review and individual participant data meta-analysis.

Int J Methods Psychiatr Res 2021 Mar 22;30(1):e1860. Epub 2020 Oct 22.

Department of Psychiatry, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India.

Objectives: Estimates of depression prevalence in pregnancy and postpartum are based on the Edinburgh Postnatal Depression Scale (EPDS) more than on any other method. We aimed to determine if any EPDS cutoff can accurately and consistently estimate depression prevalence in individual studies.

Methods: We analyzed datasets that compared EPDS scores to Structured Clinical Interview for DSM (SCID) major depression status. Random-effects meta-analysis was used to compare prevalence with EPDS cutoffs versus the SCID.

Results: Seven thousand three hundred and fifteen participants (1017 SCID major depression) from 29 primary studies were included. For EPDS cutoffs used to estimate prevalence in recent studies (≥9 to ≥14), pooled prevalence estimates ranged from 27.8% (95% CI: 22.0%-34.5%) for EPDS ≥ 9 to 9.0% (95% CI: 6.8%-11.9%) for EPDS ≥ 14; pooled SCID major depression prevalence was 9.0% (95% CI: 6.5%-12.3%). EPDS ≥14 provided pooled prevalence closest to SCID-based prevalence but differed from SCID prevalence in individual studies by a mean absolute difference of 5.1% (95% prediction interval: -13.7%, 12.3%).

Conclusion: EPDS ≥14 approximated SCID-based prevalence overall, but considerable heterogeneity in individual studies is a barrier to using it for prevalence estimation.
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http://dx.doi.org/10.1002/mpr.1860DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992289PMC
March 2021

Unique Interplay Between Molecular miR-181b/d Biomarkers and Health Related Quality of Life Score in the Predictive Glioma Models.

Int J Mol Sci 2020 Oct 9;21(20). Epub 2020 Oct 9.

Laboratory of Molecular Neurobiology, Neuroscience Institute, Lithuanian University of Health Sciences, Eiveniu str. 4, LT-50161, Kaunas, Lithuania.

In the last decade, an increasing amount of research has been conducted analyzing microRNA expression changes in glioma tissue and its expressed exosomes, but there is still sparse information on microRNAs or other biomarkers and their association with patients' functional/psychological outcomes. In this study, we performed a combinational analysis measuring and expression levels by quantitative polymerase chain reaction (qPCR), evaluating isocitrate dehydrogenase 1 () single nucleotide polymorphism (SNP), and O-6-methylguanine methyltransferase () promoter methylation status in 92 post-surgical glioma samples and 64 serum exosomes, including patients' quality of life evaluation applying European Organization for Research and Treatment of Cancer (EORTC) questionnaire for cancer patients (QLQ-30), EORTC the Brain Cancer-Specific Quality of Life Questionnaire (QLQ-BN20), and the Karnofsky performance status (KPS). The tumoral expression of miR-181b was lower in grade III and glioblastoma, compared to grade II glioma patients ( < 0.05). Additionally, for the first time, we demonstrated the association between miR-181 expression levels and patients' quality of life. A positive correlation was observed between tumoral miR-181d levels and glioma patients' functional parameters ( < 0.05), whereas increased exosomal miR-181b levels indicated a worse functional outcome ( < 0.05). Moreover, elevated miR-181b exosomal expression can indicate a significantly shorter post-surgical survival time for glioblastoma multiforme (GBM) patients. In addition, both tumoral and exosomal miR-181 expression levels were related to patients' functioning and tumor-related symptoms. Our study adds to previous findings by demonstrating the unique interplay between molecular miR-181b/d biomarkers and health related quality of life (HRQOL) score as both variables remained significant in the predictive glioma models.
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http://dx.doi.org/10.3390/ijms21207450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589546PMC
October 2020

Safety and efficacy of prothrombin complex concentrate (PCC) for anticoagulation reversal in patients undergoing urgent neurosurgical procedures: a systematic review and metaanalysis.

Neurosurg Rev 2020 Oct 3. Epub 2020 Oct 3.

Lithuanian University of Health Sciences, Kaunas, Lithuania.

Anticoagulant therapy poses a significant risk for patients undergoing emergency neurosurgery procedures, necessitating reversal with prothrombin complex concentrate (PCC) or fresh frozen plasma (FFP). Data on PCC efficacy lack consistency in this setting. This systematic review and metaanalysis aimed to evaluate efficacy and safety of PCC for anticoagulation reversal in the context of urgent neurosurgery. Articles from PubMed, Embase, and Cochrane databases were screened according to the PRISMA checklist. Adult patients receiving anticoagulation reversal with PCC for emergency neurosurgical procedures were included. When available, patients who received FFP were included as a comparison group. Pooled estimates of observational studies were calculated for efficacy and safety outcomes via random-effects modeling. Initial search returned 4505 articles, of which 15 studies met the inclusion criteria. Anticoagulants used included warfarin (83%), rivaroxaban (6.8%), phenprocoumon (6.1%), apixaban (2.2%), and dabigatran (1.5%). The mean International Normalized Ratio (INR) prePCC administration ranged from 2.3 to 11.7, while postPCC administration from 1.1 to 1.4. All-cause mortality at 30 days was 27% (95%CI 21, 34%; I = 44.6%; p-heterogeneity = 0.03) and incidence of thromboembolic events was 6.00% among patients treated with PCC (95%CI 4.00, 10.0%; I = 0%; p-heterogeneity = 0.83). Results comparing PCC and FFP demonstrated no statistically significant differences in INR reversal, mortality, or incidence of thromboembolic events. This metaanalysis demonstrated adequate safety and efficacy for PCC in the reversal of anticoagulation for urgent neurosurgical procedures. There was no significant difference between PCC and FFP, though further trials would be useful in demonstrating the safety and efficacy of PCC in this setting.
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http://dx.doi.org/10.1007/s10143-020-01406-zDOI Listing
October 2020

Isocitrate Dehydrogenase, Patient-Reported Outcomes, and Cognitive Functioning of Glioma Patients: a Systematic Review.

Curr Oncol Rep 2020 09 23;22(12):120. Epub 2020 Sep 23.

Harvard Medical School, Boston, MA, USA.

Purpose Of Review: Isocitrate dehydrogenase (IDH) mutation status has important prognostic implications in glioma patients, with IDH wild-type (IDH-WT) gliomas being associated with worse prognosis and shorter survival when compared with IDH mutant (IDH-mut) gliomas. Optimization of quality of life is a priority in the management of glioma patients. The goal of this systematic review was to identify studies that explored the association of IDH mutation status with patient-reported outcomes (PROs) and cognitive functioning of glioma patients.

Recent Findings: Studies that evaluated the association of IDH mutation status with PROs and/or cognitive functioning of glioma patients were identified from the Pubmed/MEDLINE, Clarivate analytics, and Google Scholar databases. Eight studies (7 journal articles and 2 conference abstracts) with a total of 658 low-grade glioma and high-grade glioma patients investigated the association of cognitive functioning and/or QoL with IDH status. IDH-WT status was associated with greater cognitive impairment relative to IDH-Mut status in three studies, while one study did not find the association between IDH status and perioperative cognitive functioning. One study reported worse postoperative cognitive functioning patients with IDH-WT vs. IDH-mut gliomas. In one study, IDH-WT status was linked to greater impairment on physical and communication functioning after surgery. IDH-WT gliomas are associated with greater cognitive burden than IDH-Mut tumors. The association of IDH status with QoL remains less clear. Assessment of IDH status should be considered when evaluating QoL and cognitive complaints of glioma patients. Further studies linking glioma molecular phenotypes with PROs and cognitive functioning are encouraged.
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http://dx.doi.org/10.1007/s11912-020-00978-9DOI Listing
September 2020

Prevalence of internet addiction in healthcare professionals: Systematic review and meta-analysis.

Int J Soc Psychiatry 2020 Sep 22:20764020959093. Epub 2020 Sep 22.

Neuroscience Institute, Lithuania University of Health Science, Kaunas, Lithuania.

Background: Internet addition is becoming increasingly recognised as an important mental health problem.

Aim: This study examined prevalence of internet addiction in healthcare professionals.

Method: Systematic literature review was undertaken of June 4, 2020 with goal to identify studies that evaluated prevalence of internet addiction or problematic internet use in medical professionals. Reported associations with other mental health symptoms were also considered.

Results: Prevalence of internet addiction was studied in medical residents only ( = 770; three studies), faculty members only ( = 69; one study), nurses only ( = 564; one study) and mixed samples of medical professionals ( = 415; three studies). Pooled prevalence rate of internet addiction in 1,818 healthcare professionals was 9.7% (95% confidence interval: 5.8%-13.6%). Internet addiction was associated with greater mental symptom burden and fatigue of healthcare workers.

Conclusion: Internet addiction is present in healthcare professionals, however, to a lesser extent than in medical students suggesting that increasing clinical responsibilities and increasing age can be important moderators of risk for internet addiction. Internet addiction is associated with greater burden of unfavourable mental health outcomes of healthcare professionals. Further studies exploring global burden of internet addiction in healthcare professionals and possible impact of internet addiction on work performance of healthcare professionals are encouraged.
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http://dx.doi.org/10.1177/0020764020959093DOI Listing
September 2020

Epistatic effect of Ankyrin repeat and kinase domain containing 1 - Dopamine receptor D2 and catechol-o-methyltransferase single nucleotide polymorphisms on the risk for hazardous use of alcohol in Lithuanian population.

Gene 2021 Jan 2;765:145107. Epub 2020 Sep 2.

Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Aim: The Lithuanian population has outstanding rates of alcohol consumption and alcohol related mortality. Alteration of brain dopaminergic system play a role in the risk for addiction disorders. We evaluated the association of one single nucleotide polymorphism rs1800497 in the Ankyrin Repeat and Kinase Domain Containing 1 - Dopamine Receptor D2 complex (ANKK1-DRD2) and a catechol-o-methyltransferase (COMT) rs4680 single nucleotide polymorphism with the risk for alcohol use disorder and impulsiveness in Lithuanian population. Both genetic polymorphisms are known to alter brain dopaminergic activity, thus we also investigated the possible interaction effect of these polymorphisms.

Methods: The study included 329 participants recruited from the local community. Hazardous alcohol use was evaluated using the Alcohol Use Disorder Identification Test (AUDIT). Impulsiveness was measured using the Barratt Impulsiveness Scale - 11 (BIS-11). Between group differences of AUDIT and BIS-11 scores were examined stratified by genetic polymorphisms and their combinations. The independent effect of each polymorphism and their interaction for hazardous alcohol use were evaluated using adjusted logistic regression analyses.

Results: The ANKK1-DRD2 rs1800497 polymorphism was associated with total AUDIT score, but not with the hazardous use of alcohol, as indicated by the AUDIT test cut-off of 8. The COMT rs4680 GG genotype was associated with the hazardous use of alcohol (adjusted OR = 2.094, p = 0.029), but this association was not statistically significant after adjustment for multiple comparisons. Presence of both COMT rs4680 and ANKK1-DRD2 rs1800497 GGxCT/TT polymorphisms was associated with significantly increased risk for hazardous use of alcohol (adjusted OR = 5.016, p = 0.005). The COMT rs4680 and ANKK1-DRD2 rs1800497 genetic polymorphisms, and their combination were not associated with impulsiveness.

Conclusions: Our study demonstrated that the interaction of COMT rs4680 and ANKK1-DRD2 rs1800497 genetic polymorphisms is associated with a hazardous use of alcohol.
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http://dx.doi.org/10.1016/j.gene.2020.145107DOI Listing
January 2021

Validation of the Substance Use Risk Profile Scale in Lithuanian population.

Health Qual Life Outcomes 2020 Aug 12;18(1):276. Epub 2020 Aug 12.

Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background: Personality traits are related with risk of hazardous alcohol use and alcohol dependence. The Substance Use Risk Profile Scale (SURPS) measures personality traits associated with addictive substance abuse. We examined psychometric properties of the SURPS in Lithuanian population.

Materials And Methods: Two hundred forty-seven participants (mean age 37.22 ± 0.78 years), were recruited from the local community and from an inpatient addiction treatment centre. Internal consistency, stability, factor structure, content validity, and external validity of the SURPS were examined. Hazardous alcohol use was evaluated by Alcohol Use Disorder Identification Test (AUDIT). Alcohol dependence diagnosis was established by International Classification of Diseases - 10 (ICD - 10). We also performed gender analyses for associations of personality traits with alcohol dependence and hazardous use of alcohol.

Results: The SURPS scale demonstrated appropriate internal validity, good temporal stability, and adequate criterion validity and construct validity. The SURPS scores of hopelessness, anxiety sensitivity and impulsivity were higher in the alcohol dependence group than in the control group for both males and females. Impulsivity and sensation seeking were associated with hazardous alcohol use and these associations were more prevalent in females.

Conclusions: Lithuanian translation of the SURPS scale was appropriate. The SURPS demonstrated good sensitivity for discriminating on alcohol dependence and was more sensitive for discriminating on hazardous alcohol use for females.
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http://dx.doi.org/10.1186/s12955-020-01527-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7425129PMC
August 2020

Quality-of-life trajectories after stereotactic radiosurgery for brain metastases.

J Neurosurg 2020 Jul 10:1-9. Epub 2020 Jul 10.

1Department of Neurological Surgery, University of Virginia Health System; and.

Objective: Quality of life (QOL) is an important endpoint measure of cancer treatment. The authors' goal was to evaluate QOL trajectories and prognostic value in cancer patients treated with stereotactic radiosurgery (SRS) for brain metastases.

Methods: Patients who underwent Gamma Knife radiosurgery (GKRS) between January 2016 and November 2019 were prospectively evaluated for QOL using the EQ-5D-3L questionnaire before SRS and at follow-up visits. Only patients who had pre-SRS and at least 1 post-SRS QOL assessment were considered.

Results: Fifty-four cancer patients underwent 109 GKRS procedures. The first post-SRS visit was at a median of 2.59 months (range 0.13-21.08 months), and the last post-SRS visit was at 14.72 months (range 2.52-45.21 months) after SRS. There was no statistically significant change in the EQ-5D index score (p = 0.539) at the first compared with last post-SRS visit. The proportion of patients reporting some problems on the EQ-5D dimension of self-care increased during the course of follow-up from 9% (pre-SRS visit) to 18% (last post-SRS visit; p = 0.03). The proportion of patients reporting problems on the EQ-5D dimensions of mobility, usual activities, pain/discomfort, and anxiety/depression remained stable during the course of follow-up (p ≥ 0.106). After adjusting for clinical variables, a higher recursive partitioning analysis (RPA) class (i.e., worse prognostic category) was independently associated with greater odds for EQ-5D index score deterioration (p = 0.050). Upfront whole-brain radiation therapy predicted deterioration of the EQ-5D self-care (p = 0.03) and usual activities (p = 0.024) dimensions, while a greater number of lesions predicted deterioration of the EQ-5D anxiety/depression dimension (p = 0.008). A lower pre-SRS EQ-5D index was associated with shorter survival independently from clinical and demographic variables (OR 18.956, 95% CI 2.793-128.64; p = 0.003).

Conclusions: QOL is largely preserved in brain metastasis patients treated with SRS. Higher RPA class, upfront whole-brain radiation therapy, and greater intracranial disease burden are independent predictors of post-SRS QOL deterioration. Worse pre-SRS QOL predicts shorter survival. Assessment of QOL is recommended in brain metastasis patients managed with SRS.
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http://dx.doi.org/10.3171/2020.4.JNS20788DOI Listing
July 2020

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in pediatric and adult population: a systematic review and meta-analysis.

Neurosurg Rev 2021 Jun 31;44(3):1227-1241. Epub 2020 May 31.

School of Pharmacy, MCPHS University, Boston, MA, 02115, USA.

Treatment options for hydrocephalus include endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS). Some ambiguity remains regarding indications, safety, and efficacy for these procedures in different clinical scenarios. The objective of the present study was to pool the available evidence to compare outcomes among patients with hydrocephalus undergoing ETV versus VPS. A systematic search of the literature was conducted via PubMed, EMBASE, and Cochrane Library through 11/29/2018 to identify studies evaluating failure and complication rates, following ETV or VPS. Pooled effect estimates were calculated using random effects. Heterogeneity was assessed by the Cochrane Q test and the I value. Heterogeneity sources were explored through subgroup analyses and meta-regression. Twenty-three studies (five randomized control trials (RCTs) and 18 observational studies) were meta-analyzed. Comparing ETV to VPS, failure rate was not statistically significantly different with a pooled relative risk (RR) of 1.48, 95%CI (0.85, 2.59) for RCTs and 1.17 (0.89, 1.53) for cohort studies; P-interaction: 0.44. Complication rates were not statistically significantly different between ETV and VPS in RCTs (RR: 1.34, 95%CI: 0.50, 3.59) but were statistically significant for prospective cohort studies (RR: 0.47, 95%CI: 0.30, 0.78); P-interaction: 0.07. Length of hospital stay was no different, when comparing ETV and VPS. These results remained unchanged when stratifying by intervention type and when regressing on age when possible. No significant differences in failure rate were observed between ETV and VPS. ETV was found to have lower complication rates than VPS in prospective cohort studies but not in RCTs. Further research is needed to identify the specific patient populations who may be better suited for one intervention versus another.
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http://dx.doi.org/10.1007/s10143-020-01320-4DOI Listing
June 2021

Clinical and Biological Correlates of Preoperative Cognitive Functioning of Glioma and Meningioma Patients.

Biomed Res Int 2020 8;2020:2054859. Epub 2020 May 8.

Neuroscience Institute, Lithuanian University of Health Sciences, Eiveniu str. 4, LT-50161, Lithuania.

Objectives: This study aimed to investigate the association of high-sensitivity C-reactive protein (hsCRP) and -terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentrations with cognitive functions of glioma and meningioma patients.

Methods: 177 brain tumor patients awaiting for brain tumor surgery participated in the study. Patients were assessed preoperatively, using neuropsychological tests for verbal memory, psychomotor speed, mental flexibility, and verbal fluency. The functional status of patients was evaluated using the Karnofsky Performance Index. Blood samples were drawn for evaluation of serum hsCRP and NT-proBNP concentrations upon hospital admission.

Results: The highest NT-proBNP concentration was observed in meningioma patients. Glioma and meningioma patients did not differ in hsCRB concentration. Patients in the highest hsCRP tertile were older and more frequently reported cardiovascular comorbidity. Patients in the highest NT-proBNP tertile were older, more frequently with cardiovascular comorbidity, females, and diagnosed with a meningioma. hsCRP was significantly related to slower psychomotor speed in high-grade glioma patients ( = 0.30, < 0.05). In meningioma sample, NT-proBNP correlated with decreased psychomotor speed ( = 0.38, < 0.01), mental flexibility ( = 0.33, < 0.01), worse cumulative learning ( = -0.27, < 0.05), and delayed recall ( = 0.30, < 0.01). However, the relationship between the NT-proBNP and cognitive functions became nonsignificant when demographic and clinical covariates were included into analysis. Higher hsCRP concentration remained significantly related to slower psychomotor speed ( = 0.02) and worse mental flexibility ( = 0.05) in glioma patients, independently from demographic and clinical covariates. Preoperative cognitive functioning was also predicted by older age, gender, side and location of the tumor, and tumor malignancy, and general functional status of a patient.

Conclusions: NT-proBNP was not associated with memory, language, and attention/executive cognitive domains of glioma and meningioma patients. Increased hsCRP was related to slower psychomotor speed and worse mental flexibility in glioma patients, indicating that inflammation processes are important for cognitive functioning in glial tumors.
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http://dx.doi.org/10.1155/2020/2054859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232682PMC
February 2021

Stereotactic radiosurgery for management of recurring Choroid Plexus Metastases from Non-Small Cell Lung Carcinoma.

J Neurooncol 2020 May 15;148(1):207-209. Epub 2020 Apr 15.

Department of Neurosurgery, University of Virginia Health System, University of Virginia, Charlottesville, VA, USA.

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http://dx.doi.org/10.1007/s11060-020-03498-5DOI Listing
May 2020