The Cognitive Neuroscience Society (CNS) recently held its annual meeting, CNS 2024, from September 28th to October 2nd in Houston, Texas. This event provided attendees with the opportunity to delve into the latest advancements in neurosurgery and their impact on improving patient outcomes. The conference featured a lineup of distinguished speakers who delivered engaging and informative presentations.

A major focal point of discussion at CNS 2024 was brain tumors. According to the National Institutes of Health (NIH), the incidence rate of new cases of brain and other nervous system cancers is 6.2 per 100,000 annually. Approximately 0.6 percent of individuals will receive a diagnosis of brain or other nervous system cancer at some point in their lives. In 2021, an estimated 182,520 people in the United States were living with brain or other nervous system cancer, highlighting the critical need for ongoing research in this field.

The following are concise summaries of studies presented at CNS 2024 that center on advancing knowledge and effective treatment options for brain tumors:

A Systematic Review of Fluorescence-Guided Surgery using 5-Aminolevulinic Acid/Protoporphyrin IX in Brain Metastases

  • The primary goal of this systematic review is to present a comprehensive overview of the existing literature regarding the utilization of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence-guided surgery (FGS) for the resection of brain metastases (BM). The objective is to assess the advantages and drawbacks associated with the use of 5-ALA/PpIX in BM surgery.
  • The application of 5-ALA/PpIX in FGS for BM resection presents a range of benefits and limitations. Research indicates that BMs originating from various primary lesions exhibit fluorescence regardless of histological subtypes.

A Prospective Study of Minimally Invasive Keyhole Craniotomy and Stereotactic Brachytherapy for Large Brain Oligometastases

  • Metastatic brain tumors (MBTs) are the most prevalent intracranial tumors, impacting up to 40% of cancer patients. The standard treatment typically involves surgery followed by radiation or Stereotactic Radiosurgery (SRS), resulting in a mean survival rate of 8-10 months post-SRS. Intraoperative cesium-131 (Cs-131) brachytherapy shows promise in targeting small, unifocal tumors. The aim of this study is to present the initial prospective trial comparing minimally invasive keyhole craniotomy (MIKC) and Stereotactic Brachytherapy (SBT) with SRS in patients with newly diagnosed large oligometastasis.
  • MIKC with SBT has shown effectiveness in tumor debulking and enhancing functional outcomes in patients with new brain oligometastases. The limitations of current treatments underscore the necessity for innovative modalities to decrease morbidity and mortality in oligometastasis.

Developing Genetic Screening Guidelines for Hereditary Glioma Formation

  • The formation of gliomas may have a stronger hereditary influence than previously believed. Therefore, it is important to identify patients with a genetic predisposition to glioma for proper monitoring and treatment. In order to improve referral practices, the authors conducted an analysis of the personal and family histories of patients with glioma, glioblastoma, or medulloblastoma who were seen in a cancer genetics clinic.
  • The findings revealed that a younger age at the onset of brain cancer was a significant factor in identifying potentially pathogenic variants (PV) or variants of uncertain significance (VUS). It is important to note that the absence of a personal history of other cancers or a family history of brain cancer does not rule out the presence of a genetic predisposition. Therefore, it is recommended that patients with brain tumors, especially those under the age of 25, consider undergoing a genetics evaluation to determine if they have a hereditary risk factor for their condition.

Evaluating Epilepsy and Recurrent Seizure as a Risk Factor for Primary and Secondary Brain Cancer

  • It is widely recognized that individuals with brain cancers are at an increased risk of developing epilepsy. However, the question of whether epilepsy itself predisposes individuals to developing brain cancers remains largely unexplored. To date, only one comprehensive study utilizing a large database has examined the incidence of brain cancer following a diagnosis of epilepsy. The objective of our study was to delve into the relationship between pre-existing epilepsy and the occurrence of primary and secondary brain cancers, with a specific focus on how the age at which epilepsy is diagnosed influences this connection.
  • The research revealed a significant correlation between epilepsy and the likelihood of being diagnosed with primary and secondary brain cancer.

Maternal and Perinatal Factors Associated with Childhood Brain Tumors: a Case-Control Study in Vietnam

  • Brain cancer stands as the primary cause of cancer-related fatalities in children, with the majority of childhood brain tumors being diagnosed without a clear understanding of their root causes. In Vietnam, little is known about the risk factors associated with childhood brain tumors. The aim of this case-control study was to pinpoint maternal and perinatal factors linked to brain tumors in young Vietnamese children and adolescents.
  • The study revealed that advanced maternal age and significant underweight were correlated with an increased likelihood of a child developing a brain tumor. To validate and expand upon these findings, a population-based study with a larger sample size is imperative.

MRNA Challenge Predicts Brain Cancer Immunogenicity and Response to Checkpoint Inhibitors

  • Activation of pathogen recognition receptors (PRRs) is essential for initiating the immune response and creating a favorable tumor microenvironment during oncogenesis. Our hypothesis is that PRRs play a crucial role in ICI-responsive tumors and can be targeted using a pan-PRR mimic to predict the immunogenicity of brain cancer and its response to immune checkpoint inhibitors (ICIs). The study aims to predict the responsiveness of brain tumors to ICIs.
  • The results show that the cytokine signatures following ML RNA-NP challenge vary significantly between ICI-responsive and non-responsive brain tumors. These findings pave the way for the development of a diagnostic assay that can rapidly assess tumor immunogenicity, enabling informed decisions regarding treatment with ICIs.

Preoperative Stereotactic Radiosurgery Positively Modulates the Tumor Immune Microenvironment in Glioblastoma: Preliminary Findings of a Phase I/IIa Human Clinical Trial

  • Glioblastoma (GBM) stands as the most prevalent and aggressive form of primary brain cancer, boasting a median overall survival rate of 14.6 months. For nearly two decades, the standard of care (SOC) has remained stagnant, consisting of supramarginal resection followed by postoperative fractionated radiotherapy and concomitant temozolomide. Despite substantial investments in advancing the field, viable alternatives are scarce, necessitating a much-needed shift in paradigm. While Stereotactic Radiosurgery (SRS) is commonly employed for other cancer types, its impact on GBM remains largely unexplored. The objective of this study is to investigate the hypothesis that a single preoperative dose of SRS can stimulate the immune system and alter the tumor immune microenvironment in patients with primary GBM, leading to a less immunosuppressive profile.
  • This human study underscores preoperative SRS as an innovative strategy to transform GBM therapy by reshaping the tumor immune microenvironment towards a less aggressive state, potentially enhancing the sensitivity of cells to adjuvant chemoradiation.

Temporal Muscle Thickness as a Predictor of Outcomes in Neurosurgical Cerebral Tumor Patients

  • Temporalis muscle thickness (TMT) as observed on brain magnetic resonance imaging (MRI) has been found to be correlated with sarcopenia, a condition that has been identified as a prognostic marker in glioblastoma. Despite this recognition, the clinical application of sarcopenia as a prognostic indicator has been hindered by the variability among studies and the lack of established cutoff values. The aim of this study is to explore the potential of temporal muscle thickness (TMT) on MRI as a predictor of progression-free survival (PFS) in patients diagnosed with primary glioblastoma and other types of cerebral tumors, including metastasis.
  • By utilizing TMT as a surrogate marker for pre-treatment sarcopenia, the researchers aim to enhance the ability to forecast PFS in individuals battling primary brain cancer.

Association of Primary Brain Tumor Characteristics with PROMIS-29 Quality-of-Life Metrics

  • Patients diagnosed with Primary Brain Tumors (PBTs) often face a substantial symptomatic burden and a notable decline in their quality of life. This decline may be influenced by various factors such as tumor size, location, laterality, and origin. However, the specific contributions of these factors to quality-of-life metrics remain poorly understood. The objective of this study is to investigate how the characteristics of PBTs impact patient quality of life metrics.
  • It is important to recognize that unique factors may have differing effects on quality-of-life metrics, highlighting the need for further research to clarify these specific effects in patients with PBTs.

Thank you for joining us for this recap of CNS 2024. We invite you to visit this link to explore all the posters that were presented at this exciting event. We are looking forward to CNS 2025 in Los Angeles, CA!

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