Conference Coverage

American Association of Neurological Surgeons, 80th Annual Scientific Meeting, Miami


 

A new brain cancer vaccine tailored to individual patients by using material from their own tumors has proven effective by extending the patients’ lives by several months or longer, according to results from a multicenter phase II clinical trial.

Investigators compared the effectiveness of the vaccine for more than 40 patients with recurrent glioblastoma multiforme who were treated at the University of California, San Francisco’s (UCSF) Helen Diller Family Comprehensive Cancer Center, at the Seidman Cancer Center at University Hospitals Case Medical Center in Cleveland, and at New York-Presbyterian Hospital/Columbia University Medical Center in New York City.

The trial found that the vaccine could extend survival for the patients by several months when compared with 80 other patients who were treated at the same hospitals and received standard therapy—47 weeks compared with 32 weeks. Several patients who received the cancer vaccine have survived for more than a year.

“These results are provocative,” said UCSF neurosurgeon Andrew Parsa, MD, PhD, who led the research. “They suggest that doctors may be able to extend survival even longer by combining the vaccine with other drugs that enhance this immune response.”

The next step, he said, will be a more extensive, randomized clinical trial to look at the effectiveness of the vaccine combined with the drug bevacizumab, a standard therapy for this type of cancer, compared to the effectiveness of the drug alone. Those trials, to be run by the National Cancer Institute, will begin enrolling patients later this year.

Patients With Tremor or Movement Disorder May Benefit From MR-Guided Focused Ultrasound Surgery
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) may be effective in alleviating tremor and other types of movement disorders, according to researchers.

William J. Elias, MD, Associate Professor of Neurological Surgery and Neurology at the University of Virginia School of Medicine in Charlottesville, and colleagues conducted a unilateral MRgFUS ventral intermediate nucleus thalamotomy in 15 patients with essential tremor who were refractory to medication. Pre- and post-thalamotomy assessments were obtained with a validated rating scale for tremor and MRI throughout the study period at time points of one day, one week, one month, and three months. Adverse events were recorded during the study period.

Throughout the three-month study period, the subjects’ contralateral appendicular tremor decreased substantially. The procedure’s adverse-event profile was comparable to that of stereotactic thalamic procedures. Adverse events included headache, warm sensations, dizziness, and nausea. Neuromodulation at low-power sonications was performed in a few patients, based on their intraprocedural clinical testing.

The researchers concluded that MRgFUS thalamotomy was safe and effective in alleviating contralateral appendicular tremor. This noninvasive technique, used in concert with neuromodulation acoustic parameters, may prove effective for patients with tremor and other movement disorders.

Lumbar Spinal Fusion Plus Laminectomy May Be Superior to Laminectomy Alone For Degenerative Spondylolisthesis
A laminectomy with lumbar spinal fusion may improve the quality of life for patients with degenerative grade I spondylolisthesis with lumbar spinal stenosis more than laminectomy alone, researchers reported.

Zoher Ghogawala, MD, Director of the Wallace Trials Center at Greenwich Hospital in Connecticut, and colleagues conducted a prospective, five-center, randomized controlled trial from 2002 to 2009. A total of 106 patients with degenerative spondylolisthesis (3 to 14 mm) and symptomatic lumbar spinal stenosis were randomized to receive either laminectomy alone or laminectomy with posterolateral instrumented fusion. Individuals with mechanical instability or gross motion (>3mm) were excluded.

A total of 66 patients were randomized to receive decompression alone or decompression with surgery. Patients’ mean age was 66.7, and 80.3% were female. The primary outcome measure (ie, Short Form-36 Physical Component Summary) was assessed at the clinic at one, three, six, and 12 months, and then annually by phone for five years. The two-year follow-up rate was 86%, and the four-year follow-up rate was 85%.

Surgery was associated with significant improvement in SF-36 PCS and Oswestry Disability Index scores at each time point. Laminectomy with fusion was associated with significantly better SF-36 PCS scores than laminectomy alone at six months, two years, and four years after the operation. For patients without fusion, the reoperation rate was 35.3%. When fusion was added to laminectomy, the reoperation rate was 12.9%.

The investigators concluded that lumbar spinal fusion added to laminectomy when treating degenerative grade I spondylolisthesis was associated with superior SF-36 PCS outcome and resulted in fewer reoperations within four years of the initial procedure.

Basolateral Amygdala May Control Drug Cravings
The basolateral amygdala may control an addict’s drug craving or drug-seeking behavior, according to investigators.

Jessica Wilden, MD, chief resident in the Department of Neurosurgery at Indiana University School of Medicine in Indianapolis, and colleagues exposed alcohol-preferring (P) rats to a specific odor in the presence of alcohol, a different odor in the absence of alcohol, and a neutral odor. The rats were subsequently exposed to an odor for 30 minutes in an environment in which alcohol was not available, and neuronal activity was measured through standard c-Fos protocols. Microinjections of gamma-aminobutyric acid agonists were then used to pharmacologically silence the bilateral basolateral amygdala of P rats in a 2 x 3 experimental design in the operant setting.

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