Can awake glioma surgery be the new standard of care in developing countries?

Bukhari, Syed Sarmad; Shamim, Muhammad Shahzad

doi:10.25259/sni_635_2020

Cited by 5 publications

(8 citation statements)

References 12 publications

(11 reference statements)

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“…AC provides many advantages compared with surgery under general anesthesia (GA) by enabling real-time cortical and subcortical brain mapping under local anesthesia. 4,22-28 In the awake-awake-awake approach, the patient is sedated at light, moderate, or deep levels with spontaneous ventilation during craniotomy and closure. 6,29,30 Although in the asleep-awake-asleep approach, the patient is under GA with a laryngeal mask airway/endotracheal intubation during craniotomy and closure and awakened and extubated during the mapping and resection step in.…”

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confidence: 99%

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

et al. 2022

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BACKGROUND: Awake craniotomy (AC) enables real-time monitoring of cortical and subcortical functions when lesions are in eloquent brain areas. AC patients are exposed to various preoperative, intraoperative, and postoperative stressors, which might affect their mental health. OBJECTIVE: To conduct a systematic review to better understand stress, anxiety, and depression in AC patients. METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1, 2000, to April 20, 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. RESULTS: Four hundred forty-seven records were identified that fit our inclusion and exclusion criteria for screening. Overall, 24 articles consisting of 1450 patients from 13 countries were included. Sixteen studies (66.7%) were prospective, whereas 8 articles (33.3%) were retrospective. Studies evaluated stress, anxiety, and depression during different phases of AC. Twenty-two studies (91.7%) were conducted on adults, and 2 studies were on pediatrics (8.3 %). Glioma was the most common AC treatment with 615 patients (42.4%). Awake-awakeawake and asleep-awake-asleep were the most common protocols, each used in 4 studies, respectively (16.7%). Anxiety was the most common psychological outcome evaluated in 19 studies (79.2%). The visual analog scale and self-developed questionnaire by the authors (each n = 5, 20.8%) were the most frequently tools used. Twenty-three studies (95.8%) concluded that AC does not increase stress, anxiety, and/or depression in AC patients. One study (4.2%) identified younger age associated with panic attack. CONCLUSION: In experienced hands, AC does not cause an increase in stress, anxiety, and depression; however, the psychiatric impact of AC should not be underestimated.

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confidence: 99%

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

et al. 2022

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“…Glioma is regarded as one of the dominant causes of cancer globally, and its pathological complexity necessitates combination therapies of various therapeutic elements, such as anti-cancer drugs and genes, to achieve synergistic treatment [ 4 , 5 , 20 ]. REV7 is an important subunit of pol ζ and is highly evolutionarily conserved.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, glioma has become one of the most commonly diagnosed types of cancer worldwide [1][2][3]. With the recurrence and metastasis ability of cancer cells, the number of patients diagnosed with malignant glioma is increasing [3][4][5]. Current anti-glioma therapies include chemotherapy and surgery, and previous research has shown that chemotherapy can improve the lifespan and quality of life of most glioma patients [6,7].…”

Section: Introductionmentioning

confidence: 99%

Knockdown of DNA polymerase ζ relieved the chemoresistance of glioma via inhibiting the PI3K/AKT signaling pathway

et al. 2021

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Previous reports suggest that DNA polymerase ζ is highly expressed in glioma tissues. The present study aimed to investigate the roles of the REV7 subunit of DNA polymerase ζ in glioma cell chemoresistance and its underlying mechanisms. The bioinformatics method was used to compare the expression of REV7 in glioma and normal tissues. The expression of REV7 in glioma tumor samples and the adjacent tissue was examined by reverse transcription polymerase chain reaction. Moreover, an in vitro analysis using glioma cells was used to test the effects of REV7 siRNA on the proliferation and apoptosis of glioma cell line U251 cells, and the effect of REV7 siRNA on the sensitivity of the U251 cells to cisplatin was also explored. The expression of REV7 in glioma tumors was significantly increased. Moreover, the knockdown of REV7 in glioma cells decreased the proliferation and increased the apoptosis of U251 cells; moreover, REV7 siRNA also increased the sensitivity of U251 cells to cisplatin. Finally, REV7 may regulate the proliferation, apoptosis, and chemosensitivity of U251 cells by affecting phosphoinositide 3-kinase signaling. Our data suggest that REV7 is involved in the chemosensitivity of glioma cells and provides a theoretical basis for targeting DNA polymerase ζ to improve the sensitivity of glioma cells to chemotherapy.

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“…Awake craniotomies have shown to promote a better extent of resection, a lower risk of new deficits, and improved progression-free survival among patients. 3 Histologically, astrocytomas and oligodendrogliomas are the two most common subtypes of LGGs, and can be further characterized by molecular genotypes and growth patterns. 4 Oligodendrogliomas are characterized by both an isocitrate dehydrogenase (IDH) mutation and chromosomal 1p and 19q co-deletions, and have an encouraging prognosis.…”

Section: Introductionmentioning

confidence: 99%

A 10-Year Survival-Trend Analysis of Low-Grade Glioma and Treatment Patterns from an LMIC

Bajwa,

Anis,

Yousaf

et al. 2023

Asian J Neurosurg

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Objectives The 2021 WHO Classification of Central Nervous System Tumors taxonomy laid further stress on molecular classification and prognostication of glial tumors in comparison to histopathological grading. Research shows that low-grade gliomas (LGGs) can go through malignant differentiation and lead to severe disability and death. Data from various populations will be necessary to ascertain the exact interplay between genotypic predictors of LGG and outcomes. Materials and Methods To assess the molecular pathology for glial tumors in the Pakistani population, the Shaukat Khanum Memorial Cancer Hospital carried out a retrospective chart review of electronic health records from 2008 to 2018, with immunohistochemistry analysis findings from 2010 to 2018. Patients with a pathological diagnosis of a glioma were included. Statistical Analysis Analysis was performed using IBM SPSS Statistics Version 23 and STATA Version 16. A p-value of less than 0.05 was considered statistically significant with 95% confidence intervals reported. Results In all, 281 operable tumors were recorded. The most common procedure was a subtotal resection, and astrocytomas (64.77%) were the most common tumors. Radiation therapy and PCV (procarbazine, CCNU, and vincristine) was received by 85 patients, while radiation therapy and temozolomide were administered to 15 patients. Conclusions Isocitrate dehydrogenase (IDH) wild-type LGG had a lower survival time, while improved survival times were seen for alpha-thalassemia X-linked intellectual disability syndrome (ATRX) retained and 1p19q co-deleted LGGs. Further studies are required to gain a better understanding of lower-grade glial tumor treatment and survival in Pakistan.

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Can awake glioma surgery be the new standard of care in developing countries?

Cited by 5 publications

References 12 publications

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Stress, Anxiety, and Depression Associated With Awake Craniotomy: A Systematic Review

Knockdown of DNA polymerase ζ relieved the chemoresistance of glioma via inhibiting the PI3K/AKT signaling pathway

A 10-Year Survival-Trend Analysis of Low-Grade Glioma and Treatment Patterns from an LMIC

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