Oncology Flashcards
What is the best technique to use for intraoperative subcortical monitoring?
MEP
What MEP/SSEP reduction is thought to be significant?
50% of baseline
What is the evidence for intraoperative neurophysiology?
Berger / Duffau et al - It causes an increase in transient neurological deficit, but less permanent deficit and also increased resection of tumour I.e. Allows the surgeon to be more aggressive with resection
What is the effect of chemotherapy on low grade Glioma?
PCV + radiation has a better outcome than radiation alone
What is Avastin?
Bevacizumab - VEGF-R inhibitor
What is pseudo-response with Avastin (Bevacizumab)?
This is where the lesion stops contrast enhancing due to the VEGF - but this is masking not a real effect
What is the role of Bevacizumab in Glioma?
Used in patients with recurrent GBM after failure of temozolomide
What are the current immune therapies for Glioma?
Dendritic cell vaccines
EGFR / IDH vaccines
Chimeric antigen receptors
What is the aim of resection for low grade Glioma?
Resection of the region with high FLAIR signal without causing a deficit
What is the role of FET-PET in Glioma work up?
It guides biopsy of the highest metabolically active region so that the tumour is not under graded
What is the best technique to use for intraoperative cortical monitoring?
SSEP
What is the proportion of primary brain tumours to mets?
1:3 (primary:mets)
How can recurrence of single brain metastasis be reduced?
Radical resection with supramarginal resection followed by radiotherapy has the best outcome
How would you manage an intraoperative seizure during awake craniotomy?
Cortical irrigation with ice cold saline
Give propofol / keppra
Incidence is 5-10%
How would you approach a cerebral peduncle / lateral high pontine metastasis?
Subtemporal with anterior petrosectomy
How would you treat an a aplastic insular Glioma following resection which is 1p19q and IDH-1 positive?
Radio+chemotherapy
What is the principle of surgery for gliomas?
Maximal ‘functional’ resection
What are the important points to note on MRI for colloid cysts?
Location of the foramen of monroe
Location of fornix
Location of internal cerebral
Consistency (hyperdense diffult to aspirate)
What are the management options for colloid cyst?
Observation
CSF diversion
Craniotomy - transcollosal / transcortical (transforaminal, interfornicaeal - don’t do it, transchoroidal)
Endoscopic resection
Where do you put the craniotomy for a transcallosal approach for colloid cyst?
2/3 in front and 1/3 behind the coronal suture
Where do colloid cysts arise from?
The tela choroidae (roof of the third ventricle)
What is the differential diagnosis of cyst in the pineal region?
Pineal cyst (thin rim of contrast enhancement) Pineocytoma (asymmetrical enhancement)
What is the Sperduto classification?
Classification for brain mets using the RPA and the number of brain mets. Allows prediction of survival.
What are the good prognostic factors for intracranial metastasis?
Primary controlled No extra Single met <65 years Good clinical status Origin (breast is best)
