Diffuse Astrocytoma and Oligodendroglioma: An Integrated Diagnosis and Management

For the first time, the WHO classification of brain tumors has introduced molecular parameters in the diagnosis of brain tumors. Together with embryonal tumors, the diffuse gliomas have suffered significant changes in diagnosis, prognosis, and response to treatment. A new concept of “integrated diagnosis” comes to combine the classical diagnosis with the molecular one. While it is still impossible to disregard the histopathological component, according to the new rule (“molecular beats histology”) makes molecular parameters dominant in the final diagnosis. Currently, the diffuse gliomas (oligodendroglial or astrocytic) are nosologically closer than the astrocytomas with a diffuse growth pattern, and the astrocytomas with a more circumscribed growth pattern defined by the presence of the IDH mutation. The family tree was redefined by the presence of the IDH mutation and of the 1p/19q codeletion. The implementation of this new concept in clinical practice will improve patient management, as well as the design of clinical trials and experimental studies. This must also be seen as a model for diagnosis setting in the new molecular era

The assessment of risk factors for brainstem injuries and supratentorial brain injuries in patients with traumatic brain injury

Traumatic brain injury (TBI) is an important cause of death with a significant worldwide percentage. In the United States, there are approximately 2.8 million TBIs yearly with 250,000 hospitalized patients and 50,000 TBI-related deaths. Every year, there are one million hospitalizations in the European Union, resulting in more than 50,000 deaths, most of which occur due to road traffic accidents. Needless to say, these estimations varied based on the different sources of data. The patient’s outcome is determined by the context of the trauma, the type of lesion, as well as other factors. The aim of the study was to assess variables associated with brainstem injury and supra-tentorial brain injury in patients with TBI. This cohort included 70 consecutive TBI-related deaths from the Institute of Legal Medicine Cluj-Napoca. There was a significant difference in brainstem contusion (haemorrhage contusion) in patients younger than 60. According to the computed tomography (CT) data, brain contusion and laceration were observed in association with brainstem contusion in a significant percentage of TBI-related deaths (p=0.016). Neither the meningo-cerebral blood collections nor the intraparenchymal hematomas had a significant occurrence with brainstem contusion. The diffuse axonal injuries were detected on a CT scan in a significant number of cases with brainstem contusion (p=0.011). The mass effect with brain herniation in the posterior fossa was associated with the occurrence of brainstem contusion, possibly as an extensive process (p=0.041). Analyzing the histopathological data, we observed the significant presence of intracranial haemorrhage in association with a hemorrhagic contusion in the brainstem (p=0.004), but not with meningeal haemorrhage. The poor neurological assessment evaluated by GCS was not an independent variable in relation to this brainstem lesion. That was probably caused by the complexity of the TBI. We did not include this variable in a multivariate analysis considering the poor outcome for all patient

Proposed definition of competencies for surgical neuro-oncology training

Objective: The aim of this work is to define competencies and entrustable professional activities (EPAs) to be imparted within the framework of surgical neuro-oncological residency and fellowship training as well as the education of medical students. Improved and specific training in surgical neuro-oncology promotes neuro-oncological expertise, quality of surgical neuro-oncological treatment and may also contribute to further development of neuro-oncological techniques and treatment protocols. Specific curricula for a surgical neuro-oncologic education have not yet been established. Methods: We used a consensus-building approach to propose skills, competencies and EPAs to be imparted within the framework of surgical neuro-oncological training. We developed competencies and EPAs suitable for training in surgical neuro-oncology. Result: In total, 70 competencies and 8 EPAs for training in surgical neuro-oncology were proposed. EPAs were defined for the management of the deteriorating patient, the management of patients with the diagnosis of a brain tumour, tumour-based resections, function-based surgical resections of brain tumours, the postoperative management of patients, the collaboration as a member of an interdisciplinary and/or -professional team and finally for the care of palliative and dying patients and their families. Conclusions and Relevance: The present work should subsequently initiate a discussion about the proposed competencies and EPAs and, together with the following discussion, contribute to the creation of new training concepts in surgical neuro-oncology