Most of the literature on pineoblastoma consists of case reports and single-institution series. The goal of this systematic review and individual patient data (IPD) analysis was to summarize the existing literature, identify factors associated with overall survival (OS), and provide a contemporary update on prognosis for patients with pineoblastoma. Forty-four studies were identified with 298 patients having IPD. Kaplan–Meier analyses were used to report survival outcomes based on age, tumor metastases, extent of resection (EOR), adjuvant therapy, and publication year. Cox regression was performed to identify independent predictors of time to mortality. Multivariable recursive partitioning analysis was used to identify the most important subgroups associated with mortality. Patients were classified based on publication year before and after the last systematic review on this topic (pre-2012 and 2012 onwards) and compared using univariate and multivariable analyses. This study demonstrates that EOR less-than-gross total resection, metastatic presentation, adjuvant chemotherapy without radiation, and tumor presentation in children less than three years old are associated with poorer prognosis. Since 2012, the 5-year actuarial OS has improved from 32.8% to 56.1%, which remained significant even after accounting for EOR, age, and adjuvant therapy. Pineoblastoma remains a severe rare disease, but survival outcomes are improving.

Objective: Hematoma expansion (HE) predicts disability and death after acute intracerebral hemorrhage (ICH). Aspirin and anticoagulants have been associated with HE. We tested the hypothesis that P2Y12 inhibitors predict subsequent HE in patients. We explored laboratory measures of P2Y12 inhibition and dual antiplatelet therapy with aspirin (DAPT).Methods: We prospectively identified patients with ICH. Platelet activity was measured with the VerifyNow‐P2Y12 assay. Hematoma volumes for initial and follow‐up CTs were calculated using a validated semi‐automated technique. HE was defined as the difference between hematoma volumes on the initial and follow‐up CT scans. Nonparametric statistics were performed with Kruskal–Wallis H, and correction for multiple comparisons performed with Dunn's test.Results: In 194 patients, 15 (7.7%) were known to take a P2Y12 inhibitor (clopidogrel in all but one). Patients taking a P2Y12 inhibitor had more HE compared to patients not taking a P2Y12 inhibitor (3.5 [1.2–11.9] vs. 0.1 [−0.8–1.4] mL, p = 0.004). Patients taking DAPT experienced the most HE (7.2 [2.6–13.8] vs. 0.0 [−1.0–1.1] mL, p = 0.04). The use of P2Y12 inhibitors was associated with less P2Y12 activity (178 [149–203] vs. 288 [246–319] P2Y12 reaction units, p = 0.005).Interpretation: Patients taking a P2Y12 inhibitor had more HE and less P2Y12 activity. The effect was most pronounced in patients on DAPT, suggesting a synergistic effect of P2Y12 inhibitors and aspirin with respect to HE. Acute reversal of P2Y12 inhibitors in acute ICH requires further study.

Cranioplasty is a common surgical procedure to repair skull defects. Due to cranioplasty’s relatively high complication rates, multidisciplinary surgical teams (MSTs) of neurosurgeons and plastic surgeons have been suggested to improve patient outcomes. However, indications for MST remain undefined. To investigate when MSTs are used for cranioplasty and report patient population differences and outcomes compared with solo neurosurgeons (SN), a retrospective cohort study was performed at a single institution. Of 355 cranioplasties, 268 (75.5%) were performed by SN and 87 (24.5%) by a MST. Cranioplasty cases completed by MSTs had more prior surgeries (P<0.001) and prior infectious etiology (P<0.001). Surgery-related complications occurred in 32.2% of cases. Cranioplasty cases completed by MSTs had no difference in overall complication rates compared with SNs (P=0.3360) but were more likely to experience an infectious complication (25.3% versus 10.1%, P<0.0001) and hydrocephalus (10.3% versus 3.0%, P=0.0091). Overall complication rates did not differ by cranioplasty implant type (P=0.4837) or timing (P=0.3921). The study was limited by selection bias. In conclusion, in this series MSTs were used in higher risk patients with more prior operations and infectious etiology, likely underlying the increased rate of infection and hydrocephalus. The results add to a growing literature supporting the use of MSTs for cranioplasty and raise the question of whether MST can provide better outcomes than SN in simple cranioplasty, which future prospective studies can address.

Background: Glioblastoma (GBM) is an aggressive brain tumor, with surgery being an integral part of treatment. Aggressive resections improve clinical outcomes but need to be balanced against potential functional impairment. Neuropsychological (NP) testing is an important tool neurosurgeons use to assess cognitive functioning. Importantly, associations between NP test scores and imaging biomarkers could enable a testable baseline by which to track patient outcomes over time and aid in presurgical counseling. Methods: We identified 44 patients diagnosed with primary GBM and who had detailed NP testing and presurgical imaging. Regression models for NP indices were created with tumor size, hemisphere, and lobar location as predictors. Lesion–symptom mapping (LSM) analyses were used to identify more detailed structure–function relationships. Results: Larger tumor volumes predicted worse attention, immediate memory, language, visuospatial, and overall NP performance (p < 0.05 for all). Left hemisphere involvement predicted worse attention, language, and immediate memory NP performance (p < 0.01 for all). Only visuospatial testing had lobar location significantly associated with worse scores (occipital lobe; p < 0.05). The LSM analyses identified areas around the left sagittal stratum as significantly associated with language performance (p < 0.05), with no other structure–function relationships being identified. Conclusions: These findings support the growing evidence that outside of a small number of truly critical regions, high-grade gliomas impair cognition generally, likely due to progressive tumor infiltration-associated neuroplasticity of complex parallel and interconnected networks. To investigate this, future studies should incorporate larger cohort sizes and should examine the relationship of glioma-induced network-level perturbations on cognitive decline.

Background: In 2021, the World Health Organization reclassified glioblastomas to include only gliomas with wild-type isocitrate dehydrogenase (IDHwt). Reclassification has created a challenge for retrospective identification of patients with GBM, as many were classified with outdated definitions. This study aims to address this challenge by using natural language processing (NLP) on electronic health record (EHR) data to identify patients with wild-type IDH glioma. Methods: We manually adjudicated a subset of 1499 pathology records for evidence of IDHwt glioma as well as the methylation status of the MGMT promoter. We then trained several regularized logistic regression models that identify the IDH mutation and MGMT promoter status using biomedical concepts identified in the text. These models were then validated at a second site. Kaplan–Meier curves stratifying patients by their MGMT promoter methylation status and other clinical variables were constructed for further cohort characterization. Results: The best-performing model for identifying IDHwt glioma displayed an F1 measure of 0.88. Comparing patients with methylated and unmethylated MGMT promoter showed significant differences in median overall survival times (P < 0.001). Finally, the best-performing IDHwt glioma identification model displayed an F1 measure of 0.962 when implemented at a secondary site. Discussion: Our results suggest that we can identify patients with IDHwt glioma in pathology notes in the EHR using NLP. Our models displayed excellent performance at a secondary healthcare institution, demonstrating that they can identify multi-site GBM cohorts. Furthermore, our characterization of the NM GBM cohort recapitulated known survival trends, demonstrating the utility of EHR data in studying GBM in clinical settings.