Glioblastoma with prolonged survival despite poor prognosticators

Emmanuel Costa, Tevi Morel Lawson, Julie Lelotte, Edward Fomekong, Geraldo Vaz, Nicolas Whenham, Laurette Renard, Christian Raftopoulos Published in the journal : February 2018 Category : Neurochirurgie

Glioblastoma (GBM) is the most aggressive primary tumor of the central nervous system (CNS), and our study sought to identify the characteristics of patients with prolonged overall survival (OS). To this end, we reviewed the records of 127 patients who underwent surgery in our center for GBM between January 2002 and November 2011. We then identified those patients with prolonged survival (>3years). The characteristics of all these patients and their tumors were analyzed, and the anatomic pathological diagnosis was reviewed by a second anatomical pathologist. Of these 127 patients, 101 (79.6%) underwent excisional surgery, with 12 of these surviving longer than 36 months. The GBM diagnosis was confirmed in 11 (11%) patients (F/M: 4.5; mean age: 50 years (31-68); mean Karnofsky preoperative: 82%). The average survival of these 11 patients was 74 months (36-150); seven patients (63.6%) underwent complete resection, three (27.3%) almost complete resection, and the last one (9.1%) partial resection. Only two (18.8%) patients exhibited an IDH1 mutation. Seven (63.6%) patients benefited from a complete Stupp protocol. Eight of these patients had poor prognostic factors regarding prolonged survival (age, low Karnofsky score, or unmutated IDH). In conclusion, for any patient who develops a GBM, there is some hope that survival may be prolonged, even in the presence of poor prognosticators.

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Use of a three-dimensional autologous transplant derived from osteo-differentiated adipose stem cells on patients undergoing lombar fusion through a minimally invasive transforaminal approach

Edward Fomekong 1 MD ; Denis Dufrane 2 MD, PhD; Bruno Vande Berg 3 MD, PhD; Christian Raftopoulos 1 MD, PhD Published in the journal : February 2017 Category : Neurochirurgie

In 2016, the neurosurgery department of the Cliniques universitaires Saint-Luc, Brussels, published an application of a scaffold-free osteogenic three-dimensional (3D) graft made of adipose-derived mesenchymal stem cells (AMSCs) in patients undergoing minimally-invasive transforaminal lumbar interbody fusion (MI-TLIF). Three patients with degenerative spondylolisthesis were included in the study, one with Level 1 and two with Level 2 disease. In order to obtain AMSCs, fatty tissue was collected from the abdomen by means of liposuction and differentiated afterwards in our cell/tissue bank. Clinical outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS), as well as fusion status, were assessed preoperatively and for up to 12 months’ post-surgery. At 12 months, all four operated AMSC levels could be assessed (n= 4). Our results showed that Grade 3 fusion could be confirmed at two levels out of four. Mean VAS score improved from 8.3 to 2, and ODI also improved from 47% to 31%. No donor site complication was observed. This study demonstrated that a scaffold-free 3D graft made of AMSCs can be manufactured and used as a promising alternative for spinal fusion procedures. Nevertheless, further studies involving larger patient series are required in order to confirm the technique's effectiveness.

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