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Item Advanced imaging techniques for neuro-oncologic tumor diagnosis, with an emphasis on PET-MRI imaging of malignant brain tumors(Springer, 2021-02-18) Overcast, Wynton B.; Davis, Korbin M.; Ho, Chang Y.; Hutchins, Gary D.; Green, Mark A.; Graner, Brian D.; Veronesi, Michael C.; Radiology and Imaging Sciences, School of MedicinePurpose of review: This review will explore the latest in advanced imaging techniques, with a focus on the complementary nature of multiparametric, multimodality imaging using magnetic resonance imaging (MRI) and positron emission tomography (PET). Recent findings: Advanced MRI techniques including perfusion-weighted imaging (PWI), MR spectroscopy (MRS), diffusion-weighted imaging (DWI), and MR chemical exchange saturation transfer (CEST) offer significant advantages over conventional MR imaging when evaluating tumor extent, predicting grade, and assessing treatment response. PET performed in addition to advanced MRI provides complementary information regarding tumor metabolic properties, particularly when performed simultaneously. 18F-fluoroethyltyrosine (FET) PET improves the specificity of tumor diagnosis and evaluation of post-treatment changes. Incorporation of radiogenomics and machine learning methods further improve advanced imaging. The complementary nature of combining advanced imaging techniques across modalities for brain tumor imaging and incorporating technologies such as radiogenomics has the potential to reshape the landscape in neuro-oncology. Keywords: Advanced MRI; Amino acid PET; Brain tumor; Chemical exchange saturation transfer; Diffusion-weighted imaging; FET; Glioblastoma; Glioma; High-grade malignancy; Hybrid PET/MRI; MR spectroscopy; Metastasis; Perfusion-weighted imaging; Progression; Pseudoprogression; Pseudoresponse; Radiation necrosis; Radiogenomics; Radiomics; Treatment-related change; Tumor grading.Item The experience of post-craniotomy pain among persons with brain tumors(2018-04-16) Foust, Rebecca Elizabeth; Von Ah, Diane M.; Draucker, Claire B.; Carpenter, Janet S.; Kroenke, Kurt; Stone, CynthiaPost-craniotomy brain tumor patients often experience pain in the post-surgical period which can negatively affect recovery and surgical outcomes. Research with this population has focused on pharmacological treatments of post-craniotomy pain and measurement of pain intensity. Little is known about how these patients experience the quality of their pain and how this pain is managed. The purpose of this dissertation was to provide an in-depth description of the experience of post-craniotomy pain during the post-surgical period. The information gained about how post-craniotomy patients experience pain and pain management will contribute the development of effective, tailored interventions to enhance patient satisfaction and outcomes. This dissertation project was composed of two components. The first component was an integrative review of literature examining the evidence of pain and associated symptoms in adult (aged 21 and older), post-craniotomy brain tumor patients. The review examined studies from the past fourteen years that focused on the incidence and treatment of postcraniotomy pain. It revealed that the majority of post-craniotomy patients experience moderate to severe pain after surgery. This pain is associated with nausea, vomiting, changes in blood pressure, and increased length of hospital stay. The second component was a qualitative descriptive study of a sample of 28 adult (aged 21 and older) post-craniotomy patients hospitalized on an inpatient neurosurgical stepdown unit at a Midwestern urban teaching hospital. During semi-structured interviews, participants described their experiences of post-craniotomy pain and of their experiences of postcraniotomy pain management. Data generated from the qualitative descriptive study were analyzed and resulted in two qualitatively derived products. The first was a description of participants’ experiences of the quality of their post-craniotomy pain during the post-surgical period. The six types of pain quality described were pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. The second was a description of how post-craniotomy patients experience the management of their pain during the post-surgical period. The four groups of types of pain management experiences described were pain-as-non-salient, routine pain management; pain-as-non-salient, complex pain management; pain-as-salient, routine pain management; and pain-as-salient, complex pain management.Item Neuroinflammation in Autoimmune Disease and Primary Brain Tumors: The Quest for Striking the Right Balance(Frontiers Media, 2021-08-13) Mitchell, Dana; Shireman, Jack; Potchanant, Elizabeth A. Sierra; Lara-Velazquez, Montserrat; Dey, Mahua; Pediatrics, School of MedicineAccording to classical dogma, the central nervous system (CNS) is defined as an immune privileged space. The basis of this theory was rooted in an incomplete understanding of the CNS microenvironment, however, recent advances such as the identification of resident dendritic cells (DC) in the brain and the presence of CNS lymphatics have deepened our understanding of the neuro-immune axis and revolutionized the field of neuroimmunology. It is now understood that many pathological conditions induce an immune response in the CNS, and that in many ways, the CNS is an immunologically distinct organ. Hyperactivity of neuro-immune axis can lead to primary neuroinflammatory diseases such as multiple sclerosis and antibody-mediated encephalitis, whereas immunosuppressive mechanisms promote the development and survival of primary brain tumors. On the therapeutic front, attempts are being made to target CNS pathologies using various forms of immunotherapy. One of the most actively investigated areas of CNS immunotherapy is for the treatment of glioblastoma (GBM), the most common primary brain tumor in adults. In this review, we provide an up to date overview of the neuro-immune axis in steady state and discuss the mechanisms underlying neuroinflammation in autoimmune neuroinflammatory disease as well as in the development and progression of brain tumors. In addition, we detail the current understanding of the interactions that characterize the primary brain tumor microenvironment and the implications of the neuro-immune axis on the development of successful therapeutic strategies for the treatment of CNS malignancies.Item Pain Management Experiences Among Hospitalized Postcraniotomy Brain Tumor Patients(Wolters Kluwer, 2021) Foust Winton, Rebecca E.; Draucker, Claire B.; Von Ah, Diane; School of NursingBackground: Brain tumors account for the majority of central nervous system tumors, and most are removed by craniotomies. Many postcraniotomy patients experience moderate or severe pain after surgery, but patient perspectives on their experiences with pain management in the hospital have not been well described. Objective: The aim of this study was to describe how patients who have undergone a craniotomy for brain tumor removal experience pain management while hospitalized. Methods: Qualitative descriptive methods using semistructured interviews were conducted with patients on a neurological step-down unit in an urban teaching hospital in the Midwest United States. Interviews focused on how patients experienced postcraniotomy pain and how it was managed. Narratives were analyzed with standard content analytic procedures. Results: Twenty-seven participants (median age, 58.5 years; interquartile range, 26-41 years; range, 21-83 years) were interviewed. The majority were white (n = 25) and female (n = 15) and had an anterior craniotomy (n = 25) with sedation (n = 17). Their pain experiences varied on 2 dimensions: salience of pain during recovery and complexity of pain management. Based on these dimensions, 3 distinct types of pain management experiences were identified: (1) pain-as-nonsalient, routine pain management experience; (2) pain-as-salient, routine pain management experience; and (3) pain-as-salient, complex pain management experience. Conclusions: Many postcraniotomy patients experience their pain as tolerable and/or pain management as satisfying and effective; others experience pain and pain management as challenging. Implications for practice: Clinicians should be attuned to needs of patients with complex pain management experiences and should incorporate good patient/clinician communication.Item Pain Quality Among Hospitalized Postcraniotomy Brain Tumor Patients(Wolters Kluwer, 2021) Foust Winton, Rebecca E.; Draucker, Claire B.; Von Ah, Diane; School of NursingPurpose/aims: The aim of this study was to describe how persons given a diagnosis of a brain tumor who have had a craniotomy describe the quality of their pain after surgery. Design: A qualitative descriptive design was used. Methods: Qualitative descriptive methods as described by Sandelowski guided this study. Semistructured interviews were conducted with patients hospitalized on a neurological step-down unit in an urban teaching hospital in the Midwestern United States. Interviews focused on the quality of participants' pain after surgery. Narratives were analyzed using standard content analysis. Results: Twenty-seven participants were interviewed. Most were White and female. Most underwent a craniotomy using an anterior approach with sedation. Participants described the quality of their pain with 6 different types of descriptors: pain as pressure, pain as tender or sore, pain as stabbing, pain as throbbing, pain as jarring, and pain as itching. Conclusions: Participants' descriptions of their pain quality after surgery provide a different understanding than do numerical pain ratings. Clinicians should use questions to explore patients' individual pain experiences, seeking to understand the quality of patients' pain and their perceptions.Item Trends in the Management Paradigms of Intracranial Meningioma(Thieme, 2021) Aljuboori, Zaid; Alhourani, Ahmad; Woo, Shiao; Hattab, Eyas; Yusuf, Mehran; Nelson, Megan; Andaluz, Norberto; Ding, Dale; Savage, Jesse; Williams, Brian; Neurological Surgery, School of MedicineObjective: Intracranial meningiomas are the most common primary brain tumor. Treatment paradigms have evolved over time. There are limited number of population-based studies that examine this modern evolution. Here, we describe the trends of management of intracranial meningiomas using a national database. Methods: The data were obtained from the National Cancer Database for the years 2004 to 2015, the collected variables included: patients' age, gender, insurance type, income, comorbidity score, the tumor size and grade, and treatment modality (observation, surgery, radiotherapy, or combination therapy). We performed statistical analyses to detect association between unique variables and outcomes. In addition, we performed mortality analyses for various treatment modalities. Results: A total of 199,096 patients with a diagnosis of intracranial meningioma were included, the majority of patients were white females, mean age of 61 years, and half of the tumors were ≤ 3 cm. Observation was the most commonly used management modality followed by surgical resection, radiotherapy, and combination therapy. For the entire time period, there was an increased use of observation as a primary management method. Predictors of mortality included increased age, larger tumor size, higher tumor grade, treatment at a community hospital, and higher comorbidity scores. Conclusion: Population-based studies of intracranial meningiomas are uncommon; our study is one of the few reports that examine the changes in the modern management paradigms of meningioma in the United States over time. Additionally, we shed light on the factors that affected survival of patients with this condition.