Glioblastoma is the most common primary malignancy of the central nervous system. Maximal surgical resection of glioblastoma in addition to temozolomide and fractionated radiation therapy provides an overall median survival of approximately 15 months. The addition of tumor-treating fields (Optune therapy) has the potential to increase median survival to 20 months, although compliance and ease of use remain an issue. Glioblastoma remains a devastating diagnosis fraught with complications. Curcumin is a yellow pigment from the rhizome of the ubiquitous and commercially available spice, turmeric (Curcuma longa). Turmeric has been long used in Indian traditional medicines and has been established as a safe food additive by the US Food and Drug Administration. There is a wealth of in vitro data suggesting that turmeric' s main active component, curcumin, has many favorable effects on glioblastoma. Curcumin has been shown to potentiate the effects of chemotherapy and radiation, decrease malignant spread, protect normal tissue from oxidative stress, and regulate many genetic targets resulting in glioblastoma cell death. Curcumin' s positive safety profile and potential therapeutic effects on glioblastoma make it a promising potential adjunct to current standard treatment regimens.

Up to 50% of patients with brain tumors will initially present with seizures, while an additional 10-30% will develop seizures during the course of the disease. Gliomas are the most common primary intracranial tumors and are associated with a number of changes which are involved in the pathogenesis of epilepsy, including blood-brain barrier disruption, molecular changes, edema, and peritumoral environmental changes. Epilepsy is a source of significant morbidity and mortality for patients with gliomas. The two main treatments for patients with glioma-related epilepsy involve antiepileptic drugs as well as surgical resection of the mass and surrounding epileptogenic tissue, if feasible. Given the propensity for neighboring tissue to also be epileptogenic, intraoperative electrocorticography can be of benefit to define the seizure onset and spread areas. Surgical treatment of glioma-associated epilepsy can provide significant relief for affected patients. Unlike non-lesional epilepsy, which is primarily managed medically, glioma-related epilepsy frequently requires surgery because of its medically refractory nature.

Metastasis of ovarian carcinoma to the central nervous system occurs in <2% of cases and classically localizes within the brain parenchyma. Moreover, leptomeningeal spread of these tumors is an exceedingly rare phenomenon. Here, we conduct a systematic review of the current literature on the natural history, treatment options, and proposed pathogenic mechanisms of leptomeningeal carcinomatosis in ovarian carcinoma. We also report a case of a 67-year-old female with stage IV metastatic ovarian serous carcinoma initially confined to the peritoneal cavity with a stable disease burden over the course of three years. Follow-up imaging demonstrated an intracranial lesion, which was resected via craniotomy, and pathology was consistent with the original diagnosis. Three months after surgery, she developed rapidly progressive dizziness, generalized weakness, fatigue, and ataxia. Repeat MRI demonstrated interval development of extensive and diffusely enhancing dural nodularity, numerous avidly enhancing supratentorial and infratentorial lesions, enhancement of the bilateral trigeminal nerves, internal auditory canals, and exit wound from the surgical site into the posterior aspect of the right-sided neck musculature consistent with diffuse leptomeningeal dissemination. The present case highlights that leptomeningeal dissemination of ovarian carcinoma is a potential yet rare consequence following surgical resection of an ovarian parenchymal metastasis. Progressive clinical symptomatology that develops postoperatively in this patient population should prompt urgent workup to rule out leptomeningeal disease and an expedited radiation oncology consultation if identified.

No abstract