MedNexus
Volume 34 · Issue 04 · 2018
MedNexus
In the historical development of neurosurgery, technological changes often bring revolutionary changes to treatment results. The development of auxiliary technology, especially the application of advanced imaging technology, has begun to guide clinical diagnosis and treatment[
To explore the application of multimodal image fusion in improvement of resection extent and protection of neurological function among cases of medullary gliomas.
The clinical data of 46 patients with medullary gliomas were retrospectively analyzed who were admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from October 2014 to August 2017. The patients were divided into conventional group (n=23) and multimodal group (n=23). The clinical efficacy of both groups were compared and analyzed.
The differences between two groups with regard to sex, age, growing patterns, preoperative tumor volume, preoperative KPS (Karnofsky performance status) score, postoperative pathology were not statistically significant (all P>0.05). The extent of resection in multimodal group was significantly higher than that of conventional group [(86.7±26.7)%vs. (61.8±32.9)%, P=0.007]. At 1 week post operation, the rate of short-term tracheostomy or tracheal intubation in multimodal group was lower than that in conventional group (34.8% vs. 69.6%, P=0.018). The differences between two groups with regard to short-term ventilation support and gastrostomy tubes were not statistically significant (both P>0.05). The follow-up period of 46 patients lasted for 0.6-37.0 months with a mean of 12.9±11.4 months. At 3 months post operation, the difference between two groups with regard to the retention rate of long-term tracheostomy or tracheal intubation and gastrostomy tubes was not statistically significant (allP>0.05). However, the rate of long-term ventilation support in multimodal group was lower than that in conventional group (31.8%vs. 5.0%, P=0.027) at 3-month follow-up.
The technology of multimodal image fusion could improve the resection extent of medullary gliomas without aggravating the injury of neurological function, reduce postoperative retention rate of tracheotomy or tracheal intubation and promote postoperative recovery of the patient’s long-term respiratory function.
To summarize our experience of application of intraoperative magnetic resonance imaging (iMRI) in glioma surgery and to investigate its clinical efficiency.
A retrospective analysis was conducted to evaluate the extent of resection (EOR) and outcomes of 366 glioma patients who underwent craniotomy under guidance of iMRI from December 2010 to December 2016 at Department of Neurosurgery, Huashan Hospital, Fudan University. Regular follow-up and head MRI were performed for all patients. Overall survival (OS) and progression free survival (PFS) curves were analyzed by Kaplan-Meier method. Log-rank tests and Cox proportional hazards model were used for univariate and multivariate comparisons, respectively.
A total of 366 glioma patients were enrolled into this study. The rate of gross total resection (GTR) was 67.2%. The GTR rate of glioblastoma multiform (GBM) (73.2%) was significantly higher than that of grade Ⅱ (58.5%, P<0.05) or grade Ⅲ glioma (61.9%,P<0.05). There was no significant difference in the GTR rate between grade Ⅱ and grade Ⅲ gliomas(P>0.05). Following the initial iMRI scan, 90 patients underwent further resection with a significant improvement of mean EOR from 81.9% to 95.9% (P<0.001). Our results revealed that the gender, GTR and radio-chemotherapy were all independent prognostic risk factors in GBM patients. Age and location of tumor had no significant influence on the prognosis of GBM patients(allP>0.05).
The application of iMRI could efficiently increase the EOR of glioma surgery and improve the prognosis of glioma patients.
To explore the value of 11C-methionine (MET)-PET/CT in grading brain stem glioma (BSG) and guiding its microsurgical resection.
A prospective study population comprised 63 patients who underwent MRI scans demonstrating suspicious BSG at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from January 2015 to December 2016. Among them, 20 patients only received stereotactic biopsy and MET-PET/CT scanning. The remaining 43 patients included 22 who underwent tumor resection under multi-modality guidance based on MET-PET/CT and 21 who received MR-guided resection. Semi-quantitative parameters including the maximal standardized uptake value (SUVmax), mean SUV (SUVmean), maximal tumor-to-background ratio (TBRmax), mean TBR (TBRmean) and total lesion methionine uptake (TLMU) obtained from presurgical MET-PET/CT images were compared between higher and lower tumor grading and their accuracy for indicating tumor grading. The ratio of high grade glioma resection was compared between 2 cohorts of patients.
Out of all 63 patients, 37 had high grade gliomas and the other 26 patients had low grade gliomas. The SUVmax, SUVmean, TBRmax and TBRmean of high grade gliomas were higher than those of low grade gliomas (all P<0.01), while TLMU showed no significant difference between 2 cohorts (P=0.506). The accuracy for diagnosis of high grade glioma was 70.7% (29/41), 63.4% (26/41), 80.5% (33/41) and 73.2% (30/41), respectively, and the specificity was 91.7% (11/12). Multiple modality-guided group had larger ratio of high grade tumor resection than MRI-guided group (81.0% vs. 36.4%, P=0.005). Forty-three patients undergoing microsurgical resection were followed up for an average of 12.9 months (0.3-25.4 months), and the median survival time in multiple modality- and MRI-guided cohorts were 11.9 and 14.1 months, respectively (P=0.289).
MET-PET/CT parameters are associated with histological grade and demonstrate good accuracy and specificity for tumor grading diagnosis. Multi-modality guidance appears superior to MRI guidance for resection of high grade tumors.
To explore the invasion characteristics of high-grade gliomas and to quantitatively investigate their infiltration zone using diffusion tensor imaging (DTI).
Ten patients of frontal high-grade gliomas (WHO Ⅲ-Ⅳ) were retrospectively reviewed who were admitted to Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases from October 2014 to October 2016. All patients underwent the examination of preoperative MRI and DTI. Three regions of interest (ROI), which were placed at the enhanced central region of the tumor, 1cm and 2cm from the tumor edge, were determined on T1-weighted imaging with contrast medium. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) of those ROIs were measured prior to surgery. Before the incision of dura matter, specimens of those ROIs were obtained under the guidance of navigation. Postoperative examinations of specimens including histological, tumor cell density, MMP-9 and Ki-67 were carried out. Differences in tumor cell density, MMP-9 and Ki-67 values among 3 ROIs were analyzed. Correlations among the ADC, FA values and the tumor cell density were also evaluated.
As the distance from the tumor entity increased, tumor cell density, expression levels of MMP-9 and Ki-67 significantly decreased compared with those in tumor entity (all P<0.05). To analyze the relationship of tumor cell density to ADC and FA values, the canonical discriminant formula was as follows: D=0.201 ADC+ 1.094 FA, which could be used to determine the tumor cell density with an accuracy rate of 66.7%.
As the distance from tumor entity increased, tumor cell density, invasion and proliferation decrease significantly compared with the tumor entity. There seems to be a quantitative relationship between DTI parameters and tumor cell density of high-grade gliomas, which could contribute to the formulation of surgical plan.
To explore the clinical application of multimodal image fusion in stereotactic biopsy of intracranial lesions.
A total of 34 patients underwent multimodal image-guided stereotactic biopsy and were enrolled into this study from January to December 2016 at Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University. Images including PET/CT, 1H-MRS, BOLD-fMRI, DTI were fused with structural MRI for target confirmation and trajectory design. Framed stereotactic biopsy was performed in 14 patients and frameless stereotactic biopsy was performed in the other 20 patients. The diagnostic yield and complications of biopsy were assessed.
Stereotactic biopsy was successfully performed in all cases including 32 with supratentorial lesions and 2 with infratentoria lesions. Post-biopsy pathology revealed glioma in 14 patients, lymphoma in 12, metastatic tumors in 6 and inflammatory demyelinating diseases in 2. The diagnostic yield was 100%. Post-biopsy CT confirmed the accuracy of biopsy targets. A small hematoma (< 5 ml) in target area was found in 1(2.9%, 1/34) patient without severe complications and no further operation was performed. There was no bleeding in any trajectory or newly-occurred neurological deficits.
Multimodal image fusion could provide anatomical, metabolic and functional information for stereotactic biopsy, increase diagnostic yield and reduce complications.
To investigate the clinical application of magnetic resonance diffusion tensor imaging (DTI) combined with fluorescein sodium dyeing (FLS) in surgery of high-grade gliomas (HGG) in functional brain areas.
From October 2014 to December 2016, a total of 95 cases of HGG in functional brain areas were admitted to Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University and their data were retrospectively analyzed. In the observation group, 49 patients underwent preoperative MRI scanning, enhancement and DTI, and FLS was applied to guide the removal of tumor; in the control group, 46 patients received MRI scanning and enhancement preoperatively, and the tumor was removed by conventional operation. Postoperatively, all patients underwent MRI scanning and enhancement within 72 hours for assessment of the resection extent. The changes of muscle strength and Karnofsky performance scale (KPS) scores were evaluated at 1 month post surgery.
The rate of total resection was significantly higher in the observation group (83.7%) than in control group (45.7%) (P<0.001). The rate of muscle strength reduction post surgery was significantly lower in observation group than in control (20.4%vs. 47.8%, P=0.005). KPS scores in the observation group were significantly higher than those in control (73.5% vs. 47.8%, P=0.029). In the observation group, the sensitivity of FLS in identifying tumor tissue was 91.7% (44/48) and the specificity was 90.0% (45/50).
The application of DTI combined with FLS could facilitate maximal resection of HGG in functional brain areas with a minimal loss of fiber bundles, reduce the disability rate and improve the quality of postoperative life, which is of great clinical significance.
To provide experimental foundation for application of hyperspectral imaging (HSI) in precise resection of the glioma and detection of its area and boundary in the mouse brain by HSI.
GL261 cells were implanted into the brain of C57 mice to generate the glioma. The images of 13 animal brains with gliomas (10 in vitro and 3 in vivo) were obtained by hyperspectral imaging and operating microscope. The spectrum of glioma and normal brain were extracted. The accuracy of HSI images were compared with that of 7.0-T MRI images.
The HSI spectrum of tumor mass was significant different from normal brain tissue in the whole range of 460-700 nm. However, the HSI spectrum of infiltrating tumor margin (ITM) showed differences from internal capsule and corpus callosum in 460-600 nm, but no differences from dentate gyrus in the 460-700 nm range. Compared with the cortex and thalamus, the HSI spectral reflectance of ITM was lower in 500-600 nm range, but higher in 650-700 nm range. The mass and the boundary of gliomas could be clearly figured out in the HSI R700/R545 images. Based on the tumor areas calculated by hematoxylin-eosin staining (HE) staining, the accuracies of Red Green Blue (RGB) images, MRI T2, and HSI R700/R545 images were 81.9%±4.5%, 84.4%±4.7% and 92.4%±2.5%, respectively.
HSI can be used to identify the mass and boundary of mice gliomas accurately and serve as a potential real-time and label free imaging tool during precise glioma resection.
To discuss the alterations of brain network efficiency in patients with refractory epilepsy.
A total of 26 patients with refractory epilepsy and 26 healthy controls with age, sex and education level matched were enrolled into this study. The 26 patients were admitted to Department of Epilepsy Surgery at Anhui Provincial Hospital Affiliated to Anhui Medical University from October 2015 to June 2016. Data of resting-state fMRI in both epilepsy and control groups were collected and preprocessed with Network Construction which was one module of GRETNA software for obtaining of matrix of brain network. Network Analysis was used to obtain global and local efficiency. With the sparsity of connected matrix set as threshold, the brain network efficiencies in 2 groups were compared in the range of 0.05-0.40.
There was no statistical difference in age, sex and education level between epilepsy and control groups (all P>0.05), while the score of Montreal Cognitive Assessment (MoCA) in epilepsy group (19.6±2.7) was significantly lower than that in control (26.8±3.6) (P=0.026). The global network efficiency in refractory epilepsy group was significantly lower than that in healthy control group in the range of 0.11-0.18 (P<0.05). The average local network efficiency was compared between 2 groups in the range of 0.05-0.40. The results showed that the local efficiency in the hippocampus was lower in epilepsy group than control, while the local efficiencies in the right insula, left opercular inferior frontal gyrus, left inferior temporal gyrus, left superior occipital gyrus and right globus pallidus were higher in epilepsy group than control.
The global network efficiency in refractory epilepsy group seems to be significantly lower than that in healthy control group within a certain range of threshold. The abnormal local efficiency in certain brain areas may be the neural network basis of clinical symptoms in patients with intractable epilepsy.
To investigate the early efficacy of deep brain stimulation (DBS) of subthalamic nucleus (STN) in the treatment of dysarthria in patients with Parkinson's disease (PD).
From May 2017 to November 2017, 10 PD patients treated with STN-DBS at Neurosurgery Department affiliated to Nanjing Medical University and 10 healthy volunteers (healthy control group) were recruited retrospectively. Ten PD patients without anti-Parkinson disease medication were recorded in a relatively quiet room at the states of 1 month after operation with stimulation-off, 1 month after operation with stimulation-on, and 3 months after stimulation-on. The speech signal was analyzed by Praat software and 3 fundamental frequency parameters were extracted which were the mean fundamental frequency, the range and standard deviation of fundamental frequency. The speech signals from the healthy control subjects were collected and analyzed at the same time.
The speech fundamental frequency range (PD group: 15.5±4.8 St, control group: 22.5±5.6 St, t=-2.962, P=0. 008) and the standard deviation of fundamental frequency (PD group: 2.4±0.7 St, control group: 3.7±0.8 St, t=-4.017, P=0. 001) in PD group with stimulation-off 1 month post operation were significantly lower than those in healthy control group. There was no significant difference in any parameter of fundamental frequency of the PD patients between the state of 1 month after stimulation-on and the state of 1 month after operation (all P > 0.05). At 3 months after stimulation-on, the fundamental frequency range (19.23.8 St, P=0.017) and the fundamental frequency standard deviation (3.20.8 St, P=0.001) of the speech were significantly higher than those at 1 month after operation with stimulation-off, and those was not significant statistical different compared with controls (all P > 0.05).
Early stage of STN-DBS treatment could improve the phonological tone of PD patients and relieve the stiffness of laryngeal muscles and vocal cord.
To evaluate the effect of subthalamic nucleus deep brain stimulation (STN-DBS) on Parkinson's disease and analyze predictive factors of the operational outcomes.
A total of 228 patients with Parkinson's disease (PD) who underwent STN-DBS at Department of Neurosurgery, Brain Health Center, Affiliated Hospital of Logistics College of Chinese People's Armed Police Force from January 2007 to June 2015 were enrolled into this retrospective study. The scores of Unified Parkinson's Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Mini-Mental State Examination (MMSE) before and 6, 12 and 24 months after STN-DBS were retrospectively analyzed. All patients were classified into 2 groups based on the activities of daily living at 24 months after DBS. The good prognostic group (122 cases) showed a Schwab and England (S&E) scale score of more than 70 during the off-period, and the poor prognostic group (106 cases) showed a score of no more than 70 during the off-period. The preoperative state in the 2 groups was compared and multiple logistic regression analysis was used to analyze the factors affecting the prognosis of DBS.
The UPDRS II, UPDRS III and S&E scores decreased significantly after 24 months (allP<0.05), whereas the BAI, BDI and MMSE scores showed no significant difference compared with the preoperative state (allP>0.05). There were significant differences in PD onset age, Hoehn-Yahr scale, age at surgery, preoperative UPDRS II, MMSE and S&E scores between the 2 groups. Multiple logistic regression analysis showed that the independent factors of daily activities after STN-DBS included the age at surgery (OR=1.200, 95% CI: 1.079-1.334, P<0.01), MMSE scores (OR=0.598, 95% CI: 0.423-0.846, P<0.01) and preoperative S&E scale scores during the off-period (OR=0.959, 95% CI: 0.921-0.998, P<0.05).
STN-DBS could improve the clinical symptoms of patients with PD. Age at surgery, MMSE scores and preoperative S&E scale scores during the off-period appear to be the independent factors of prognosis. The onset age of PD, Hoehn-Yahr scale, preoperative UPDRS II scores and S&E scale scores during the on-period may also predict the therapeutic effect of STN-DBS.
To investigate the correlation between the overall scores of multimodal neurophysiological methods [electroencephalography (EEG), brainstem auditory evoked potential (BAEP), somatosensory evoked potential (SEP)] and therapeutic effect of cervical spinal cord stimulation (cSCS) in patients with persistent vegetative state (PVS) resulting from non-traumatic brain injury.
A retrospective analysis was conducted on the clinical data, neurophysiological scores and 1-year outcomes of 48 PVS patients who underwent treatment of cSCS (study group) at Department of Neurosurgery, Daqing Oilfield General Hospital from January 2010 to February 2017. The results were compared with the clinical data and outcomes of 50 patients undergoing conservative resuscitating treatment (control group) during the same period. We investigated the relationship between multimodal neurophysiological scores and therapeutic effect of cSCS treatment by Spearman rank correlation analysis in the study group.
In the study group, 18 cases (37.5%) were resuscitated from PVS, 11 cases (22.9%) reported obvious therapeutic effect. In the control group, 3 cases (6.0%) were resuscitated from PVS, 4 cases (8.0%) had obvious therapetuic effect at 1 year post treatment. The treatment effect was significantly different between study group (R=0.6077) and control group (R=0.3966) by Ridit analysis (P<0.05). The cSCS treatment demonstrated better therapeutic effect than conservative resuscitating treatment. The Spearman rank correlation analysis showed that there was a positive correlation between the cSCS efficacy and neurophysiological scores (rs=0.854, P<0.05), i. e., higher overall neurophysiological scores indicated better therapeutic effect of cSCS.
(1) The cSCS awakening technology could promote neurological rehabilitation, improve the awakening ratio in PVS patients and facilitate early wake-up of PVS patients. (2) There is a positive correlation between multimodal neurophysiological scores and therapeutic effect of cSCS treatment. Multimodal neurophysiological scores play an important role in helping doctor choose cSCS awakening technology in clinical practice.
To investigate the predictive value of preoperative and intraoperative electrophysiological parameters in facial nerve (FN) function after cerebellopontine angel (CPA) tumor surgery.
A total of 58 patients with CPA tumor underwent operations from August 2016 to March 2017 at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University and were enrolled into this retrospective study. Preoperative blink reflex (BR) and FN F wave response were tested in all patients. The R1 component latency and mean F wave latency were determined. Intraoperative facial motor evoked potentials (FMEP) was applied to monitor the FN function and the amplitude ratio of FMEP was documented. According to the House-Brackmann (H-B) grading system, the functional classification of FN was determined preoperatively, at 1 week, 3 months and 6 months postoperatively. Multiple logistic regression analysis was applied to explore the predictor of postoperative FN function.
A total of 58 cases of CPA tumor underwent microsurgical excisions by retrosigmoid approach. Total and subtotal resections were performed in 55 (94.8%) and 3 cases, respectively. Single factor Logistic regression analysis showed that the results of blink reflex in patients with good FN outcome were better than those in the group with poor outcome at 3 follow-up time points (P<0.05). The results of F wave response in patients with good FN outcome were better than those in poor outcome group at 6 months post operation (P<0.05). At 3 and 6 months post surgery, the maximal tumor diameters in the good outcome group were (31.9±10.2) mm and (31.9±9.3) mm, respectively, which were smaller than those in the poor outcome group [(37.8±9.7) mm and (40.0±10.0) mm, respectively] (bothP<0.05). At 1 week, 3 and 6 months post surgery, the FMEP amplitude ratios in the good outcome group were (84.6±21.3)%, (83.0±19.0)% and (81.0±19.1)%, respectively, which were higher than those in the poor outcome group [(66.2±27.0)%, (63.4±29.0)% and (59.6±31, 2)%] (allP<0.05). Multivariate Logistic regression analysis showed that FMEP amplitude ratio was the independent predictor of FN outcome at 1 week, 3 and 6 months post operation (P<0.05). The maximal tumor diameter was the independent predictor of FN outcome at 3 and 6 months post operation (P<0.05). BR classification was the independent predictor of FN outcome at 6 months after operation (P<0.05). ROC (receiver operating characteristic) curve analysis showed that the FMEP amplitude ratio cut-off values of 89.2% [AUC (area under the curve)=0.709], 58.2% (AUC=0.706) and 58.2% (AUC=0.713) predicted good FN function at 1 week, 3 and 6 months after surgery, respectively.
BR and maximal tumor diameter have certain predictive values for postoperative FN function. The FMEP amplitude ratio is a valuable predictor for postoperative FN function and its value of at least 60% is predictive of favorable long-term postoperative FN function.
To explore the clinical effect of long-term mild hypothermia therapy on high-grade aneurysmal subarachnoid hemorrhage (aSAH).
A total of 58 patients with high-grade aSAH were retrospectively analyzed who were treated with long-term mild hypothermia at Department of Neurosurgical Intensive Care Unit (ICU), Xuanwu Hospital, Capital Medical University from March 2015 to January 2017. Among them, 24 cases were treated with microsurgical clipping and 34 with interventional endovascular embolization. Follow-up study was carried out through outpatient clinic visit or telephone with the modified Rankin Scale (mRS) score after hospital discharge.
In 58 patients, the duration of long-term mild hypothermia therapy was 5-14 days with an average of 7.0±4.4 days. Cardiac arrhythmia occurred in 37 (63.8%) patients, hypotension in 50 (86.2%), deep venous thrombosis in 8 (13.8%), gastrointestinal motility disorder in 54 (93.1%), stress ulcers in 8 (13.8%), pneumonia in 30 (51.7%) and acute respiratory distress syndrome in 4 (6.9%) patients. Cerebral vasospasm was reported in 28 (48.3%) patients, chills in 21 (36.2%), coagulation dysfunction in 17 (29.3%), stress hyperglycemia in 15 (25.9%), hypoalbuminemia in 13 (22.4%), catheter-related infection in 6 (10.3%) and delayed cerebral ischemia in 10 (17.2%) patients. There were 8 (13.8%) cases of death reported during treatment. Univariate analysis showed that high-grade Hunt-Hess grades (Ⅳ and Ⅴ) and cerebral vasospasm were the risk factors for death during treatment of long-term mild hypothermia (all P <0.05). A total of 48 patients were followed up for 3-6 months with an average of 4.3±1.9 months. Among them, 56.5%(26/46) achieved favorable outcome and 43.5% (20/46) reported unfavorable results. Among the patients with poor outcome, 6 died and 14 were moderately or severely disabled.
Long-term mild hypothermia therapy could improve the prognosis of patients with high-grade aSAH.
To investigate the fornix of patients undergoing resection of third ventricle tumor through transcallosal interforniceal approach.
The clinical data of 5 patients with third ventricle tumor were retrospectively analyzed who were admitted to Department of Neurosurgery, Tsinghua University Yuquan Hospital from December 2015 to June 2016. All patients received operation through transcallosal interforniceal approach. DTI (diffusion tensor imaging) was performed before and after operation. The fractional anisotropy (FA), apparent diffusion coefficient (ADC) values and length of fornix were measured.
Total resection was achieved in 5 cases. At 1 month post operation, the DTI functional analysis showed that the FA value of fornix decreased slightly in 3 patients, the ADC value decreased slightly in 1 patient and the length of fornix decreased in 4 patients, compared with those before operation. Those parameters returned to preoperative levels at 3 months after operation.
The effects of operation on fornix were slight and temporary. After proficient operation, there was no significant change in the value of FA, ADC or the length of the fornix. DTI could be an effective method to evaluate the safety of operation.
To investigate the application of three-dimensional reconstruction 3D printing technology in the operation of cervical dumbbell tumors.
We prospectively studied 5 patients with dumbbell tumors in the cervical spine admitted to Department of Neurosurgery, General Hospital of Ningxia Medical University from June 2016 to December 2016. All patients underwent resection of tumors by posterior median approach. CT angiography and MRI examination before operation were conducted in 5 patients, and the original image data of the patients were transferred into Mimics 17.0 for reconstruction and a 3D printer for building the 3D lesion model. The model was used to formulate surgical plan, simulate the operation and guide surgical treatment.
The reconstructed 2D image and 3D printing model clearly reflected the relationship between tumors and peripheral vessels, nerves and tissues, providing more evident basis for the Toyama classification of tumors. Three cases received gross total resection and 2 cases had subtotal resection. No vertebral artery injury or nerve dysfunction was observed in this series. None of the patients developed myasthenia, cerebrospinal fluid leakage, infection or cervical spinal deformity.
The 3D printing model could comprehensively, clearly and accurately display the relationship between dumbbell-shaped tumors of the cervical spinal canal and their surrounding anatomical structures. That technique would be beneficial for maximal tumor resection and reduction of postoperative complications.
To investigate the application value of real-time B type ultrasound guidance in resection of low-grade gliomas.
Seventy-two cases of patients with low-grade gliomas were selected, who were treated at Department of Neurosurgery, Central Hospital of Jiamusi from June 2012 to June 2016, and were divided into observation group (36 cases) and control group (36 cases). Conventional tumor localization method was used in control group prior to resection, while the patients in observation group underwent tumor resection under real-time B type ultrasound guidance. The following aspects were compared between 2 groups including surgical operation, accuracy of tumor localization, total resection rate, ADL (activities of daily living) score and KPS (Karnofsky performance status) score.
The operation time in the observation group were significantly less than that in control group (P<0.01). The accuracy of tumor localization and total resection rate in the observation group were significantly higher than those in control group (bothP<0.01). At 6 months post operation, the ADL score in observation group was higher than preoperative score(84.7±8.8, 66.4±7.6, respectively)(P<0.001), while there was no statistical difference between postoperative and preoperative score in control group(P>0.05). The 6-month follow-up showed that the patients’ preoperative KPS scores in observation (81.1±7.8) and control (71.4±9.9) groups were significantly higher than postoperative scores (58.1±8.2, 56.9±9.2, respectively) (P<0.001) and the improvement in observation group was even greater (P<0.01).
Real-time B type ultrasound guidance used for low-grade gliomas resection could achieve good clinical results, significantly reduce the operation time and improve the patient’s quality of life.
hypertensive intracerebral hemorrhage (HICH) is a common complication of hypertension, accounting for 20% of all stroke cases. 50% of HICH is located in the basal ganglia region, which has become an important public health problem in China and the world because of its high morbidity, mortality and disability rate[
Clinically, apart from the common cerebral atherosclerosis rupture hemorrhage and middle cerebral artery (MCA) aneurysm rupture hemorrhage, the arteriovenous malformation (AVM) hemorrhage in this area is also a factor that cannot be ignored. However, part of AVM in this area is the main blood supply artery from MCA, the location is deep, not exposed to the cortex, and the deformity mass is not large, although this kind of AVM is rare in clinic[
To explore the therapeutic effect and mechanism of molecular mimicry-based vaccine in C6/SD rat model.
Mixed vaccines were prepared containing allogeneic 9L cells and cell lysates and syngeneic C6 cell lysates. C6 glioma cells were implanted into SD rats to establish the animal model. A total of 39 rats were randomly divided into 100, 000 treatment group, 200, 000 treatment group and control group. Subcutaneous vaccination were performed at 8 d post modeling and the survival time of rats was observed. MRI examination was taken at 7, 14, 21, 28, 35, 70 d and the tumor volumes were measured. At 20 d, 3 rats in each group were randomly selected for HE staining and immunohistochemical staining, and expressions of Fascin, HS1, MMP-2, Podoplanin, CD8 and CD4 were assessed.
The survival time in the 100, 000 and 200, 000 treatment groups (29.0 d and 47.5 d, respectively) was longer than that in the control group (18.5 d) (P<0.05) and there was no significant difference between the 2 treatment groups (P>0.05). The tumor volume in treatment group first increased and then gradually decreased. At 14 d and 21 d, the mean volumes of tumor in 100, 000 and 200, 000 treatment groups [14 d: (220.68±45.92) mm3, (164.98±45.36) mm3, respectively; 21 d: (426.48±39.69) mm3, (376.23±43.89) mm3, respectively] were less than that in the control group [14 d: (265.30±40.57) mm3; 21 d: (515.64±15.28) mm3] (all P<0.05). There was no significant difference between 2 treatment groups (P>0.05). At 20 d, the glioma cell density in the treatment groups was lower than that in the control group. The expression levels of Fascin, HS1, MMP-2 and Podoplanin in the treatment group were lower than that in the control group, while the expressions of CD4 and CD8 in treatment groups were higher than those in the control group.
The molecular mimicry-based vaccine could induce immune response to intracranial glioma in tumor bearing rats, thereby reducing tumor volume and invasiveness and prolonging the survival time of rats.
To evaluate the expression of PD-1/PD-L1 in gliomas and its relationship with the tumor grade and prognosis.
Related studies were searched from PubMed, Embase, The Cochrane Library databases from inception to November 1st, 2016. Researchers screened literature, extracted data and evaluated the risk of bias of eligible studies dependently. The meta-analysis was conducted by Revman 5.3 software.
A total of 17 studies and 1 179 gliomas were included. Meta-analysis showed that the expression rates of PD-L1 in tumor cells and tumor-infiltrating lymphocytes were 51% (RD=0.51, 95%CI: 0.41-0.61, P<0.001) and 51% (RD=0.51, 95%CI: 0.30-0.71, P<0.001), respectively. In terms of the relationship of PD-1/PD-L1 expression to WHO grade of gliomas, the meta-analysis showed that the higher grade was associated with higher positive rate of PD-L1 expression, but the difference between adjacent grades was not statistical significant (Ⅱvs. Ⅲ: RR=0.94, 95%CI: 0.72-1.23, P=0.66; Ⅲ vs. Ⅳ: RR=0.77, 95%CI: 0.56-1.05, P=0.10; Ⅱ vs. Ⅳ: RR=0.72, 95%CI: 0.53-1.97, P=0.03). Survival analysis showed that the prognostic risk of PD-L1 high expression group was higher than that in low expression group (HR=1.51, 95%CI: 1.21-1.79, P<0.001) and the difference was statistically significant.
PD-1/PD-L1 seems to have a high expression rate in gliomas and is associated with tumor grade, which might be an important factor in the prognosis of gliomas.
Rathke's cleft cyst (RCC) has the same histological origin as pituitary adenomas and is a rare congenital non-neoplastic disease[
Cranial metastasis of thyroid cancer is very rare, and it is mostly reported in individual cases at present, with an incidence of about 2.5%[
Diabetic peripheral neuropathy is one of the most common and serious complications of diabetes. Up to 50% of diabetic patients will eventually complicate diabetic peripheral neuropathy, which is mainly manifested as numbness, pain and weakness in the extremities distributed like stockings and gloves. It is the main cause of death and disability of diabetes[
Solitary plasmacytoma is a malignant tumor caused by abnormal proliferation of monoclonal plasma cells, accounting for less than 10% of plasmacytomas, and can be divided into bone solitary plasmacytoma and extramedullary plasmacytoma[
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