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The Glasgow Neurosociety
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in association with SI, or Surgical Neurology International, and SI Digital are happy to present
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the abstracts and discussion of the 10th anniversary Glasgow Neurosociety meeting held in November of 2022 in Glasgow, Scotland.
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Hassan Ishmael is president of the Glasgow Neurosociety at that time. He's from the Wolfson School of Medicine at the University of Glasgow in Scotland and the United Kingdom
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Faculty commentators are Likith L. Akhandi, who's the consultant neurosurgeon at the Queen Elizabeth University Hospital in Glasgow
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And Amy Davidson, a neurologist, also at the University of Glasgow, also at the Institute of Infection, Immunity, and Inflammation in Glasgow, Scotland.
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Other Glasgow neurohosts were Alidith Middleton, Vice President of Glasgow neuro,
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and Edica Choudry, another Vice President of Glasgow neuro.
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And onto our next panelist is Rishia Rishia He's going to be talking about his work, analyzing meningiomas in children,
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a rural Indian study. Over to you, Rishia. Well, thank you so much, Hassan, and thank you so much for the committee for having me here. So my name is Rishia. I am a third geometrical student
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and I study at the University of Manchester. And today I'd like to just present my work which was done with the aim of analyzing meningumas and children. And so the way I'm going to talk about this
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is the first of all, I'm just going to give a brief introduction about meningiomers. And
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then afterwards, I'll talk about my work and possibly talk about some of the implications that it might have. So I'm just going to start off with talking about meningiomers. So for many of the
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viewers, this will be routine. And it will be especially so for the panel specialist doctors today, but I'm just going to go through it for the sake of someone who might not be very familiar with
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meningiomers. So
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meningiomers, obviously, are one of the most common type
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of primary CNS tumors. They may originate from the arachnoid cells that are present on the inner surface of the dura. There are many risk factors that can obviously increase the risk of developing
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these meningiomers, including things such as ionizing radiation to the skull. And there have been other risk factors that have been - implicated as well, but obviously do require further research.
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Things such as differences in sex hormones, diabetes, arterial hypertension, and possibly even mobile phone usage have been implicated with meningiomas. Meningiomas by themselves are frequently
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asymptomatic, but sometimes they can have some symptoms, especially those are related with a mass effect. So for example, causing some sort of neurological symptoms, possibly some seizures and
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headaches. And I'm going to talk about that in my study as well. It's mainly, like the corner store, it's
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the way it's mainly diagnosed is with the help of an MRI, although PET scans are, could be quite useful in diagnosing meningiomas.
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That according to the World Health Organization classification, they divide into three different grades, grades one, two, and three, depending upon the characteristics and the treatment is
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usually surgical.
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And so with that being said, I'm just going to talk a little bit about my work. So this work and the way I got involved with this actually is a
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bit special. So I actually reached out, I am of Indian ethnicity. So I do go back to India every now and then to visit my family that live there. And so I came into contact with one of the
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neurosurgeons and it's quite an experience in neurosurgeon And he actually works in a hospital and this is a government hospital. So the way healthcare works in India is you've got a private sector
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and you've got the government sector as well. And the private sector is quite well funded and they tend to have,
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they tend to be much more, they tend to be what people use more the public sector the government sector is where surgeons do work and it works, it's based on a free-for-all model. So it's free at
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the point of care. So here's a surgeon who works in the public sector. So I got into touch with him and I was actually fascinated to find out that many jumas were being treated in this part of India,
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which is the rural south-western part of India. So then we got into contact and we decided to sort of analyze the pediatric meningumas to just look at, it's a bit like a case series of just looking
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retrospectively at the pediatric patients who came to the hospital and then analyzing them. So I'm just going to go through my findings now. So pediatric meningumas by themselves tend to be quite
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rare.
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And this was quite surprising that I was quite lucky that I was able to find some data on this, especially in India So pediatric meninger was sent to be quite rare.
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And there has been some work on it that's been, especially coming from the, that's quite established in the Western world really, but looking at the developing countries, there's really not much
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out there. So there was some work that was done in China a couple of years ago in which they analyzed about 32 pediatric patients with meningiomas. And quite recently, there was a piece of work
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that came from Mumbai and India as well But basically what we sort of try to do is just analyze these patients and divide them and then analyze sort of characteristics that we found in these patients.
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So we're just gonna go through them right now.
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So like I said, intercranial meningiomas in children often consider to be rare. And these tumors are anywhere from say 04 to 46
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of all brain tumors in children. And like I said, as compared to the thoroughly studied pattern of meninguma development in adults pediatric meningumus tend to show differing developmental patterns.
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So one study that was actually conducted in the University of Iowa in the US said that pediatric meningumus tend to have more malignant histological subtypes and they also tend to have greater rates
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of recurrence. So like I said, we just wanted to analyze the characteristics and see how, see what they show basically and then just put out our research To the world so that it could potentially
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be useful. So I'm just going to talk about it now. So this was like a set of retrospective study and this was an analysis of about 26 children presenting with meningumus and this was done. So
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the data over here was tracing all the way back into 1975 when they were, was, was started to be recorded. So this was done in a rural government run hospital in Southwest in India So
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just talk a little bit about the patient characteristics. So the patients that were mentioned in this pediatric cohort were from as young as children that were one, to just say about a year old, to
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patients who were about 17 years of age. Now meningiomers tend to mainly have a female per respondent. So they tend to be quite, they tend to be more prevalent in women as compared to men. However,
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in this cohort that we found that it was quite surprising, it was slightly more prevalent in men as compared to women So it was about 18 is to one. So slightly more common in men as compared to
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women. About 23 of these meningerumus happened in the posterior fossa, about 45 in the sphenoid, and about 21 in the tuberculum cellae, with the remaining developing in other regions for which the
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precise location on data and subtype was not available.
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Out of these 26 cases,
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four patients actually tend to have atypical or malignant meningiomas.
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The hospital data has said that the complete tumor excision was actually achieving about 18 of patients or whereas about, there was mortality seeing about 3 of these patients. Now, one thing that
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this study tried to do was to try and follow up on these patients to see how they were doing. And as you can appreciate in a country like India where the population is massive and with majority of
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these patients actually coming in from low socioeconomic backgrounds, it was quite difficult to do that. So unfortunately, we were not able to follow up these patients, but
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we did find some information about one or two patients. I'm just gonna mention that here, it might not have much. a scientific benefit, but I'm just going to mention it. So we actually found out
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that one of our patients who was about 13 years of age, when he had the surgery,
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he actually had one of the anaplastic variant tubers, and he actually died because he developed a cerebral hernia and he actually refused, but when it came back again, he actually refused,
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surgical treatment, and he died because of his cerebral hernia I'm just going to discuss, with all of that data being said, I'm just going to bring out a couple of, just going to discuss a few, a
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few points, to sort of compare between adult meningiomas and what this study could potentially indicate. Like I said, pediatric meningiomas tend to be relatively rare, and they're quite difficult
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to find. Like we said, in this study, it was more common in men as compared to women,
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there is often a female predispondent. So that was something we was quite surprised to find. Obviously, the sample size in this case was very, very small. So we can't see it with certainty.
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We don't really know why this could have happened. Like we mentioned, sex hormones might be a potential risk for meningioma. So possibly sex hormones could play a role in pediatric meningiomas. So
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there was some interesting study that was done by rushing it out in the United States. And they basically mentioned that about 72 of pediatric meningiomas actually had a neurofibromatosis as well,
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which
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was quite interesting to find. And obviously, we weren't able to analyze that in our study So, the symptoms that.
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Our patients mainly demonstrated a very non-specific headache was actually the most common symptom. And epilepsy was a common symptom as well. And
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this was quite interesting because like I said, not much study has been done on this. So possibly this could sort of shed some light as to how many germ as many present in children.
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And when these many germ as they develop, they can actually cause an increase in intracranial pressure and they can cause obviously a local emulsor factor and they can also cause some cranial nerve
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dysfunction, especially in nerves, in cranial nerves, two, three, four, six and seven as well.
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So that's it from me.
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So we always had a lot of limitation in this study. The study was not, it didn't have a very large sample size. The data was very difficult to find and we didn't have much guidance when it came to
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sort of coming up with this abstract and this manuscript. But with all of that being said, I think what this could potentially help with is just after that data pool, which is so limited
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to find, especially with regards to pediatric meninger tumors, coming from developing countries. So that's it from me. Thank you so much
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Thank you very much. You know, I think it's a big data compared to because it's such a they're rare tumors. So yeah, well done for that. So my first thing is Anna, you've said most of the
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meningumas you see in adults, which is much, much more common than the children, are de no meningumas. They happen without a rhyme of reason. Now for kids, you correctly looked at primary causes.
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One of them is the NF2, you know, it's a family history. I know you can, it's very unlikely you'll get gene testing done on these children, but family history is a good way of, you know,
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looking, did you look into that or was it just.
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No, so we did not look into the family history. We were just trying to just mention some of our discussions to look at some of the literature has already been out there. And those points we
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mentioned, we did not personally Yes, the other thing is radiation. So has any of these children been given radiation for things like tinea or you know a little things like that you know? Yeah,
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so this is something I forgot to mention. So no to none of these children were actually given radiation and even with regards to the meningumal treatment after surgery they were not given radiation
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or chemotherapy So my final question is what proportion of them were grade 2s and 3s whereas in adults you find you know now almost 90 percent are grade 1s and only about 10 percent are 2s and 3s. So
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we weren't able to
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buy them based on histological classification and this is a major limitation of our study and this is mainly because we weren't able to find accurate data and we didn't want to
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sort of give out any assumptions but we weren't able to
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divided based on the Simpson grading and to apologize for that, Randy. Not Simpson, I mean WHO. Anyway, so
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the time's a very good paper because it's probably, we looked at literature, are there enough other many papers which has got so many numbers of pediatric meningiomers?
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So there've been some recent papers coming and so like I said, there was some work coming off in China in which they had about 40 children. There was some recent paper coming in, conducted in
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Mumbai in which they had around 16 patients. But like I said, these patients were dating back all the way to 1975. How many did you do you have? We had about 26. Yeah, that's a good number.
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Anyway, well done, pass it on to Dr. Davidson.
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Yeah, no really great, really interesting.
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cards on the table. I obviously know very little about meningiomas. I tend to find them when I scan people for other things and then refer them to my surgical colleagues. So you mentioned about the
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NF2 stuff. So just out of interest, is that something that you scream for an all pediatric meningiomas or is that something you think that we should be doing? If that's a common factor, you know,
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even without a family history, do you think we'd have a de novo hit rate that would be worthwhile thinking about something like that?
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That's a very good question. So it could be possibly something that we could look into. Obviously, this was coming from a setting in which resources related and obviously given in that sort of
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setting, it would be very difficult is
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for neurofibromatosis and it could be coming onto the NHS, coming onto the UK and coming onto the developed part of the world Obviously,
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the fact that it's related to NF2 wasn't something that we found out from our study, but it was something that was mentioned in a study, a very interesting study conducted at the University of Iowa.
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So with that being said, where in those sort of settings in which the resources are available, I think that's a very, very interesting proposition to possibly look into the relationship between NF2
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and meningiomas, and possibly that could be a way in which NF2s could be possibly screened for. But like I mentioned, this wasn't something that came from our study, and I had to apologize. My
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knowledge on this is very limited. I don't need to apologize. You've done really great work, especially in what I imagine would have been challenging circumstances to collect the data. So, and as
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you say, you've added knowledge to
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an individual who didn't have much knowledge about before, it can only be a good thing never be sorry. It's good.
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I guess actually I've got a question about the practicalities of collecting such data obviously given you mentioned it was in a public hospital the data records went back to 1975. This is just from a
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pure research point where the practicality is all trying to collect data like this from your point of view. So it was actually quite challenging. So just to give some insights, some of these. So
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tracing up to maybe 10 years back, the data was actually shifted onto a sort of an EPR setting that you notice in the NHS. So there were digitalized records available. But before that, most of
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these records were handwritten and they were stored in
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thick piles of books. And they were divided because of which it was slightly easier for us But this was data that was just collected and stored away in a bookshelf and possibly to be forgotten, but
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it was quite good that we were able to get something out of it at least, I believe.
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Well, and actually, Jirek and given, again, just talking about the practicalities, given that difficulty, Jirek and
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from a research point of view, any might have potentially been missed, given that difficulty of trying to find these paper records Yeah, that could also be a limitation, not only to our study,
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but especially to, like I said, coming from resource-limited settings, and especially looking years and years back, like going almost 50 years back in time, where data obviously is very difficult
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to come from. Many of these hospitals would not have even recorded the surgeries were carried out, and the.
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and especially coming from back in those days, it was very difficult to even invalidate the credentials of the surgeons actually performing these surgeries, especially in those kind of settings. So
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I could imagine, I would imagine that it's very difficult to find data regarding this, but
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the best word of it is what we could find and we put out there really. Absolutely. No, thank you and a really interesting discussion And that wraps up this panel discussion recording. We hope you
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