Oncology

Question 1

What is the best technique to use for intraoperative subcortical monitoring?

Answer 1

MEP

Question 2

What MEP/SSEP reduction is thought to be significant?

Answer 2

50% of baseline

Question 3

What is the evidence for intraoperative neurophysiology?

Answer 3

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

Question 4

What is the effect of chemotherapy on low grade Glioma?

Answer 4

PCV + radiation has a better outcome than radiation alone

Question 5

What is Avastin?

Answer 5

Bevacizumab - VEGF-R inhibitor

Question 6

What is pseudo-response with Avastin (Bevacizumab)?

Answer 6

This is where the lesion stops contrast enhancing due to the VEGF - but this is masking not a real effect

Question 7

What is the role of Bevacizumab in Glioma?

Answer 7

Used in patients with recurrent GBM after failure of temozolomide

Question 8

What are the current immune therapies for Glioma?

Answer 8

Dendritic cell vaccines
EGFR / IDH vaccines
Chimeric antigen receptors

Question 9

What is the aim of resection for low grade Glioma?

Answer 9

Resection of the region with high FLAIR signal without causing a deficit

Question 10

What is the role of FET-PET in Glioma work up?

Answer 10

It guides biopsy of the highest metabolically active region so that the tumour is not under graded

Question 11

What is the best technique to use for intraoperative cortical monitoring?

Answer 11

SSEP

Question 12

What is the proportion of primary brain tumours to mets?

Answer 12

1:3 (primary:mets)

Question 13

How can recurrence of single brain metastasis be reduced?

Answer 13

Radical resection with supramarginal resection followed by radiotherapy has the best outcome

Question 14

How would you manage an intraoperative seizure during awake craniotomy?

Answer 14

Cortical irrigation with ice cold saline
Give propofol / keppra
Incidence is 5-10%

Question 15

How would you approach a cerebral peduncle / lateral high pontine metastasis?

Answer 15

Subtemporal with anterior petrosectomy

Question 16

How would you treat an a aplastic insular Glioma following resection which is 1p19q and IDH-1 positive?

Answer 16

Radio+chemotherapy

Question 17

What is the principle of surgery for gliomas?

Answer 17

Maximal ‘functional’ resection

Question 18

What are the important points to note on MRI for colloid cysts?

Answer 18

Location of the foramen of monroe
Location of fornix
Location of internal cerebral
Consistency (hyperdense diffult to aspirate)

Question 19

What are the management options for colloid cyst?

Answer 19

Observation
CSF diversion
Craniotomy - transcollosal / transcortical (transforaminal, interfornicaeal - don’t do it, transchoroidal)
Endoscopic resection

Question 20

Where do you put the craniotomy for a transcallosal approach for colloid cyst?

Answer 20

2/3 in front and 1/3 behind the coronal suture

Question 21

Where do colloid cysts arise from?

Answer 21

The tela choroidae (roof of the third ventricle)

Question 22

What is the differential diagnosis of cyst in the pineal region?

Answer 22

Pineal cyst (thin rim of contrast enhancement)
Pineocytoma (asymmetrical enhancement)

Question 23

What is the Sperduto classification?

Answer 23

Classification for brain mets using the RPA and the number of brain mets. Allows prediction of survival.

Question 24

What are the good prognostic factors for intracranial metastasis?

Answer 24

Primary controlled
No extra
Single met
<65 years
Good clinical status
Origin (breast is best)