Clinical Research Directory

Surgery and Laser Interstitial Thermal Therapy for Bilateral Glioblastomas

Butterfly glioblastomas (bGBM), defined as tumours crossing the midline to involve hemispheres bilaterally, have a dismal prognosis with a median survival of 3.3-6 months and only 9% of patients with bGBM survive 2-years. These figures put bGBM in the worst end of the spectrum of GBM prognosis, significantly inferior to the survival figures quoted in the literature with standard of care - 14.6 months - particularly when 5-aminolevulinic acid is used as surgical adjuvant - 17.47 months. Despite the poor outcome of this disease, there is preliminary evidence suggesting that active oncology treatment can impact the survival of patients with this condition.With particular regards to surgical resection versus biopsy, there is a suggestion that resection improves overall survival at 6 months with no clear difference at 12 and 18 months of follow up. Laser-induced thermal therapy (LITT) is a minimally invasive laser ablation technique used in a range of brain tumours, including glioblastomas, with similar overall survival to the ones reported for open surgery in patients with lesions not amenable to open resection. The minimally invasive nature of this technique, significantly reducing the collateral damage to the surrounding brain structures, suggests Its potential in the treatment of this bGBM \[14\] with significant implications as a deficit-sparing technique, particularly if associated with preoperative and intraoperative monitoring and mapping techniques. The SLITT-GBM study will combine unilateral open surgery for maximal tumour resection with contralateral LITT to the smaller component/residual.

Environmental Pollutants and Neurological Disorders

Environmental pollutants have emerged as a major global health concern, with growing evidence linking exposure to both traditional contaminants such as heavy metals (lead, mercury, cadmium, arsenic) and novel pollutants-including micro- and nanoplastics, per- and polyfluoroalkyl substances (PFAS), antibiotics, and endocrine-disrupting chemicals-to adverse neurological outcomes. These pollutants can cross or disrupt the blood-brain barrier, accumulate in neural tissue, and trigger oxidative stress, inflammation, epigenetic modifications, and metabolic reprogramming. Brain tumours and cerebrovascular diseases represent two major categories of neurosurgical disorders with high morbidity and mortality. However, their interaction with environmental pollutant exposure remains poorly understood. Recent studies suggest that pollutant-induced molecular alterations, such as aberrant DNA methylation, lipid metabolism disruption, and neurovascular endothelial dysfunction, may contribute to tumour initiation, malignant progression, aneurysm formation, and stroke occurrence. Given the increasing human exposure to these pollutants and the lack of large-scale clinical data, it is urgent to establish a systematic investigation in neurosurgical patients. This study aims to profile pollutant exposure (heavy metals, PFAS, microplastics, and other novel contaminants) using multi-biospecimen analysis (blood, urine, hair, tumour and peri-tumour tissues), and to explore their mechanistic links to the pathogenesis of brain tumours and cerebrovascular diseases. The findings are expected to provide new evidence for understanding environment-brain interactions and to identify potential biomarkers for disease risk stratification and prevention.

Investigating Visual Verticality Disorder and Lateropulsion in a Neurosurgical Cohort of Patients With Brain Tumours

The overall objective of this research is to investigate the clinical characteristics pre- and post-brain tumour resection with a focus on visual verticality disorder, and lateropulsion, including neuroimaging analysis, of a neurosurgical cohort of patients with brain tumours. This prospective observational cohort study will investigate clinical and neuroimaging characteristics and the relationship between lateropulsion and visual verticality disorder in patients pre- and post-brain tumour resection. Patients (aged 18-80 years, with a confirmed diagnosis of brain tumour and a neurosurgical pathway) will be enrolled from the state-wide Neurosurgery Service of Western Australia at Sir Charles Gairdner Hospital.

High-resolution PET-CT Specimen Imaging for the Perioperative Visualization of Resection Margins

These are patients in whom a benign or malignant tumor was recorded requiring surgery. During that surgery, the surgeon will cut away the tumor as part of the treatment of the disease. In this process, it is important that the tumor is removed correctly and completely. To verify that the correct tissue was completely removed, the tissue is examined microscopically. However, a microscopic analysis takes a relatively long time and the result is not known until a few days after the surgery is completed. If that microscopic analysis should eventually reveal that the tumor was not completely removed, additional treatment is usually necessary. An assessment of the excised tissue during surgery would allow additional tissue to be excised in the same operation if necessary. Thus, in this way, additional treatments can also be avoided. This could lead to shorter treatment time and less emotional strain for the patient, as well as lower costs. To date, however, there are no effective techniques to do this. PositronEmissionTomography (PET) imaging can be used to image the tumor that needs to be excised. To do this, a tracer must be administered through the blood before the operation. This tracer is a slightly radioactive substance that can be detected by the PET camera even at low concentrations. This technique is already routinely used in the hospital to detect cancer or inflammatory tissue in the body. During this study, however, it's not the intention to look at the tumor while it is still in the patient's body, but rather after it has been cut out of the patient's body by the surgeon. To do this, the piece of tissue cut away will be scanned using a specially designed PET-CT scanner. The overall goal of this study is to gain additional knowledge. More specifically, the investigators wish to determine which medical conditions may benefit from high-resolution PET-CT specimen imaging.