Brain tumour can be a chronic disease that affects individuals in many aspects. The course of events in the disease, the treatment and prognosis has an effect on the physical, as well as mental and social health and therefore influences individuals’ quality of life and wellbeing. The aim of this study was to describe the experience of quality of life and living with a brain tumour as an adult. A descriptive systematic literature study was used to analyze eleven scientific articles. The analysis resulted in four categories, physical changes involves difficulties in the daily life, emotional distress involves suffering, to feel anxiety at the thought of death and feel the need of social support. The result showed that people that lived with a brain tumour were submitted to changes that had a negative effect on their daily life. They experienced an emotional distress and suffering that further added in a negative way on their daily life. The constant threat of death leads to a feeling of death anxiety. To be able to cope with their everyday life and manage the process that the disease brought it was important to have social support and understanding from their next of kin and surroundings. The knowledge about this disease and the consequences it has for the single individual contributes to a greater understanding for the person that is affected. Further research about experiences amongst people that lives with serious diseases is necessary so that they get treated adequately and get help and understanding within the care system. This literature study shows that people who lived with brain tumor experienced sadness and depression that made its mark on daily life. Together with constant worries and the mental fatigue brought these problems to each individual. / Hjärntumör kan vara en kronisk sjukdom som påverkar människan på många olika sätt. Sjukdomens förlopp, behandling och prognos inverkar på den fysiska psykiska och sociala hälsan och därmed påverkar människors livskvalitet och välbefinnande. Syftet med denna litteraturstudie var att beskriva upplevelse av livskvalitet och att leva med hjärntumör hos vuxna människor. En beskrivande systematisk litteraturstudie användes för att analysera de elva vetenskapliga artiklarna. Analysen resulterade i fyra kategorier: fysiska förändringar medför svårigheter i det dagliga arbetet, känslomässig påfrestning innebär lidande, att känna dödsångest och att känna behov av socialt stöd. Resultatet visade att människorna som levde med hjärntumör var utsatta för förändringar som hade inverkan på det dagliga livet. De upplevde en känslomässig påfrestning och lidande som ytterliggare negativt påverkade livskvalitet. Det ständiga hotet om döden skapade känsla av dödsångest. För att kunna klara av vardagen och gå igenom den processen som sjukdomen förde med sig var det viktigt att känna socialt stöd och förståelse från närstående och omgivningen. Kunskapen om denna sjukdom och vilka konsekvenser den har för den enskilde individen bidrar till ökad förståelse för den drabbades livssituation. Vidare forskning om upplevelser hos människor som lever med svåra sjukdomstillstånd är nödvändig för att de människorna ska få adekvat bemötande, hjälp och förståelse i vården. Denna litteraturstudie visar att människor som levde med hjärntumör upplevde nedstämdhet och depression som präglade det dagliga livet. I kombination med ständig oro och den mentala tröttheten medförde det problem för den enskilda människan.

Abstract The goal of this study was to explore preoperative evaluation of patients with intracranial tumours using magnetic resonance imaging (MRI) methods: oedema-attenuated inversion recovery (EDAIR) sequence in low-field MRI, and diffusion-weighted imaging (DWI) and resting-state functional MRI (fMRI) in high-field MRI. The aim was also to increase our knowledge about the effects of brain surgery on eloquent brain cortices using new MRI techniques. The total number of patients in these studies was 50 (24 women). Enhancement of the tumour in ten patients after intravenous administration of gadolinium-based contrast agent in low-field MRI was examined with a new sequence, EDAIR, and compared with more conventionally used partial saturation spin echo sequences. EDAIR may facilitate the perception of small enhancing lesions and is valuable in low-field imaging, where T1-based contrast is inferior to high-field imaging. DWI was performed on 25 patients in order to evaluate the potential of this imaging method to assist in differential diagnosis of intracranial tumours. It was shown that apparent diffusion coefficient values of the tumour and peritumoural oedema produced by DWI were different in benign and malignant tumours. Resting-state blood oxygen level-dependent (BOLD) fMRI was performed on eight patients and ten healthy volunteers to examine if functional sensorimotor areas in the brain could be determined without any task-related activations. It was shown that intracranial tumours do not appear to hamper visualization of the sensorimotor area in resting-state BOLD fMRI when independent component analysis is performed, and this method may be used in preoperative imaging when activation studies cannot be performed. Conventional BOLD fMRI with motor and auditory stimuli was used with seven patients as the effect of brain surgery was studied. The results suggest that resection of a tumour with preoperative oedema probably decreases pressure on the brain and makes the functional cortex transiently more easily detectable in BOLD fMRI. In conclusion, the MRI imaging methods used in this study can give valuable additional information about the tumour, specifically for preoperative imaging and planning for surgery.

Segmentation of magnetic resonance images is an important part of planning radiotherapy treat-ments for patients with brain tumours but due to the number of images contained within a scan and the level of detail required, manual segmentation is a time consuming task. Convolutional neural networks have been proposed as tools for automated segmentation and shown promising results. However, the data sets used for training these deep learning models are often imbalanced and contain data that does not contribute to the performance of the model. By carefully selecting which data to train on, there is potential to both speed up the training and increase the network’s ability to detect tumours. This thesis implements the method of importance sampling for training a convolutional neural network for patch-based segmentation of three dimensional multimodal magnetic resonance images of the brain and compares it with the standard way of sampling in terms of network performance and training time. Training is done for two different patch sizes. Features of the most frequently sampled volumes are also analysed. Importance sampling is found to speed up training in terms of number of epochs and also yield models with improved performance. Analysis of the sampling trends indicate that when patches are large, small tumours are somewhat frequently trained on, however more investigation is needed to confirm what features may influence the sampling frequency of a patch. / Segmentering av magnetröntgenbilder är en viktig del i planeringen av strålbehandling av patienter med hjärntumörer. Det höga antalet bilder och den nödvändiga precisionsnivån gör dock manuellsegmentering till en tidskrävande uppgift. Faltningsnätverk har därför föreslagits som ett verktyg förautomatiserad segmentering och visat lovande resultat. Datamängderna som används för att träna dessa djupinlärningsmodeller är ofta obalanserade och innehåller data som inte bidrar till modellensprestanda. Det finns därför potential att både skynda på träningen och förbättra nätverkets förmåga att segmentera tumörer genom att noggrant välja vilken data som används för träning. Denna uppsats implementerar importance sampling för att träna ett faltningsnätverk för patch-baserad segmentering av tredimensionella multimodala magnetröntgenbilder av hjärnan. Modellensträningstid och prestanda jämförs mot ett nätverk tränat med standardmetoden. Detta görs förtvå olika storlekar på patches. Egenskaperna hos de mest valda volymerna analyseras också. Importance sampling uppvisar en snabbare träningsprocess med avseende på antal epoker och resulterar också i modeller med högre prestanda. Analys av de oftast valda volymerna indikerar att under träning med stora patches förekommer små tumörer i en något högre utsträckning. Vidareundersökningar är dock nödvändiga för att bekräfta vilka aspekter som påverkar hur ofta en volym används.

När en individ drabbas av hjärntumör kan det vara aktuellt med intervention i form av neurokirurgisk resektion. I de fall där neurokirurgisk intervention krävs görs om möjligt en preoperativ kartläggning av individens språk i syfte att identifiera känsliga språkområden i kortikala strukturer. I dagsläget används nTMS, navigerad transkraniell magnetstimulering, som genom att temporärt slå ut funktionen i specifika kortikala områden är en användbar metod för nämnda syfte. Patienten får då benämna bilder föreställande substantiv samtidigt som fokala delar i hjärnan stimuleras enskilt med magnetstimulering. Syftet med föreliggande studie var att undersöka huruvida benämningsförmågan av substantiv förändrades vid nTMS hos personer med hjärntumör och på vilket sätt, samt om tumörlokalisation påverkade deltagarnas benämning vid nTMS-undersökning. Samtliga deltagare i studien var patienter med hjärntumör som tidigare undersökts med nTMS på en neurofysiologisk klinik vid ett sjukhus i sydöstra Sverige. Undersökningarna filmades och har sedermera utgjort materialet till datainsamlingen i föreliggande studie. Analys gjordes på grupp- och populationsnivå, där grupperna skapades utifrån deltagarnas tumörlokalisationer. Resultatet visar att benämningsförmågan förändras då ett antal olika språkliga fenomen uppkom vid preoperativ testning med nTMS. De fem vanligaste fenomenen på populationsnivå var tvekljud, latens, inskottsljud, uteblivet svar samt oprecis artikulation. Vid jämförelse på gruppnivå framkom att ingen signifikant skillnad föreligger avseende tumörlokalisation. Resultatet kan tyda på att språkets neurofysiologi består av samarbetande komplexa nätverk. Resultatet kan också styrka teorier om tumörinducerad plasticitet. / When an individual is diagnosed with a brain tumour, intervention by neurosurgery might be needed. In case of neurosurgery, a preoperative assessment of the individual’s language functions is carried out, if possible, in order to identify sensitive language areas in cortical structures. Today, nTMS, navigated transcranial magnetic stimulation, is being used, which temporarily shuts down functions in specific cortical areas and thus is a useful method to fulfill this aim. The patient is asked to name a series of pictures representing nouns while focal parts of the brain is stimulated with magnetic stimulation. The purpose of the present study was to examine whether the naming ability of nouns changed during nTMS in individuals with brain tumour and in what way, as well as whether the location of the tumour affected the participants naming abilities during nTMS. All participants in the present study were patients with brain tumour, previously examined with nTMS in a neurophysiological clinic at a hospital in the South East of Sweden. The examinations were video recorded and have subsequently formed the material for data analysis in the present study. Analysis was made on group and population level. The groups were created based on the participants tumour localisation. The result shows that the naming ability changes as a number of language related phenomenon aroused in the preoperative examination using nTMS. The five most common phenomena on population level were hesitation sound, latency, sound interjection, no response and inaccurate articulation. Comparison on group level revealed no significant difference regarding tumour location. The result might indicate that the neurophysiology of language consists of collaborating complex networks. The result can also support theories regarding tumour induced plasticity.

Malgré un intérêt grandissant pour la question du devenir des survivants de tumeur cérébrale pédiatrique, l’évaluation de leur équilibre est souvent négligée. Les objectifs de nos travaux étaient de 1) examiner les écrits portant sur l’équilibre chez les survivants de tumeur cérébrale pédiatrique; 2) comparer l'équilibre debout et la qualité de vie entre les survivants et un groupe d’enfants témoins; et 3) examiner l'association entre l'équilibre debout et qualité de vie chez les survivants. Notre recension des écrits démontra que les survivants de tumeur cérébrale présentent des troubles de l’équilibre, mais les limites méthodologiques des études nous empêchent de conclure de manière définitive. Ensuite, nous avons recruté un groupe d’enfants survivants d’une tumeur cérébrale de la fosse postérieure et un groupe d’enfants sains. Leur équilibre était évalué à l’aide du Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) et du Pediatric Balance Scale (PBS). Certains participants ont aussi été évalués avec une plate-forme de force où les limites de stabilité étaient documentées. Finalement, tous les enfants et leurs parents remplissaient le Pediatric Quality of Life Inventory (PedsQL4.0). Nos résultats démontrent que les survivants présentent une diminution de l’équilibre mise en évidence par le BOT-2, mais que leur qualité de vie est similaire aux enfants sains. La performance au BOT-2 est associée à la dimension physique du PedsQL4.0, suggérant une relation entre l’équilibre et la qualité de vie. Nos résultats suggèrent qu’une évaluation de l’équilibre pourrait être bénéfique chez cette clientèle afin de mieux cerner ses besoins de réadaptation. / There is growing interest in studying outcomes in survivors of pediatric brain tumours. Physical outcomes, especially balance abilities, are less investigated. Objectives of this thesis are to: 1) examine the literature for balance outcomes in survivors of pediatric brain tumours, 2) compare standing balance and health-related quality of life (HRQOL) between survivors of pediatric posterior fossa brain tumours (PFBT) and typically-developing controls and 3) explore the association between balance and HRQOL. A comprehensive review demonstrated that although the literature suggests that survivors of pediatric brain tumours display ongoing balance deficits, studies have limitations, emphasizing the need for further research. Survivors of pediatric PFBT and typically-developing children were recruited and their balance assessed with the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) and Pediatric Balance Scale (PBS). Dynamic balance was also evaluated for some participants using a force platform. The Pediatric Quality of Life Inventory measured HRQOL. Statistical analyses included Mann-Whitney U tests to compare results between groups and Spearman's rank correlation coefficient to determine the association between balance and HRQOL. Balance abilities were significantly worse in survivors as measured by the BOT-2. The PBS displayed a ceiling effect. Certain laboratory outcome measures suggested balance difficulties. All participants’ HRQOL scores were within normative values. In survivors, an association was found between BOT-2 scores and the physical dimension of HRQOL. Survivors of PFBT demonstrate persistent balance difficulties, best assessed by the BOT-2; however, they report normal HRQOL. Future research should be collaborative and focus upon the best ways to manage balance deficits.

L'objectif de ce travail de thèse est de développer une sonde optique dédiée à aider le neurochirurgien à parfaire la résection des glioblastomes. Ce type de tumeurs est le plus fréquent et le plus agressif. Améliorer son exérèse permettrait d’augmenter la durée de survie moyenne du patient. Une exposé des tumeurs cérébrales et de leur prise en charge médicale introduit cette thèse. Le développement comporte trois volets. En premier lieu, le dispositif expérimental et la sonde utilisée fibrée sont caractérisés. Pour ce faire, des fantômes optiques calibrés aux géométries variées ont été conçus. Après validation, ils ont permis de définir la profondeur détectée en fonction de la variation de coefficients optiques.Deuxièmement, un programme de simulation Monte-Carlo a été développé et adapté au dispositif de mesures. Grâce aux mesures sur fantômes, ce programme a été validé. Cet outil permet un gain de temps considérable dans le processus de définition des propriétés de détection d'une sonde en fonction de sa géométrie.Enfin, dans le but d'identifier des indicateurs potentiels du tissu cérébral tumoral, une campagne de mesures sur modèle animal a été menée. Une étude spectroscopique approfondie a été effectuée sur des échantillons frais ex vivo. Plusieurs indices caractéristiques des tissus tumoraux ont été mis en évidence grâce à ce travail. / This work is dedicated to the development of an optical probe, which aims at helping the neurosurgeon during glioblastoma surgery. These brain tumours are the most frequent and aggressive ones. The quality of the tumour resection is crucial for the patients’ survival.As an introduction, the different types of brain tumours are described and the way they are taken in care is explained. The manuscript is divided into three parts. First, the experimental set-up and the home-made fibre-probe are characterized, thanks to optical calibrated phantoms. The depth of detection has been determined for several optical coefficients and phantom geometries.A dedicated Monte-Carlo simulation program has been developed. Based on phantom measurements, this program has been validated. The time-consuming process of fibre probe characterisation via phantoms can be replaced by the use of the program.At last, the identification of indicators of tumourous brain tissue is studied by means of an animal model. A spectroscopic study has been performed on fresh ex-vivo rat brain slices. Several tumourous indicators have been highlighted within this study.

No description available.

Galvos smegenų pilnavertiškam funkcionavimui turi būti palaikoma optimali galvos smegenų kraujotaka ir įsotinimas deguonimi. Darbo tikslas - nustatyti ir palyginti galvos smegenų kraujotakos pokyčius neurochirurginių operacijų metu naudojant sevofluraną ir propofolį. Mokslinio darbo tikslui pasiekti nustatyti uždaviniai: nustatyti galvos smegenų kraujotakos pokyčius transkranijiniu ultragarsiniu doplerografu matuojant vidurinės smegenų arterijos kraujo tėkmės greitį viršpadangtinių galvos smegenų navikų ir galvos smegenų arterinių aneurizmų operacijų metu bei operuojant ligonius, neturinčius galvos smegenų susirgimų (kontrolinė grupė); palyginti galvos smegenų kraujotakos pokyčius viršpadangtinių galvos smegenų navikų šalinimo operacijų metu naudojant sevofluraną ir propofolį; palyginti galvos smegenų kraujotakos pokyčius sevoflurano anestezijoje atliekant galvos smegenų navikų šalinimo, arterinių aneurizmų išjungimo operacijas ir operuojant ligonius, neturinčius galvos smegenų susirgimų (kontrolinė grupė); nustatyti ir palyginti sisteminės kraujotakos pokyčius bei įvertinti ir palyginti ligonių būklę po neurochirurginių operacijų naudojant sevofluraną ir propofolį. Klinikinio tyrimo metu ištirta 260 ligonnių. Nustatyta, kad bendrosios anestezijos palaikymui, atliekant neurochirurgines operacijas, sevofluranas gali būti naudojamas taip pat saugiai, kaip ir propofolis. Sevofluranas, naudojamas dozėmis iki 2,0 proc. tūrio iškvėpiamose dujose chirurginiam anestezijos gyliui... [toliau žr. visą tekstą] / Optimal cerebrovascular circulation and oxygen saturation must be maintained for full cerebral functioning. The aim of the study is to determine the changes of the cerebral circulation during supratentorial tumour resection or cerebral arterial aneurysm clipping surgery under sevoflurane and propofol anaesthesia. The following objectives were established: to determine and evaluate changes of the cerebral circulation by measurements of cerebral blood flow velocity in the middle cerebral artery using transcranial Doppler ultrasonography during supratentorial brain tumour resection or cerebral arterial aneurysm clipping surgery or operations for patients without cerebral pathology (control group); to compare the changes of the cerebral circulation during supratentorial brain tumour resection surgery under sevoflurane and propofol anaesthesia; to compare the changes of the cerebral circulation during supratentorial brain tumour resection, cerebral arterial aneurysm clipping or operations for patients without cerebral pathology (control group) under sevoflurane anaesthesia; to determine and compare the changes of the systemic hemodynamic during neurosurgery under sevoflurane and propofol anaesthesia; to determine and compare recovery period after sevoflurane and propofol anaesthesia.After giving written informed consent 260 eligible patients were enrolled in the study. The obtained results showed, that sevoflurane can be used as safely as propofol for maintaining general... [to full text]

Malgré un intérêt grandissant pour la question du devenir des survivants de tumeur cérébrale pédiatrique, l’évaluation de leur équilibre est souvent négligée. Les objectifs de nos travaux étaient de 1) examiner les écrits portant sur l’équilibre chez les survivants de tumeur cérébrale pédiatrique; 2) comparer l'équilibre debout et la qualité de vie entre les survivants et un groupe d’enfants témoins; et 3) examiner l'association entre l'équilibre debout et qualité de vie chez les survivants. Notre recension des écrits démontra que les survivants de tumeur cérébrale présentent des troubles de l’équilibre, mais les limites méthodologiques des études nous empêchent de conclure de manière définitive. Ensuite, nous avons recruté un groupe d’enfants survivants d’une tumeur cérébrale de la fosse postérieure et un groupe d’enfants sains. Leur équilibre était évalué à l’aide du Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) et du Pediatric Balance Scale (PBS). Certains participants ont aussi été évalués avec une plate-forme de force où les limites de stabilité étaient documentées. Finalement, tous les enfants et leurs parents remplissaient le Pediatric Quality of Life Inventory (PedsQL4.0). Nos résultats démontrent que les survivants présentent une diminution de l’équilibre mise en évidence par le BOT-2, mais que leur qualité de vie est similaire aux enfants sains. La performance au BOT-2 est associée à la dimension physique du PedsQL4.0, suggérant une relation entre l’équilibre et la qualité de vie. Nos résultats suggèrent qu’une évaluation de l’équilibre pourrait être bénéfique chez cette clientèle afin de mieux cerner ses besoins de réadaptation. / There is growing interest in studying outcomes in survivors of pediatric brain tumours. Physical outcomes, especially balance abilities, are less investigated. Objectives of this thesis are to: 1) examine the literature for balance outcomes in survivors of pediatric brain tumours, 2) compare standing balance and health-related quality of life (HRQOL) between survivors of pediatric posterior fossa brain tumours (PFBT) and typically-developing controls and 3) explore the association between balance and HRQOL. A comprehensive review demonstrated that although the literature suggests that survivors of pediatric brain tumours display ongoing balance deficits, studies have limitations, emphasizing the need for further research. Survivors of pediatric PFBT and typically-developing children were recruited and their balance assessed with the Bruininks-Oseretsky Test of Motor Proficiency-2nd edition (BOT-2) and Pediatric Balance Scale (PBS). Dynamic balance was also evaluated for some participants using a force platform. The Pediatric Quality of Life Inventory measured HRQOL. Statistical analyses included Mann-Whitney U tests to compare results between groups and Spearman's rank correlation coefficient to determine the association between balance and HRQOL. Balance abilities were significantly worse in survivors as measured by the BOT-2. The PBS displayed a ceiling effect. Certain laboratory outcome measures suggested balance difficulties. All participants’ HRQOL scores were within normative values. In survivors, an association was found between BOT-2 scores and the physical dimension of HRQOL. Survivors of PFBT demonstrate persistent balance difficulties, best assessed by the BOT-2; however, they report normal HRQOL. Future research should be collaborative and focus upon the best ways to manage balance deficits.

A disease has consequences not only for the afflicted person but also for those who interact with him or her. A low-grade glioma is a brain tumour whose regarding its psychosocial implications for adult patients and their next of kin has received little attention in the literature. In the light of this the overall aim of the present thesis was to provide increased knowledge about how patients with low-grade glioma and their next of kin experience and deal with everyday life. The methods of the studies were mainly qualitative. Thirty-nine patients and 28 next of kin were interviewed and all except one next of kin completed a quality of life questionnaire. The onset of low-grade glioma was described from the patients’ perspective as a process, either rapid (up to a few months) or prolonged over several years. This phase of low-grade glioma encompassed repeated visits to physicians and care institutions. The onset of low-grade glioma was accompanied by stress, anxiety and uncertainty in the case of both the patients and those nearest. The symptoms and problems the patients experienced covered a broad range of consequences, physical, psychological and social. The patients presented a wide range of ways to cope with illness-related problems. The next of kin were often deeply involved in the patients’ situation and many of them experienced extremely stressful emotions mainly in the early period of the illness. They had experience of positive encounters in health care but more often they had had a sense both of powerlessness and of being invisible and neglected. Relations and roles changed in ways that mostly were experienced as negative. Enabling strength in everyday life had to do with alleviation of strain and having a positive outlook upon life. By means of the questionnaire Subjective estimation of Quality of Life (SQoL) the patients and those nearest estimated their quality of life as being comparatively high. Only one variable, among the patients the absence of work/meaningful occupation and among the next of kin the absence of own children, being estimated at below 60% of the maximum score.