The annual meeting of the American Association of Neurological Surgeons was held from April 22 to 26 in Los Angeles and attracted more than 7,000 participants from around the world, including neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals, and others interested in neurological surgery. The conference highlighted recent advances in neurological surgery, with presentations focused on the prevention, management, and rehabilitation of nervous system disorders, including disorders of the spinal column, spinal cord, brain, and peripheral nerves.
In one study, John Y.K. Lee, M.D., of the University of Pennsylvania in Philadelphia, and colleagues found that fluorescent-guided pituitary adenoma surgery using folate targeting was effective for visualizing pituitary adenomas and margins in real time.
Specifically, the investigators found that pituitary adenomas and margins could be visualized with preoperative injection of OTL38, a folate analog conjugated to NIR dye. In addition, near-infrared optical contrast was significantly stronger for FRalpha-overexpressing tumors, as hypothesized by the investigators. Last, FRalpha overexpression was predicted by intraoperative quantification of signal-to-background-ratio (SBR) when the endoscope was held at an appropriate distance.
“We now can see tumors by injecting specific dyes that glow in the near infrared range. Utilizing special cameras that are small enough to fit in the nose, we can now remove pituitary adenomas in a more thorough way,” said Lee.
Lee reported owning stock options in Visionsense, which makes 3-D endoscopic cameras.
In another study, Doris Du Wang, M.D., Ph.D., of the University of California in San Francisco, and colleagues found that maximizing the extent of resection in insular gliomas portends greater seizure freedom after surgery.
“Of the 109 patients who underwent surgical resection for insular glioma, 68 percent were seizure-free one year after surgery and 39 percent were seizure-free at final follow-up. Median time to seizure recurrence was 46 months,” said Wang. “Multivariate regression analysis revealed that greater extent of resection was a significant predictor of seizure freedom.”
Mark W. Youngblood, M.D., of Yale University in New Haven, Connecticut, and colleagues found that genomic subgroups in meningioma exhibit distinct clinical and molecular features that may eventually guide treatment approaches and use of targeted therapies.
“In this study, we collected over 1,500 meningioma cases from Yale University and other collaborators and assessed the relationships of established genomic subgroups with clinical and molecular features,” said Youngblood. “We discovered new associations with location, histology, Ki-67, patient age, and tumor volume while also confirming previous associations with location, histology, and grade.”
Using molecular profiling, the investigators identified gene expression biomarkers associated with each genomic subgroup and found that these were often driven by subgroup-specific super-enhancers, which are regulatory elements that control expression of cell identity genes and can become hijacked to drive oncogenesis.
“Based on comprehensive analysis of cases from the Yale neurosurgery department and other collaborators, our study identifies important molecular targets associated with each genomic subgroup in meningioma, laying the groundwork for development of precision therapies,” said Youngblood. “Additionally, we’ve found that the features of a given tumor are largely predictive of a patient’s underlying driver mutation, which could improve clinical decision-making in treatment of these lesions.”
AANS: Women Rising in Numbers of U.S. Neurosurgeons
TUESDAY, April 25, 2017 (HealthDay News) — The proportion of female neurosurgery residents is slowly increasing, according to a report presented during the 2017 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting, being held April 22-26 in Los Angeles.
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