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Article ; Online: Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment.

Lütgendorf-Caucig, Carola / Freyschlag, Christian / Masel, Eva Katharina / Marosi, Christine

2020 Volume 22, Issue 9, Page(s) 93

Abstract: Purpose of review: The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing ... ...

Abstract	Purpose of review: The incidence of glioblastoma multiforme (GBM) increases with age; more than half of newly diagnosed patients are older than 65 years. Due to age-dependent decreasing organ functions, comorbidities, functional decline, and increasing risk of social isolation, not all patients are able to tolerate standard therapy of GBM with 6 weeks of radiochemotherapy. Recent findings: A set of alleviated therapies, e.g., chemotherapy or radiotherapy alone, hypofractionated radiotherapies with different total doses and variable fractionation regimens as well as hypofractionated radiotherapy with concomitant and adjuvant chemotherapy, have been evaluated during the last years. However, clinicians are still unsure which therapy would fit best to a given patient. Recently, the predictive value of comprehensive geriatric assessment regarding tolerance of chemotherapy and prediction of early mortality has been validated for older GBM patients in a retrospective trial. Thus, it appears that neuro-oncology is now ready for the prospective implementation of geriatric assessment to guide treatment planning for elderly GBM patients.
MeSH term(s)	Aged ; Bevacizumab/therapeutic use ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Dose Fractionation, Radiation ; Geriatric Assessment ; Glioblastoma/therapy ; Humans ; Radiation Dose Hypofractionation
Chemical Substances	Bevacizumab (2S9ZZM9Q9V)
Language	English
Publishing date	2020-07-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	2057359-5
ISSN	1534-6269 ; 1523-3790
ISSN (online)	1534-6269
ISSN	1523-3790
DOI	10.1007/s11912-020-00951-6
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Article ; Online: Passive leg raising in brain injury patients within the neurointensive care unit. A prospective trial.

Bauer, Marlies / Basic, Daniel / Riedmann, Marina / Muench, Elke / Schuerer, Ludwig / Thomé, Claudius / F Freyschlag, Christian

Anaesthesiology intensive therapy

2022 Volume 53, Issue 3, Page(s) 200–206

Abstract: Introduction: In critically ill brain-injured patients maintaining balanced fluid management is a crucial part of critical care. Many factors influence the relationship between fluid management, cerebral blood flow and cerebral oxygenation. Passive leg ... ...

Abstract	Introduction: In critically ill brain-injured patients maintaining balanced fluid management is a crucial part of critical care. Many factors influence the relationship between fluid management, cerebral blood flow and cerebral oxygenation. Passive leg raising (PLR)-induced changes predict fluid responsiveness in the majority of non-neurological ICU patients. In patients with intracranial lesions, PLR testing has been hypothesized to increase intracranial pressure (ICP), although data are lacking. We wanted to investigate the feasibility of PLR with expected intracranial pressure increase, according to the higher cerebral blood volume. This should be self-limiting in patients with intact cerebral autoregulation. Material and methods: We prospectively included patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (aSAH) in this pilot trial. PLR was performed within 48 hours after the initial diagnosis and on days 5-8. All patients had ICP monitoring. Absence of intracranial hypertension (defined as ICP < 25 mm Hg) was considered a positive test result. Results: Ten patients were recruited for this study. The cohort consisted of 6 male patients with TBI and 4 female patients with aSAH. Mean patient age was 55.6 years (range 35-76). Overall, 18 tests could be performed, of which only one had to be terminated due to temporarily elevated ICP. 9 out of 10 patients had no intracranial hypertension during the acute (mean ICP increase 8.45 mm Hg, range 4-16) or during the subacute phase (mean ICP increase 9.12 mm Hg, range 3-18). Conclusions: PLR is feasible in patients with intracranial pathology to assess fluid responsiveness and provide optimized patient volume management without increasing the risk of persistent intracranial hypertension.
MeSH term(s)	Adult ; Aged ; Brain Injuries/therapy ; Female ; Humans ; Intracranial Hypertension/etiology ; Intracranial Hypertension/therapy ; Intracranial Pressure ; Leg ; Male ; Middle Aged ; Prospective Studies
Language	English
Publishing date	2022-02-12
Publishing country	Poland
Document type	Clinical Trial ; Journal Article
ISSN	1731-2531
ISSN (online)	1731-2531
DOI	10.5114/ait.2021.108361
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Article ; Online: Awake brain mapping of cortex and subcortical pathways in brain tumor surgery.

Freyschlag, C F / Duffau, H

Journal of neurosurgical sciences

2014

Abstract: Awake surgery is not a new technique: this is a new philosophy. Indeed, in surgery for diffuse gliomas performed in awake patients, the goal is not anymore to remove a "tumor mass" according to oncological boundaries (which in essence do not exist in ... ...

Abstract	Awake surgery is not a new technique: this is a new philosophy. Indeed, in surgery for diffuse gliomas performed in awake patients, the goal is not anymore to remove a "tumor mass" according to oncological boundaries (which in essence do not exist in infiltrating neoplasms), but to resect a part of the brain invaded by a chronic tumoral disease, according to functional limits both at cortical and subcortical levels. Therefore, intraoperative electrical mapping is accepted as the gold standard in order to gain information about the functionality of the underlying tissue when performing neurooncological surgery. This review should give the reader an overview of principles and indications of mapping of eloquent cortex and subcortical pathways with practical considerations for cerebral tumors. In gliomas, awake mapping has been demonstrated as increasing the surgical indications in socalled "critical areas" with nonetheless a significant decrease of postoperative morbidity while maximizing the extent of resection. Beyond clinical implications, awake surgery represents a unique opportunity to study neural networks underpinning sensorimotor, visuospatial, language, executive and even behavioral functions in humans. This led to propose new models of connectomics, breaking with the localisationist view of brain processing, and opening the window to the concept of neuroplasticity. In summary, awake mapping enables to make a link between surgical neurooncology and cognitive neurosciences, to improve both survival and quality of life of glioma patients.
Language	English
Publishing date	2014-05-20
Publishing country	Italy
Document type	Journal Article
ZDB-ID	193139-8
ISSN	1827-1855 ; 0390-5616 ; 0026-4881
ISSN (online)	1827-1855
ISSN	0390-5616 ; 0026-4881
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Article ; Online: Awake brain mapping of cortex and subcortical pathways in brain tumor surgery.

Freyschlag, C F / Duffau, H

Journal of neurosurgical sciences

2014 Volume 58, Issue 4, Page(s) 199–213

Abstract	Awake surgery is not a new technique: this is a new philosophy. Indeed, in surgery for diffuse gliomas performed in awake patients, the goal is not anymore to remove a "tumor mass" according to oncological boundaries (which in essence do not exist in infiltrating neoplasms), but to resect a part of the brain invaded by a chronic tumoral disease, according to functional limits both at cortical and subcortical levels. Therefore, intraoperative electrical mapping is accepted as the gold standard in order to gain information about the functionality of the underlying tissue when performing neuro-oncological surgery. This review should give the reader an overview of principles and indications of mapping of eloquent cortex and subcortical pathways with practical considerations for cerebral tumors. In gliomas, awake mapping has been demonstrated as increasing the surgical indications in so-called "critical areas" with nonetheless a significant decrease of postoperative morbidity‑while maximizing the extent of resection. Beyond clinical implications, awake surgery represents a unique opportunity to study neural networks underpinning sensorimotor, visuospatial, language, executive and even behavioral functions in humans. This led to propose new models of connectomics, breaking with the localizationist view of brain processing, and opening the window to the concept of neuroplasticity. In summary, awake mapping enables to make a link between surgical neurooncology and cognitive neurosciences, to improve both survival and quality of life of glioma patients.
MeSH term(s)	Brain Mapping/methods ; Brain Neoplasms/surgery ; Connectome/methods ; Humans ; Intraoperative Neurophysiological Monitoring/methods ; Neural Pathways/physiology ; Neurosurgical Procedures/methods ; Wakefulness
Language	English
Publishing date	2014-12
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	193139-8
ISSN	1827-1855 ; 0390-5616 ; 0026-4881
ISSN (online)	1827-1855
ISSN	0390-5616 ; 0026-4881
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Article ; Online: How I do it-optimizing radiofrequency ablation in spinal metastases using iCT and navigation.

Kavakebi, Pujan / Freyschlag, C F / Thomé, C

Acta neurochirurgica

2017 Volume 159, Issue 10, Page(s) 2025–2028

Abstract: Background: Exact positioning of the radiofrequency ablation (RFA) probe for tumor treatment under fluoroscopic guidance can be difficult because of potentially small inaccessible lesions and the radiation dose to the medical staff in RFA. In addition, ... ...

Abstract	Background: Exact positioning of the radiofrequency ablation (RFA) probe for tumor treatment under fluoroscopic guidance can be difficult because of potentially small inaccessible lesions and the radiation dose to the medical staff in RFA. In addition, vertebroplasty (VP) can be significantly high. Method: Description and workflow of RFA in spinal metastasis using iCT (intraoperative computed tomography) and 3D-navigation-based probe placement followed by VP. Conclusion: RFA and VP can be successfully combined with iCT-based navigation, which leads to a reduction of radiation to the staff and optimal probe positioning due to 3D navigation.
MeSH term(s)	Catheter Ablation/methods ; Fluoroscopy ; Humans ; Spinal Neoplasms/diagnostic imaging ; Spinal Neoplasms/secondary ; Spinal Neoplasms/surgery ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2017-08-01
Publishing country	Austria
Document type	Journal Article
ZDB-ID	80010-7
ISSN	0942-0940 ; 0001-6268
ISSN (online)	0942-0940
ISSN	0001-6268
DOI	10.1007/s00701-017-3267-0
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Article ; Online: ChatGPT in glioma adjuvant therapy decision making: ready to assume the role of a doctor in the tumour board?

Haemmerli, Julien / Sveikata, Lukas / Nouri, Aria / May, Adrien / Egervari, Kristof / Freyschlag, Christian / Lobrinus, Johannes A / Migliorini, Denis / Momjian, Shahan / Sanda, Nicolae / Schaller, Karl / Tran, Sebastien / Yeung, Jacky / Bijlenga, Philippe

BMJ health & care informatics

2023 Volume 30, Issue 1

Abstract: Objective: To evaluate ChatGPT's performance in brain glioma adjuvant therapy decision-making.: Methods: We randomly selected 10 patients with brain gliomas discussed at our institution's central nervous system tumour board (CNS TB). Patients' ... ...

Abstract	Objective: To evaluate ChatGPT's performance in brain glioma adjuvant therapy decision-making. Methods: We randomly selected 10 patients with brain gliomas discussed at our institution's central nervous system tumour board (CNS TB). Patients' clinical status, surgical outcome, textual imaging information and immuno-pathology results were provided to ChatGPT V.3.5 and seven CNS tumour experts. The chatbot was asked to give the adjuvant treatment choice, and the regimen while considering the patient's functional status. The experts rated the artificial intelligence-based recommendations from 0 (complete disagreement) to 10 (complete agreement). An intraclass correlation coefficient agreement (ICC) was used to measure the inter-rater agreement. Results: Eight patients (80%) met the criteria for glioblastoma and two (20%) were low-grade gliomas. The experts rated the quality of ChatGPT recommendations as poor for diagnosis (median 3, IQR 1-7.8, ICC 0.9, 95% CI 0.7 to 1.0), good for treatment recommendation (7, IQR 6-8, ICC 0.8, 95% CI 0.4 to 0.9), good for therapy regimen (7, IQR 4-8, ICC 0.8, 95% CI 0.5 to 0.9), moderate for functional status consideration (6, IQR 1-7, ICC 0.7, 95% CI 0.3 to 0.9) and moderate for overall agreement with the recommendations (5, IQR 3-7, ICC 0.7, 95% CI 0.3 to 0.9). No differences were observed between the glioblastomas and low-grade glioma ratings. Conclusions: ChatGPT performed poorly in classifying glioma types but was good for adjuvant treatment recommendations as evaluated by CNS TB experts. Even though the ChatGPT lacks the precision to replace expert opinion, it may serve as a promising supplemental tool within a human-in-the-loop approach.
MeSH term(s)	Humans ; Brain Neoplasms/drug therapy ; Brain Neoplasms/pathology ; Artificial Intelligence ; Glioma/pathology ; Glioma/surgery ; Decision Making
Language	English
Publishing date	2023-07-03
Publishing country	England
Document type	Journal Article
ISSN	2632-1009
ISSN (online)	2632-1009
DOI	10.1136/bmjhci-2023-100775
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Article ; Conference proceedings: Cerebraler Energie- und Membranmetabolismus bei Patienten mit Glioblastoma multiforme

Rietzler, A / Steiger, R / Walchhofer, L / Rehwald, R / Glodny, B / Kerschbaumer, J / Freyschlag, C / Stockhammer, G / Gizewski, E / Grams, A

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren

2020 Volume 192, Issue S 01

Event/congress	101. Deutscher Röntgenkongress und 9. Gemeinsamer Kongress der DRG und ÖRG, Leipzig, 2020-05-20
Language	German
Publishing date	2020-04-01
Publisher	© Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article ; Conference proceedings
ZDB-ID	554830-5
ISSN	1438-9010 ; 1438-9029 ; 0340-1618 ; 0936-6652 ; 1433-5972
ISSN (online)	1438-9010
ISSN	1438-9029 ; 0340-1618 ; 0936-6652 ; 1433-5972
DOI	10.1055/s-0040-1703445
Database	Thieme publisher's database

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Article ; Online: Insights from a Multicenter Study on Adult H3 K27M-Mutated Glioma: Surgical Resection's Limited Influence on Overall Survival, ATRX as Molecular Prognosticator.

Ryba, A / Özdemir, Z / Nissimov, N / Hönikl, L / Neidert, N / Jakobs, M / Kalasauskas, D / Krigers, A / Thomé, C / Freyschlag, C F / Ringel, F / Unterberg, A / Dao Trong, P / Beck, J / Heiland, D H / Meyer, B / Vajkoczy, P / Onken, J / Stummer, W /

Suero Molina, E / Gempt, J / Westphal, M / Schüller, U / Mohme, M

Neuro-oncology

2024

Abstract: Background: H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 WHO classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic ...

Abstract	Background: H3 K27M-mutated gliomas were first described as a new grade 4 entity in the 2016 WHO classification. Current studies have focused on its typical appearance in children and young adults, increasing the need to better understand the prognostic factors and impact of surgery on adults. Here, we report a multicentric study of this entity in adults. Methods: We included molecularly confirmed H3 K27M-mutated glioma cases in patients >18 years diagnosed between 2016 and 2022. Clinical, radiological, and surgical features were analyzed. Univariate and multivariate analyses were performed to identify prognostic factors. Results: Among 70 patients with a mean age of 36.1 years, the median overall survival (OS) was 13.6 + 14 months. Gross-total resection was achieved in 14.3% of patients, whereas 30% had a subtotal resection and 54.3% a biopsy.Tumors located in telencephalon/diencephalon/myelencephalon were associated with a poorer OS, while a location in the mesencephalon/metencephalon showed a significantly longer OS (8.7 vs. 25.0 months, p=0.007). Preoperative Karnofsky Performance Score (KPS) < 80 showed a reduced OS (4.2 vs. 18 months, p=0.02). Furthermore, ATRX loss, found in 25.7%, was independently associated with an increased OS (31 vs. 8.3 months, p=0.0029). Notably, patients undergoing resection showed no survival benefit over biopsy (12 vs. 11 months, p=0.4006). Conclusion: The present study describes surgical features of H3 K27M-mutated glioma in adulthood in a large multicentric study. Our data reveal that ATRX status, location and KPS significantly impact OS in H3 K27M-mutated glioma. Importantly, our dataset indicates that resection does not offer a survival advantage over biopsy.
Language	English
Publishing date	2024-03-20
Publishing country	England
Document type	Journal Article
ZDB-ID	2028601-6
ISSN	1523-5866 ; 1522-8517
ISSN (online)	1523-5866
ISSN	1522-8517
DOI	10.1093/neuonc/noae061
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Article ; Online: Das akute Subduralhämatom bei geriatrischen Patienten: Wieviel Neurochirurgie brauchen wir? // The role of age in the treatment of traumatic brain injury

Unterhofer, C / Hartmann, S / Wittlinger, K / Freyschlag, C / Ortler, M / Thome, C

Journal für Neurologie, Neurochirurgie und Psychiatrie

2018 Volume 19, Issue 2, Page(s) 53–58

Abstract: Increasing life expectancy leads to aging of the population. It remains unclear, which factors influence neurosurgical decision-making when it comes to indications for e.g. evacuation of subdural hematomas in very old patients. Therefore, we aimed to ... ...

Abstract	Increasing life expectancy leads to aging of the population. It remains unclear, which factors influence neurosurgical decision-making when it comes to indications for e.g. evacuation of subdural hematomas in very old patients. Therefore, we aimed to investigate first, the importance of imaging criteria, patients wishes or their next of kinwishes and patient demographics on therapeutic decisions made by neurosurgeons. Second, to explore personal preferences regarding lifeprolonging neurosurgical interventions among ambulatory, autonomous elderly people. p bKurzfassung: /bMan kann vom neurochirurgischen Dilemma sprechen, wenn ein geriatrischer Patient mit einem schweren Schädel-Hirn-Trauma und einem akuten Subduralhämatom in den Schockraum kommt. Vor allem bei Patienten, die sich in einem schlechten neurologischen Zustand befinden und zum Zeitpunkt der Therapieentscheidung nicht mehr bei Bewusstsein sind, kann das Erstellen eines Behandlungsplanes aus vielerlei Gründen erschwert sein. Es werden bereits im Schockraum Fragen aufgeworfen, wie zum Beispiel, ob in Anbetracht des Alters überhaupt eine operative Behandlung in Betracht gezogen wird. Sollte man sich zu einer Operation entscheiden, ist auch die Invasivität der Behandlung (große Entlastungskraniotomie vs. Versuch einer Entleerung über eine kleinere osteoplastische Kraniotomie, Einsatz von multimodalem invasivem Monitoring) eine Einzelentscheidung. Des Weiteren stellt sich die Frage, ob patientenbezogene Faktoren für Neurochirurgen eine Rolle spielen und inwiefern soziale Faktoren und Lebensumstände der Patienten in der Entscheidung zur weiteren Therapie miteinfließen.br Aufgrund all dieser Fragen ist es umso verständlicher, dass in der Akutsituation die richtige Entscheidung oft schwer zu treffen ist man will doch nur das Beste für die schwer verletzten Patienten erreichen.br Die Vielzahl an kontroversen Fragestellungen, die bei der Entscheidung zum weiteren Procedere entstehen können, die unterschiedlichen Operationsarten, die gewählt werden können und den persönlichen Zugang von Neurochirurgen zu geriatrischen Patienten nahmen wir zum Anlass, unsere Umfragen zu starten: In unserer ersten Studie haben wir Neurochirurgen zu Indikationsstellungen und Therapie beim akuten Subduralhämatom bei einer geriatrischen Patientin befragt. In der zweiten Umfragestudie haben wir geriatrische Menschen interviewt, bezüglich ihrer Wünsche und Ängste, sollten sie selbst ein schweres Schädel-Hirn-Trauma mit Bewusstseinsverlust erleiden. Die Ergebnisse finden wir erstaunlich und widersprüchlich zugleich.
MeSH term(s)	akutes Subdural-Hämatom, geriatrischer Patient, Schädel-Hirn-Trauma, acute subdural hematoma, craniocerebral injury, geriatric patient
Publishing date	20180613
Document type	Article ; Online
ZDB-ID	2151261-9
ISSN	1680-9440 ; 1608-1587
ISSN (online)	1680-9440
ISSN	1608-1587
Database	Krause and Pachernegg publications database

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Conference proceedings: One year with Optune in Austria: First report on clinical experiences

Freyschlag, Christian / Kerschbaumer, Johannes / Pinggera, Daniel / Thomé, Claudius

2017 , Page(s) P 043

Event/congress	68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS); Magdeburg; ; Society of British Neurological Surgeons; 2017
Keywords	Medizin, Gesundheit
Publishing date	2017-06-09
Publisher	German Medical Science GMS Publishing House; Düsseldorf
Document type	Conference proceedings
DOI	10.3205/17dgnc606
Database	German Medical Science

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