Neoplasms

All Conditions

Nervous System Diseases

Symptoms and General Pathology

Rare Diseases

Glioma

Brain Neoplasms

Epilepsy

Epilepsy, Temporal Lobe

Brain Diseases

Central Nervous System Diseases

Central Nervous System Neoplasms

Nervous System Neoplasms

Epilepsies, Partial

Syndrome

Epileptic Syndromes

This study will use light scattering spectroscopy (LSS) to analyze brain tissue removed from patients during brain surgery to determine if this new technology can be used to differentiate between normal and cancerous cells. LSS focuses light on cells or tissues, and the way that light is reflected back from the tissues provides information about the size of cells and the density of the cell nuclei (the part of the cell that contains the genes).

Patients between 18 and 75 years of age with a known or suspected brain tumor and patients with temporal lobe epilepsy that does not respond to medication may be eligible for this study. (Examination of tissue from patients with epilepsy will allow comparison of tumor and non-tumor brain cells.) All patients must require surgery to treat their condition.

Participants will be admitted to the Clinical Center for 3 to 10 days for physical and neurological examinations, blood and urine tests, and other tests needed to prepare for surgery. They will then undergo surgery. A small amount of tissue removed during surgery for pathological review will be collected for use in this study.

Half of the tissue will be examined using LSS to help determine the size of the cell and its nucleus. Studies will be done to measure how many of the cells are actively dividing and which proteins are expressed more often in tumor cells compared with normal cells. This information may shed light on how tumor cells are different from normal cells.

Participants may be contacted for up to 3 years to follow their health status.

Optical spectroscopy for detection of brain tumors and tumor margins has been shown to be of use in distinguishing gliomas and metastatic tumor cells from surrounding white matter. Optical spectroscopy has the potential to provide immediate and accurate diagnostic information about the nature and quantity of neoplastic cells, in a minimally-or non-invasive fashion. We propose to use a new method of optical spectroscopy, polarized light-scattering spectroscopy (LSS), which permits discrimination of malignant cancer cells from normal brain cells by virtue of alterations in the cytoplasmic and nuclear ratios of these cells.

Patients suspected of having, or with prior biopsy proof of, a WHO grade II-IV central nervous system (CNS) glial tumor(s); those with metastatic brain tumor; or patients with medically-refractory temporal lobe epilepsy with a presumed hippocampal source of seizures, who are seen in the Surgical Neurology Branch, NINDS, will be considered for entry into this study. Tissue samples of tumor or normal lateral temporal neocortex resected as part of standard care will be collected at surgery and utilized for research.

Light Scattering Spectroscopy to Determine Brain Tumors

Spectroscopic Determination of Brain Tumor Cells

National Institute of Neurological Disorders and Stroke (NINDS)

Heart and Blood Diseases

Diseases and Abnormalities at or Before Birth

Wounds and Injuries

Behaviors and Mental Disorders

Hemorrhage

Subarachnoid Hemorrhage

Congenital Abnormalities

Intracranial Hemorrhages

Brain Injuries

Brain Injuries, Traumatic

Hematoma

Unconsciousness

Coma

Arnold-Chiari Malformation

Infratentorial Neoplasms

Supratentorial Neoplasms

Craniocerebral Trauma

Trauma, Nervous System

Cerebrovascular Disorders

Vascular Diseases

Spinal Dysraphism

Neural Tube Defects

Nervous System Malformations

Consciousness Disorders

Neurobehavioral Manifestations

Neurologic Manifestations

Chiari Malformation Type 2

Merve Tugba Ozfidan Donmez, MD

Ozlem Korkmaz Dilmen, MD

Yusuf Tunali, MD

Fatma Eren Akcil, MD

1. The primary aim of this study is to investigate the correlation between the length of ICU stay and a newly developed FIVE score in neuro-intensive care patients.
2. The secondary objectives are to evaluate the impact of the FIVE score on hospital length of stay, Modified Rankin Scale, and mortality, as well as to determine the correlation between the GCS, FOUR, and FIVE scores

Consciousness monitoring is crucial in neuro-intensive care. Despite the use of different scoring systems to establish a common language among evaluators, the Glasgow Coma Scale (GCS) remains the most widely used in clinical practice. In GCS evaluation, verbal response, motor response, and eye response are assessed. Another scoring system, FOUR (Full Outline of UnResponsiveness ) Score is similar to the Glasgow Coma Score (GCS). But it is designed to provide a more comprehensive neurological assessment. The FOUR score evaluates four areas: including eye opening, motor response, brainstem reflexes, and respiration, and assigns a score for each area. A comprehensive education regarding those scores was given the intensive care healthcare providers before the trial.

In this study, the investigators developed the Full Intracranial Validity Evaluation (FIVE) Score, by adding the mean arterial pressure and gag reflex components to the FOUR score. The investigators believe that this new score, which can be used for clinical monitoring, may offer an alternative to FOUR and GCS monitoring. According to this scoring system, in addition to the criteria for the FOUR score, patients with a mean arterial pressure between 60-130mmHg receive 2 points; patients under inotropic support with a mean arterial pressure between 60-130mmHg receive 1 point; patients with a mean arterial pressure below 60mmHg or above 130mmHg receive 0 points. Additionally, for patients with infratentorial mass, the investigators add the assessment of gag reflex in the calculation of the FIVE score. If the reflex is absent, 0 points are given; if it is unilateral, 1 point is given, and if it is preserved, 2 points are given.

The demographic data, diagnoses, systemic comorbidities, the American Society of Anaesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and the APACHE II scores of patients were recorded.

The GCS, FOUR, and FIVE scores of the patients were recorded at neuro ICU admission, every 12 hours during neuro ICU follow-up period and discharge. In our clinic, GCS monitoring is routinely performed hourly for every patient admitted to the ICU. For patients with a decrease of two or more points in GCS score, FOUR and FIVE scores were re-evaluated and recorded without waiting for the 12 hours. Besides this, the worst, the best and the mean GCS, FOUR, and FIVE scores were recorded in the neuro ICU follow-up period. The assessment count of the GCS, FOUR, and FIVE scores during clinical follow-up was recorded.

The length of ICU and hospital stay were recorded. The Modified Rankin Scale of the patients was recorded six months after ICU discharge.

The primary aim of this study is to investigate the correlation between the length of ICU stay and a newly developed FIVE score in neuro-intensive care patients. The secondary objectives are to evaluate the impact of the FIVE score on length of hospital stay, Modified Rankin Scale, and mortality, as well as to determine the correlation between the GCS, FOUR, and FIVE scores.

A New Approach in Intensive Care Unit Consciousness Assessment: FIVE Score

The New Developed FIVE Score and Its Comparison With GCS and FOUR Scores Regarding Length of Hospital Stay Morbidity and Mortality in Neuro-intensive Care Patients. an Observational Prospective Study

Glasgow Coma Scale (GCS) and Four/Five Scores, along with the highest, lowest, and average scores, discharge scores, Modified Rankin Scores at 6 months post-discharge, and length of stay information measured upon admission to the intensive care unit will be shared.

Full Intracranial Validity Evaluation, minimum value:0, maximum value: 20, higher scores mean a better situation

Glasgow Coma Score, minimum value:3, maximum value: 15, higher scores mean a better situation

In scoring post-discharge morbidity six months after intensive care unit discharge, Modified Rankin Score is used. minimum value:0, maximum value:6, higher scores mean a worse outcome

Istanbul University - Cerrahpasa (IUC)

medical doctor

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Light Scattering Spectroscopy to Determine Brain Tumors	NCT00067418	Epilepsy, Tempo... Temporal Lobe		-	National Institutes of Health Clinical Center (CC)
A New Approach in Intensive Care Unit Consciousness Assessment: FIVE Score	NCT06036732	Postoperative I... Postoperative I... Supratentorial ... Infratentorial ... Arnold Chiari M... Subarachnoid He... Traumatic Brain... Epilepsy, Tempo... Cerebrovascular... Intensive Care ... Coma Unconsciousness Assessment, Sel...		18 Years - 80 Years	Istanbul University - Cerrahpasa (IUC)

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