Purpose: Current methods for glioma response assessment are limited. This study aimed to assess the technical and clinical feasibility of molecular profiling using longitudinal intracranial cerebrospinal fluid (CSF) from patients with gliomas. Experimental Design: Adults with gliomas underwent longitudinal intracranial CSF collection via Ommaya reservoirs or ventriculoperitoneal shunts. Cell-free DNA (cfDNA) was extracted and analyzed using PredicineCARE for cancer variant profiling and/or PredicineSCORE for low-pass whole-genome sequencing. Results: Five patients (two females and three males; median age, 40 years; range, 32–64 years) underwent longitudinal intracranial CSF collection via Ommaya reservoirs (n = 4) or ventriculoperitoneal shunts (n = 1). In total, 47 CSF samples were obtained (median volume, 4.00 mL; 0.5–5 mL). Forty-one samples (87.2%) yielded sufficient cfDNA for testing. Patient-specific tumor-associated variant allelic frequencies (VAF), and thus tumor fraction, decreased in pre- versus postchemoradiation samples, including through pseudoprogression. These also increased with radiographic progression in three patients, although identifying the time of definitive disease progression from MRIs was a significant limitation. In two patients with isocitrate dehydrogenase (IDH)–mutant gliomas, decreasing IDH1 VAF after resection and chemoradiation correlated with decreased CSF D-2-hydroxyglutarate levels (0.64× and 0.62×, respectively, for the first patient and 0.01× and 0.07× for the other patient), although D-2-hydroxyglutarate and IDH1 VAF were not concordant in one patient thereafter. Moreover, the copy-number burden decreased below the limit of quantification during treatment and increased above the limit at progression. Conclusions: Longitudinal intracranial CSF cfDNA can be obtained in patients with gliomas during their disease course. However, before deploying this technique, numerous questions and challenges should be answered.

Background: Cognitive decline is common in patients with Glioblastoma (GB), occurring in both treated and untreated cases. It frequently presents as impairments in memory, attention, language, or other cognitive functions. In addition, these cognitive deficits can affect quality of life, functional independence, and overall survival, and they are associated with psychiatric conditions such as anxiety and depression. Methods: This narrative review evaluates cognitive deficits in GB patients, both with and without treatment. It also explores the impact of tumor features such as size, location, and histology, along with patient characteristics such as age and education, and discusses the effects of standard therapies, such as surgery, chemotherapy, and radiotherapy, on cognitive outcomes. Results: Cognitive impairment in GB is influenced by tumor- and patient-specific factors, as well as treatment modalities. Initially, combination therapies such as surgery, radiotherapy, and chemotherapy may improve cognitive domains by reducing tumor burden, relieving cerebral edema, and reducing mass effects, subsequently bringing indirect effects of improved mental health and mood. While certain treatments like radiotherapy and chemotherapy carry risks of delayed neurotoxicity, studies indicate that, on balance, treated patients generally show better preservation or improvement in cognitive function than those who go untreated. However, excessive treatment aggressiveness and cumulative neurotoxic effects may diminish cognitive benefits. Conclusion: Cognitive function is an independent factor in GB, which could affect survival in GB patients, therefore making routine cognitive assessments essential for prognosis, treatment planning, and rehabilitation. Neuroprotective agents, cognitive rehabilitation, and personalized, multidisciplinary strategies can help optimize both survival and cognitive preservation.

Introduction: Recently, to reduce the incidence of oculocardiac reflex (OCR) in strabismus surgery, retrobulbar block and anticholinergic drugs or local anesthesia are also used. The present study evaluated the effects of Tetracaine eye drop as a topical nerve blocker on OCR during strabismus surgery. Methods and materials: In this randomized trial, 70 strabismus surgery candidates were randomly divided into placebo or synthetic teardrop (E) and Tetracaine eye drop (T) groups, so 3 drops of each solution were dropped in four directions of patients’ eye immediately after applying anesthesia and before surgery. The incidence and severity of OCR during the stages of muscle release and incision (cutting), hemodynamic changes, the required time for OCR recovery and atropine dose were assessed. Results: OCR was more seen in release phase compared to cutting phase. There were no significant differences between two group regarding the incidence and severity of OCR in the release phase (p > 0.05), but the incidence and severity of OCR in the cutting phase was more in group E than group T (p = 0.02, for both). The duration of OCR improvement (p-value = 0.74) and Atropine consumption (p-value = 0.92) did not differ between the groups. Conclusion: Tetracaine eye drop only reduces the incidence and severity of OCR during the incision stage of strabismus surgery.

Background: Cognitive decline is common in patients with Glioblastoma multiform (GBM) even with treatment modalities, and often presents as impairments in memory, attention, language, and other cognitive functions. In addition, cognitive deficits can affect the quality of life, functional independence, and survival and are associated with other psychological disorders such as anxiety and depression. Methods: This literature review evaluates the cognitive deficits in GBM patients with and without treatment. Then we explore the relationship between tumor characteristics such as size, location, histology, and patient characteristics such as age and education level, as well as whether existing therapies, such as surgery, chemotherapy, and radiotherapy, and any change in cognitive function. Results: Cognitive impairment in patients with GBM is affected by tumor characteristics, patient-specific factors, and treatment modalities however some treatments such as a combination of surgery, radiotherapy, and chemotherapy, initially were associated with improvement of cognitive outcomes because the treatments are related to reduced tumor burden, alleviation of cerebral edema, reduced mass effect, and then indirect effects of improved mental health and mood. While certain treatments, such as radiotherapy and chemotherapy pose risks of delayed neurotoxicity, the overall preservation and improvement of cognitive function were more pronounced in treated versus untreated patients. However, the studies suggest that beyond a certain level of treatment aggressiveness and the existence of neurotoxicity or damage, the benefit of therapy is above cognitive preservation. Conclusion: This review highlighted cognitive function as an independent factor that could affect survival in GBM patients, therefore routine cognitive assessments in clinical practice is a helpful strategy to predict the prognosis, treatment planning, and rehabilitation efforts. Interventions such as neuroprotective agents, cognitive rehabilitation programs, and personalized, multidisciplinary strategies are crucial in helping to balance treatment effectiveness with cognitive preservation.