Learning about Neurosurgery and Neurology

30/12/2025

🧠 Clinical Case #1 | Intraventricular Tumor with Seizure Presentation

We recently admitted a 50-year-old woman who presented with a generalized tonic-clonic seizure. Postictally, she developed a transient right-sided Todd’s paresis and sensomotor aphasia, which have mostly resolved. On admission, she was fully oriented with no focal neurological deficits except for mild word-finding difficulties.

Her history includes breast cancer in 2020, treated with surgery, radiochemotherapy, and ongoing tamoxifen.

Imaging revealed a large intraventricular lesion in the left lateral ventricle, accompanied by perifocal edema. She was started on levetiracetam externally and dexamethasone was initiated in our department.

MRI with contrast is underway. Surgical resection is scheduled for Monday. The patient expressed a strong wish to return home for the New Year holiday after pre-op workup is completed.

Would you consider temporary discharge in such a case? What additional diagnostic information you would like to obtain?

27/12/2025

🧠 New Results: Glasdegib + Chemoradiotherapy in Newly Diagnosed Glioblastoma
🧪 Phase Ib/II GEINO 1602 trial published in Nature Communications
📅 Published: Dec 2025 | DOI: 10.1038/s41467-025-66747-z

The hedgehog signaling pathway may contribute to treatment resistance in glioblastoma (GBM). The GEINO 1602 study explored adding Glasdegib, a hedgehog pathway inhibitor, to standard therapy (Stupp regimen).

👥 79 patients received:
• Glasdegib + radiotherapy + concomitant and adjuvant temozolomide,
• Followed by Glasdegib monotherapy.

📊 Key Results:
▪️ 15-month overall survival (OS): 52.1% (did not surpass 60% futility threshold)
▪️ 2-year OS: 29.2%
▪️ Median progression-free survival (PFS): 7.1 months
▪️ Glasdegib was well tolerated at 75 mg/day

🔬 Takeaway:
Though the primary endpoint was not met, long-term survival in ~30% of patients warrants further investigation. Ongoing translational research will explore biomarkers of benefit.

📌 Funded by GEINO & Pfizer (IIR), this trial highlights the need to refine patient selection for hedgehog-targeted therapies in GB.

26/12/2025

New Study: Navtemadlin in Recurrent Glioblastoma – Insights from a Window-of-Opportunity Trial
📚 Science Translational Medicine, Feb 2025 | DOI: 10.1126/scitranslmed.adn6274

Researchers tested the MDM2 inhibitor Navtemadlin (KRT-232) in 21 patients with TP53-wildtype recurrent glioblastoma.
Patients received 2 doses before surgery and continued treatment post-op.

🔍 Key findings:
▪️ Navtemadlin showed pharmacodynamic activity (p53 pathway activation),
▪️ but progression-free survival (PFS) was only 3.1 months,
▪️ and overall survival (OS) did not significantly improve.

🔬 Mechanistic insights:
▪️ Tumors showed resistance without TP53 mutation.
▪️ Oligodendroglial features (e.g., OLIG2+ enrichment) emerged at relapse.
▪️ Combining Navtemadlin + Temozolomide increased tumor cell death in neurosphere models without harming normal bone marrow.

📌 Conclusion:
Targeting MDM2 alone may not be enough – combination strategies (e.g., with Temozolomide) could unlock better outcomes in future trials.

17/12/2025

🧠 New Study: Navtemadlin in Recurrent Glioblastoma – Insights from a Window-of-Opportunity Trial
📚 Science Translational Medicine, Feb 2025 | DOI: 10.1126/scitranslmed.adn6274

Researchers tested the MDM2 inhibitor Navtemadlin (KRT-232) in 21 patients with TP53-wildtype recurrent glioblastoma.
Patients received 2 doses before surgery and continued treatment post-op.

🔍 Key findings:
▪️ Navtemadlin showed pharmacodynamic activity (p53 pathway activation),
▪️ but progression-free survival (PFS) was only 3.1 months,
▪️ and overall survival (OS) did not significantly improve.

🔬 Mechanistic insights:
▪️ Tumors showed resistance without TP53 mutation.
▪️ Oligodendroglial features (e.g., OLIG2+ enrichment) emerged at relapse.
▪️ Combining Navtemadlin + Temozolomide increased tumor cell death in neurosphere models without harming normal bone marrow.

📌 Conclusion:
Targeting MDM2 alone may not be enough – combination strategies (e.g., with Temozolomide) could unlock better outcomes in future trials.

17/12/2025

https://www.youtube.com/watch?v=7XTQtsC2Jvk

Resection of a Parietal Astrocytoma with ECOG and Exoscopic Assistance

Patient was a 28-year-old male with history of a single seizure. Biopsy identified the parietal mass to be a gemistocytic astrocytoma.

16/12/2025

Subependymal Giant Cell Astrocytoma (SEGA) in Tuberous Sclerosis – Case Report & Modern Treatment Approach

A 24-year-old patient with genetically confirmed Tuberous Sclerosis Complex (TSC) was found to have a growing SEGA near the right lateral ventricle. Despite being clinically stable, an interdisciplinary tumor board recommended treatment with Everolimus. After just 6 months, MRI showed tumor shrinkage and the therapy was well tolerated.

🔬 What is SEGA?
A slow-growing brain tumor typically seen in TSC patients. It can cause hydrocephalus, seizures, or developmental regression if left untreated.

💊 Treatment with mTOR inhibitors (e.g., Everolimus)
✔️ Standard of care for non-resectable or multiple SEGAs
✔️ Effects: tumor reduction and better seizure control
✔️ Requires regular drug level checks and MRI monitoring

📌 Take-home message:
Everolimus is now a standard treatment for progressive SEGA. Early therapy decisions in specialized TSC centers can help avoid surgery and preserve long-term quality of life.

14/12/2025

New publication in International Journal of Cancer (IJC, 2025): Hemorrhage in Resected Brain Metastases – Risk Factors & Outcomes
(Guelen et al., Wasilewski et al.)

In a cohort of 880 patients undergoing surgery for brain metastases at Charité, we investigated the impact of intralesional and intracranial hemorrhage (ICH) on survival, functional status, and treatment planning.

🔍 Key Findings
• Hemorrhage was linked to larger tumor volume and melanoma or NSCLC origin.
• Antithrombotic therapy was not associated with increased bleeding risk.
• ICH did not independently predict overall survival – prognosis was mainly driven by tumor burden, systemic disease, and adjuvant treatment.

🎯 Clinical implication:
Hemorrhage should be seen as a marker, not a driver, of outcome — management decisions should focus on biology, performance status, and extracranial disease.

📄 Read more (Open Access):
🔗 https://doi.org/10.1002/ijc.70250

💬 Huge thanks to the entire team, especially Melisa Guelen, Peter Vajkoczy, Julia Onken, and Jawed Nawabi, for their tireless work and multidisciplinary collaboration!

Brain metastases may present with hemorrhage, yet risk factors and clinical outcomes remain unclear. Based on a cohort of 880 patients with resected brain metastases, this study identified tumor volu...

06/12/2025

TROPION-Lung01 Phase III Trial: Dato-DXd vs. Docetaxel in NSCLC

The TROPION-Lung01 trial (Ahn et al., JCO 2025; DOI
) evaluated Datopotamab Deruxtecan (Dato-DXd) against docetaxel in previously treated advanced/metastatic non-small cell lung cancer (NSCLC).

Patients: 604, randomized 1:1 (Dato-DXd vs. Docetaxel)
Primary endpoints:

PFS (progression-free survival): 4.4 vs. 3.7 months, HR 0.75 (p = .004). Strongest benefit in nonsquamous NSCLC: 5.5 vs. 3.6 months, HR 0.63

OS (overall survival): 12.9 vs. 11.8 months, HR 0.94 (not statistically significant)

Safety: Grade ≥3 AEs: 26% (Dato-DXd) vs. 42% (Docetaxel)
ILD/Pneumonitis: 8.8% vs. 4.1%

Conclusion:
Dato-DXd significantly improves PFS vs. docetaxel, especially in nonsquamous NSCLC, with fewer high-grade side effects. OS benefit did not reach statistical significance.

06/12/2025

🧠 Patients with brain or spine tumors are at high risk for life-threatening emergencies – either at diagnosis or during treatment.

A new review from Mayo Clinic highlights the most common and critical situations:

✅ Intracranial Hypertension & Brain Herniation
→ From tumor growth or edema. Symptoms: headache, nausea, unconsciousness. Needs fast ICU management.

Seizures & Status Epilepticus
→ Especially in low-grade gliomas or metastases. First seizures often lead to diagnosis. Requires urgent treatment with antiepileptics.

Spinal Cord Compression
→ Often from vertebral metastases. Leads to pain, weakness, or paralysis. MRI + steroids + surgery or radiation may be needed.

Tumor Bleeding, Stroke, Thrombosis
→ Brain tumor patients have a higher risk of bleeding and clots. Anticoagulation must be balanced carefully.

Radiation Necrosis or Chemotoxicity
→ Side effects of treatment can mimic tumor progression. Important to differentiate and treat accordingly.

Source: Suarez-Meade et al., Current Oncology Reports (2022)
HERE: https://doi.org/10.1007/s11912-022-01259-3

These emergencies require fast recognition and multidisciplinary action – often in the ICU.

Purpose of Review Patients with brain and spine tumors are at high risk of presenting cancer-related complications at disease presentation or during active treatment and are usually related to the type and location of the lesion. Here, we discuss presentation and management of the most common emerge...

03/12/2025

https://www.youtube.com/watch?v=pgUrl9xvsD0

Interesting video on thoracic arachnoid cyst resection

Harel Deutsch, M.D.Rush University Medical Center, Chicago, IllinoisArachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts ma...

29/11/2025

New in BMC Cancer (online first): In an 88-patient cohort (1996–2022), we found that gross total resection was linked to longer progression-free survival (HR 0.36), age predicted overall survival, and most patients required hormone replacement after therapy. Radiotherapy showed no clear survival or local-control advantage in this series, highlighting the need for prospective studies to optimize sequencing and long-term quality of life.

https://lnkd.in/dnnWUBSa

Hashtag Hashtag Hashtag Hashtag Hashtag Hashtag Hashtag

This link will take you to a page that’s not on LinkedIn