Volume 36 · Issue 06 · 2020

To explore the clinical features, diagnosis and therapeutic strategies of pediatric optic pathway gliomas.

A retrospective analysis was conducted on the clinical data of 32 pediatric patients of pathologically confirmed optic pathway glioma who were treated at Neurosurgery Department of Beijing Children’s Hospital, Capital Medical University between January 2016 and August 2019. All patients underwent craniotomy, which was performed through the longitudinal fissure approach in 19 cases, transcallosal interforniceal approach in 11, pterygium approach in 1, and right frontal cortex fistula approach in 1. Among them, diffusion tensor imaging (DTI) combined with intraoperative navigation was employed in 16 cases during operation. Regular clinical and imaging follow-up was performed to assess the outcome of the patients post operation.

The median age of 32 children at admission was 2 years (6 months to 9 years and 6 months) old, of whom 22 had ophthalmic symptoms, 16 had intracranial hypertension symptoms, and 6 had emaciation. Gross total resection of the tumor was achieved in 8 cases, subtotal resection in 21 and partial resection in 3. Postoperative pathological results indicated 9 cases of pilocytic astrocytoma and 23 cases of pilomyxoid astrocytoma. Post operation, 1 patient underwent chemotherapy-assisted radiotherapy, 4 underwent radiation therapy alone, 23 patients underwent chemotherapy, and 4 patients did not undergo chemotherapy and radiotherapy. The median follow-up time of 32 patients was 1.4 years which ranged from 2 months to 4 years. Tumor progression was reported in 6 patients and 2 died.

The clinical manifestations of children with optic pathway gliomas are mainly ophthalmological symptoms, which may be accompanied by cranial hypertension symptoms, and some children show severe wasting. Treatment should combine surgery with radiotherapy and chemotherapy. Most postoperative children seem to have good outcomes, while care should be taken to ensure the quality of life of the child.

To explore the prognostic value of imaging classification of medulloblastoma (MB) in children.

The clinical data of 253 children with MB admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from September 2011 to March 2016 were analyzed retrospectively. All children underwent the examination of cranial MRI prior to surgery. According to the signal enhancement characteristics of tumor on T1-weighted enhancement, the patients were divided into 4 types: type Ⅰ: 54 cases (21.3%), type Ⅱ: 115 cases (45.5%), type Ⅲ: 55 cases (21.7%), and type Ⅳ: 29 cases (11.5%). All those patients were treated with tumor resection followed by radiotherapy, chemotherapy or radiotherapy combined with chemotherapy. After discharge, all patients were followed up through outpatient clinic visits or telephone to inquire about their living status. The patients′ outcomes were evaluated based on the survival period: > 4 years as good outcome, 2-4 years as fair, and < 2 years as poor. Univariate and multivariate logistic regression analysis were used to determine whether MB imaging classification was an independent risk factor for the outcome.

Among 253 children, 187 (73.9%) underwent total resection of tumor and 66 (26.1%) underwent subtotal resection. The results of postoperative pathological examination revealed MB in all patients. Among them, 114 were classic type, 57 were desmoplastic/nodular type, 10 were extensive nodularity type, 8 were large cell/anaplastic type, and 64 were unclassified type. Postoperative complications included mutism in 62 cases (24.5%, 62/253), hydrocephalus in 10 cases (4.0%, 10/253) which further underwent ventriculoperitoneal shunting. The follow-up duration of 253 children was 32.9±13.9 months (6.6-80.0 months). At the latest follow-up, 176 children survived and 77 died. Of all 253 children, 47 (18.6%) had good outcome, 163 (64.4%) had fair outcome and 43 (17.0%) had poor outcome. Multivariate logistic regression analysis showed that the image classification of MB was an independent risk factor (OR=0.512, 95% CI: 0.364-0.720, P<0.001).

Based on the characteristics of T1 enhancement of brain MRI, the survival of MB patients could be predicted. Generally speaking, the prognosis of type Ⅰ and type Ⅱ seems good or fair, that of type Ⅲ may be poor, and type IV is rare. However, the findings still need to be verified by further research.

To explore the clinical characteristics and prognostic factors of intracranial ependymoma in children.

A retrospective analysis was conducted on the clinical data of 36 children with intracranial ependymoma confirmed by postoperative pathological examination at Department of Neurosurgery, Children′s Hospital of Fudan University from January 2008 to December 2016. The male to female ratio of 36 children was 2 ∶1, of whom 17 (47.2%) were younger than 3 years old and 19 (52.8%) were at least 3 years old. Tumors were supratentorial in 11 cases (30.6%) and infratentorial in 25 cases (69.4%). Postoperative radiotherapy was administered in 12 cases and chemotherapy in 7. The related factors affecting the prognosis of children with ependymoma were identified by using Kaplan-Meier method and Cox multivariate regression analysis.

Of the 36 patients, 31 (86.1%) cases underwent gross total resection and 5 (13.9%) underwent subtotal resection. According to the World Health Organization (WHO) criteria, postoperative pathological examination revealed that WHO grade Ⅰ-Ⅱ were in 6 cases (16.7%) and grade Ⅲ in 30 cases (83.3%). The total survival duration of 36 cases was 1.5-138.0 months, with a median of 49.0 months. The 5-year overall survival rate in 36 cases was 58% (21/36). Univariate analysis results indicated that age, extent of resection, postoperative radiotherapy were associated with the overall survival in children with intracranial ependymoma (all P<0.05). Multivariate Cox regression analysis suggested that age (OR=0.086, 95%CI: 0.014-0.513, P=0.007) and extent of resection (OR =0.111, 95%CI: 0.024-0.515, P=0.005) were independent factors affecting the overall survival of patients with ependymoma.

Children with intracranial ependymoma are more common in men, which is more often seen at infratentorial site than supratentorial site. The prognosis seems worse in younger patients. Surgical removal is the major therapy and patients who achieve total resection may have better prognosis.

To discuss the clinical features, diagnosis and treatment of children with congenital dermal sinus tract.

A retrospective analysis was conducted on the clinical data of 56 children with congenital dermal sinus admitted to Department of Neurosurgery, Shanghai Children′s Medical Center of Shanghai Jiao Tong University School of Medicine from January 2005 to September 2017. There were 47 primary cases and 9 recurrent cases. The median age of 56 children was 2 y (1m to 11y). The congenital dermal sinus was located in the posterior occipital region in 2 cases, cervical area in 1, thoracic area in 7, lumbar area in 26, sacral and coccygeal area in 20. The skin lesion area was observed prior to surgery. Head or spine MRI examination was undertaken. The 47 primary cases underwent resection of the dermal sinus tract .The lesions were removed for those with spinal or intracranial lesions. For those with combined tethered spinal cord syndrome, spinal cord untethering was performed. Comparison between pre- and post-operative conditions was conducted to evaluate changes in the neurological function, which, as well as medical imaging, was followed up.

In 56 cases, there were "needle-eye-like holes" in the lesion area of the children. In 43 cases, preoperative MRI suggested intradural lesions. In the remaining 13 cases, preoperative MRI did not indicate intradural lesions, 9 of which had epidural or epidermal cysts revealed later during operation. Overall, 92.9% (52/56) of children had dermal sinus combined with spinal cord endothelial cyst (33 cases) or epidermoid cyst (19 cases). The median follow-up time for 56 children was 4 years (2 months to 12 years). Of the 46 cases of children without central nervous system infection, 16 had neurological function damage before surgery. Among those, 4 cases recovered after surgery, 9 cases were improved and 3 cases remained unchanged. In 10 cases with combined central nervous system infection, there was neurological function damage before surgery. Among them, 8 cases improved after surgery, and 2 cases deteriorated.

Children with needle-eye-like holes in the posterior occipital region and midline of the spine should be examined jointly with MRI. For cases diagnosed as congenital dermal sinus, early surgical treatment should be considered as soon as possible. For cases where MRI does not indicate the presence of intradural lesions, the intradural area should still be explored.

To analyze the clinical characteristics and surgical outcome of temporal lobe epilepsy in children with different pathological types.

A retrospective analysis was conducted on 34 children with temporal lobe epilepsy who underwent surgery at Department of Neurosurgery, Children′s Hospital Affiliated to Capital Institute of Pediatrics from September 2016 to May 2019. The patient’s age ranged from 0.4 to 17.0 years, with a median age of 4 years and a median duration of illness of 16 months (1 month to 13 years). Among the 34 patients, 24 underwent standard anterior temporal lobectomy, 5 received enlarged resection of mass lesions, 2 underwent selective amygdalohippocampectomy, 2 underwent resection of mass lesions only, and 1 received anterior temporal lobectomy plus resection of tuberous lesion in the frontal lobe. The tissue specimens underwent pathological examination. All those patients were followed up for ≥12 months and were divided into tumor group and non-tumor group according to the pathological results. The age, gender, duration of illness, seizure type and Engel rating were compared between the 2 groups.

All 34 patients underwent operation successfully. MRI showed that all the lesions were removed completely. No serious complications occurred after surgery. The pathological diagnosis was as follows: 22 cases (64.7%) of mixed neuronal-glial tumors [including 16 cases (47.1%) of gangliogliomas, 3 cases (8.8%) of dysembryoplastic neuroepithelial tumors and 3 cases (8.8%) of unclassified mixed neuronal-glial tumors], 1 case (2.9%) of xanthoastrocytoma, 8 cases (23.5%) of focal cortical dysplasia and 6 cases of which were accompanied by hippocampal sclerosis, 1 case (2.9%) with tuberous sclerosis, 1 case (2.9%) with cerebral arteriovenous malformation, and 1 case (2.9%) without definite histopathological diagnosis. The median follow-up duration of all 34 children was 24.5 (12.0-43.0) months. By the last follow-up, MRI showed that there was no tumor recurrence in the tumor group. EEG (electroencephalography) showed that the epileptic discharges of all patients were significantly reduced or disappeared compared with pre-operation except for 2 patients who still had many epilepsy discharges in the temporal region of the operated side. The seizure outcome indicated 29 cases of Engel class Ⅰ, 3 cases of Engel class Ⅱ, 1 case of Engel class Ⅲ, and 1 case of Engel class Ⅳ. Compared with those in the non-tumor group (11 cases), children in the tumor group (23 cases) were significantly younger [3.0 (0.4-17.0 ) years old vs. 11.0 (2.8-14.0) years old, P = 0.003] and had a shorter course [1.0 (0.1-7.2) years vs. 4.0 (0.3-13.0) years, P = 0.008]. There was no statistically significant difference in gender, seizure type or Engel rating between the 2 groups (all P > 0.05).

Tumors seem more common in children with temporal lobe epilepsy undergoing surgery, and most of them are gangliogliomas. Children with tumors are younger and have a shorter duration of illness before surgery, and the prognosis of surgery in both tumor and non-tumor temporal lobe epilepsy in children seems favorable.

To explore the treatment and clinical effects of skull depression fracture in neonates.

A retrospective analysis was performed on the clinical outcomes of 10 neonatal patients with skull depression fractures admitted to Department of Neurosurgery, Children Hospital of Fudan University from January 2015 to June 2018. The age of 10 patients was 8-27 d, none had a history of head trauma, and there was no history of abdominal trauma during pregnancy. There were 2 cases of frontal depression, 3 cases of temporal depression and 5 cases of parietal depression. Among them, surgical reduction was performed in 2 cases, one cranial pry reduction, and cranial milling and reduction in 1. All the other 8 cases were treated by conservative observation.

In 10 cases of neonatal skull depression fracture, 2 patients had complete reduction of cranial depression without postoperative complications. The skull returned to normal shape after 2 months of imaging follow-up. Natural reduction of the skull without any neurological complication was observed in imaging follow-up (2-6 months) of 8 patients undergoing conservative treatment. Three patients with bleeding were followed up and bleeding absorption was indicated, and all 10 patients achieved good outcomes.

Most neonatal skull depression fractures lead to good outcomes through non-surgical treatment, which could avoid the trauma risk of surgery and anesthesia.

To investigate the influencing factors of visual acuity after surgery of optic pathway glioma in children.

The clinical data of 30 children with optic pathway glioma admitted to Department of Neurosurgery, Beijing Children′s Hospital, Capital Medical University from January 2015 to August 2018 were retrospectively analyzed. All patients underwent tumor resection. Postoperative radiotherapy combined with chemotherapy was administered in 1 case and 25 cases underwent postoperative chemotherapy. Regular outpatient and telephone follow-up was conducted post discharge. The factors that might affect postoperative visual acuity of patients were statistically analyzed using univariate analysis.

Gross total resection was achieved in 1 patient and subtotal resection in 29. Post operation, 9 patients were pathologically diagnosed with pilocytic astrocytoma and 21 patients with pilomyxoid astrocytoma. Out of 30 patients, 1 was lost to follow-up, 3 died, and the remaining 26 were followed up for 3-48 months. Compared with preoperative conditions, 17 children had stable visual acuity and 9 had impaired visual acuity post operation. The preservation rate of visual acuity was 65.4% (17/26). Univariate analysis showed that maximal tumor diameter was the influencing factor of visual acuity post operation of optic pathway glioma in children (P<0.001).

Children with the maximal tumor diameter ≥5 cm seem to have a higher risk of visual impairment after surgery, and in those cases early detection and early intervention may be necessary.

To investigate the surgical treatment and its efficacy of congenital dermal sinus combined with the central nervous system (CNS) infection.

A retrospective review was conducted on the clinical data of 15 cases of congenital dermal sinus combined with the CNS infection admitted to Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital from January 2014 to January 2019. Once the diagnosis was confirmed, all cases underwent early surgery combined with postoperative anti-infection therapy. Efficacy of anti-infection post operation was assessed based on the symptoms and results of laboratory tests. Spina bifida neurological scale (SBNS) was used to evaluate the patient’s improvement of neurological function.

Congenital dermal sinuses in 15 cases were all completely resected and treatment outcomes of comorbidities such as spinal tethering were satisfactory. Poor wound healing occurred in 1 case. None of the 14 patients developed surgical related complications. Follow-up duration ranged from 6 to 66 months with a median of 23 months. Infection was effectively controlled in all 15 cases and no relapses occurred. The results based on SBNS showed that the symptoms associated with neurological dysfunction were relieved in all 15 cases to varying degrees. The median (P₂₅, P₇₅) of SBNS score at the latest follow-up post operation was 15 (13, 15)points, which was higher than that prior to operation [13 (11, 15) points](Z=-2.699, P=0.007).

Early surgical removal of infection lesion in combination with targeted antibiotic therapy proves to be an effective approach with few complications in the control of infection and treatment of congenital dermal sinus combined with CNS infection.

To examine the expression characteristics of METTL7B in Chinese glioma patients and its role in the patient′s prognosis.

We retrospectively reviewed the sequencing results and clinical information of 288 glioma patients with METTL7B expression enrolled in the mRNAseq_325 dataset of Chinese Glioma Genome Atlas (CGGA). Immunohistochemical staining was conducted for the tumor specimens. Kaplan-Meier survival curve was used to study the effect of METTL7B abundance on the survival of patients with varying degrees of gliomas. Univariate and multivariate Cox regression analysis was conducted to identify the factors related to the patient’s survival. The genes co-expressed with METTL7B were screened by Pearson′s correlation analysis, which were subjected to biological function analysis using gene enrichment tool of R software.

Among 288 patients, the expression level of METTL7B in patients with World Health Organization (WHO) Ⅱ-Ⅳ gliomas [median (quartile spacing)] was [1.05 (1.93)], [3.07 (3.17)] and [4.71 (2.57)] respectively, that inIDH1 mutation and IDH1 wildtype was [4.99 (3.40)] and [1.53 (2.77)] respectively, and that in gliomas with 1p/19q codeletion and 1p/19q non-codeletion tumor tissues was [0.98 (1.79)] and [3.85 (3.39)] respectively. The results above presented a statistical significance (allP<0.01). Immunohistochemical staining confirmed that METTL7B positive rate was significantly higher in high-grade gliomas than low-grade gliomas. The median survival ofMETTL7B high and low expression patients (144 cases in each) was 20.0 months (1.0 to 136.0 months) and 80 months (2.0 to 149.0 months), respectively, and the difference was statistically significant (P<0.01). In patients with WHO Ⅱ-Ⅳ grade gliomas, the high expression ofMETTL7B significantly reduced the patient′s survival (all P<0.05). Multivariate Cox regression analysis showed thatMETTL7B expression was the independent influencing factor of the survival of glioma patients (HR=1.684, 95%CI: 1.158-2.449, P<0.01). In the CGGA database, there are 252 genes positively correlated withMETTL7B expression (r>0.45,P<0.05), whose biological functions were mainly related to cell adhesion, carbohydrate metabolism and protein folding, and mainly involved in protein processing in the endoplasmic reticulum, local adhesion and proteoglycans in cancer.

In the brain glioma tissues, with the increase of tumor grade, the expression of METTL7B also increases significantly, which can be used as a prognostic factor of high-grade glioma and its mechanism is worth further exploration.

To explore the related factors affecting the outcomes of patients with intracranial ependymomas.

The clinical data of 156 cases of ependymoma undergoing the first operation at Department of Neurosurgery, the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2017 were analyzed retrospectively. The effects of sex, age, tumor location, pathological grade, tumor resection extent, preoperative KPS (Karnofsky performance status) score, postoperative radiotherapy and chemotherapy on progression free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier method. Among the indicators with statistically significant differences, the independent factors affecting survival were determined with multivariate Cox regression analysis.

In 156 patients, the follow-up time ranged from 4.5 to 84.0 months (median: 33.5 months). At the last follow-up, 36 patients (23.1%) died and 120 patients (76.9%) survived, of which 96 patients (61.5%) did not relapse and 24 patients (15.4%) relapsed. The 5-year OS was 78.2% (122/156) and 5-year PFS was 62.2% (97/156). The independent prognostic factors for OS and PFS were pathological grade, preoperative KPS score and tumor resection extent (all P<0.05). Only univariate analysis showed that the PFS of patients undergoing chemotherapy was longer than that of those without chemotherapy, and the difference was statistically significant (P=0.022).

High pathological grade, incompleteness of tumor resection and low preoperative KPS score are independent risk factors for OS and PFS in patients with ependymoma after surgery.

To introduce the technique of in situ bone flap (ISBF) combined with free middle turbinate mucosal flap (FMTMF) to reconstruct the defect during endoscopic extended transsphenoidal approach (EETA) and to preliminarily evaluate its efficiency.

A retrospective study was conducted on the clinical data of 21 patients who underwent operation through EETA between May 2019 and December 2019 at Neurosurgery Department of the First Affiliated Hospital of Chongqing Medical University. Among them, there were 19 cases of craniopharyngioma and 2 cases of suprasellar arachnoid cyst. All 21 patients underwent skull base reconstruction using ISBF combined with FMTMF. The complications and efficiency of reconstruction were analyzed by clinical and imaging follow-up post operation.

The ISBF of 21 patients was achieved one time during operation. Thin-slice CT in the saddle area on the day after the operation showed no shift of bone flaps. Visual improvement was reported in 11 patients and no visual improvement in 10. After surgery, 1 patient had CSF leakage complicated with intracranial infection, and 2 patients were suspected of intracranial infection, and those 3 patients underwent lumbar drainage. There was no operation of a second CSF leak repair or death. Postoperative follow-up of 21 patients lasted for a median of 4 months(3-10 months). The patients recovered well and had no intranasal discomfort and delayed CSF leakage after surgery. The thin-slice CT in the saddle area showed that the bone flaps had different degrees of healing, of which 19 patients showed hyperenhancement in the FMTMF on contrast-enhanced MRI of the saddle area indicating good growth of FMTMF.

Application of ISBF combined with FMTMF in skull base reconstruction of EETA seems to be associated with an excellent reconstruction result and reduction of nasal trauma, which also has a positive effect on reducing the risk of secondary surgery.

To investigate the clinical features and surgical outcomes of patients with intradural extramedullary capillary hemangiomas (CH).

Seven patients with intradural extramedullary CH were admitted to Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital from July 2006 to January 2017 and underwent microsurgery whose clinical data were retrospectively analyzed in this study. Those patients included 6 males and 1 female, with a mean age of 44.4±12.8 years old (range: 23-62 years old). At admission, the lumbar segment was most commonly affected (5 cases), followed by conus medullaries (2 cases). Their clinical symptoms included low-back pain and leg pain, limb weakness, urination and defecation dysfunctions. The lesion usually demonstrated isointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and homogeneously enhanced after injection of contrast materials. Five patients were preoperatively diagnosed as schwannoma, 1 as hemangioma and 1 as cavernous malformation. Seven cases underwent tumor resection via posterior midline approach. Clinical follow-up was routinely carried out after surgery. Functional status was evaluated based on the modified McCormick′s classification (MMS) system. Imaging follow-up was conducted to explore the recurrence.

Among the 7 patients, complete excision of the tumor was achieved in 6 and tumor in the area of conus medullaris was partially removed in 1 case. One patient developed numbness in the saddle area after surgery, and the rest of the patients had no surgical complications. The average follow-up period was 113.0±49.9 months (range: 34-160 months). At the last follow-up, MMS grade Ⅰ was achieved in 6 cases and Ⅱ in 1 case. Pain, urination and defecation dysfunctions improved in patients. An imaging review showed no recurrence of the tumor.

Intradural extramedullary CH seems rare, which usually occurs in lumbar and thoracic segments, affects male patients of 40-50 years old and tends to be misdiagnosed prior to operation. Microsurgery could lead to relatively good outcome with low recurrence rate.

To explore the operative techniques and surgical efficacy of microsurgical resection of lumbar intraspinal lesions using minimally invasive tubular retractor system.

A retrospective analysis was conducted on the clinical data of 26 patients with lumbar intraspinal tumors (subdural lesion in 24 cases and extradural in 2) who underwent surgical treatment at Department of Neurosurgery, Shanxi Provincial People's Hospital from March 2016 to March 2018. Among them, the lesion was less than 3 cm in length in 24 cases and multiple segments were involved in the remaining 2 cases including 1 with the length of 7 cm and 1 of 22 cm. All the lesions were resected by microsurgery using minimally invasive tubular retractor system assisted with electrophysiological monitoring. The improvement of local pain was evaluated by visual analogue scale (VAS). The improvement of spinal cord function was evaluated based on Japanese Orthopedic Association (JOA) score. The degree of articular process injury and spinal stability were assessed by imaging follow-up.

All 26 patients underwent total resection of lesions without exacerbation of neurological dysfunction, cerebrospinal fluid leakage or infection. Postoperative follow-up time was 12-16 months (13.6±1.3 months). At 3 months post surgery, the radicular pain of 12 patients was completely relieved. The median VAS score reduced from 7 (5-9) to 0 (0-1). At 12 months post operation, the JOA score of 26 patients recovered from 11.4±1.7 points to preoperative 25.7±0.9 points. The differences in both VAS and JOA scores were statistically significant (both P<0.01). Re-examination of CT showed that the stability of articular process or spine was not affected, and the imaging follow-up revealed no recurrence.

Under electrophysiological monitoring, the microsurgical resection using minimally invasive tubular retractor system could be performed for small space-occupying lesions and multi-segmental cystic lesions in the lumbar spinal canal, which seems to be associated with relatively high rate of complete resection, few complications, small damage to muscles and facet joints, and good spinal stability.

To investigate the effects of preoperative symptoms and surgical time window on the outcome of patients with acute basilar artery occlusion (BAO) undergoing endovascular therapy.

A retrospective study was conducted on the clinical data of 42 patients with acute BAO who underwent endovascular treatment at Department of Neurosurgery, Tangdu Hospital of Air Force Medical University from January 2017 to September 2019. The symptom severity of all patients was evaluated based on the Glasgow Coma Scale (GCS) prior to surgery, of which 12 cases were mild-medium (9-15 points), 18 cases were severe (6-8 points), and 12 cases were extremely severe (3-5 pints). In terms of surgical time window, the time from onset to femoral artery puncture was 0-6 hours in 17 cases, > 6-9 hours in 16 cases, and > 9-24 hours in 9 cases. Modified thrombolysis in cerebral ischemia grade (mTICI) was used to evaluate recanalization post operation. Successful revascularization was defined as an mTICI of 2b or 3. CT reexamination was performed within 36 hours post operation to determine whether the patient had symptomatic intracerebral hemorrhage. All patients were followed up through outpatient clinic or telephone at 3 months post discharge. Modified Rankin Scale (mRS) was used to assess the patient′s outcome. A favorable clinical outcome was defined as an mRS of 0-3, functional independence was defined as an mRS of 0-2, and poor outcome was defined as an mRS of 4-6. Univariate and multivariate logistic regression analyses were used to determine whether preoperative symptoms and surgical time window were independent influencing factors of the outcome of patients.

Among 42 patients, 38 (90.5%) achieved successful recanalization and consisted of 35 cases with the mTICI of 3 and 3 cases with the mTICI of 2b. Unsuccessfully recanalization was reported in 4 cases (9.5%), which consisted of 2 with the mTICI of 2a and 2 with the mTICI of 0. During hospitalization, 3 (7.1%) patients died. Among them, 2 cases suffered postoperative breathing and cardiac arrest, considered to be caused by brain stem failure, and the remaining 1 died of respiratory failure due to secondary lung infection. Symptomatic intracerebral hemorrhage occurred in 1 case (2.9%). The median follow-up time of 39 patients was 3 months (1-4 months). At 3 months post discharge, 20 (51.3%) cases reported favorable clinical outcome and included 17 with functional independence, and 19 (48.7%) had a poor outcome and included 8 deaths. Univariate analysis showed that age and the severity of preoperative symptoms were influencing factors of the patient′s outcome (both P <0.05). Further multivariate logistic regression analysis showed that extremely severe preoperative conditions (GCS: 3-5) was an independent risk factor for poor outcome ( OR = 0.039, 95% CI: 0.004-0.404, P = 0.007).

It has been preliminarily suggested that heavier preoperative symptoms in patients with acute BAO occlusion is predictive of worse outcome of endovascular treatment. Surgical time window does not seem to be an independent influencing factor of the outcome.

To conduct a preliminary study on Labbe vein using CTP (CT perfusion) visualized three-dimensional reconstruction.

We retrospectively analyzed the imaging data of 50 adult patients (100 sides) who underwent head CTP examination at Zibo Central Hospital from July 2018 to September 2018 and had no intracranial venous system disease or cerebrovascular disease. We observed the development and shape of Labbe vein, and measured the diameter of Labbe vein.

A total of 90 Labbe veins (48 on the left and 42 on the right) were observed in all 50 patients (100 sides). Among them, the single-trunk type was observed on 60 sides (60%), double-trunk type on 15 sides (15%) and 25 (25%) were not shown (10 on the left and 15 on the right). The diameters of Labbe vein on the left and right sides were 1.66±0.62 mm (0.57-2.46 mm) and 1.63±0.64 mm (0.67-2.81 mm), respectively. For the 86 Labbe veins emptying into the transverse sinus, the posterior edge of the entering point was 0.98±0.35 cm (0.33-1.54 cm) above the lower horizontal line and 4.48±1.36 cm (2.83-7.56 cm) posterior to the midpoint of zygomatic arch.

Through the CTP three-dimensional visualized reconstruction, the Labbe vein can be clearly displayed in most cases and the surface projection of position where the Labbe vein empties into the transverse sinus can be marked.

To analyze the expression characteristics and clinical significance of S100 calcium binding protein A11 (S100A11) in gliomas.

Clinical information and sequencing data of 310 glioma samples from Chinese Glioma Genome Atlas (CGGA) database were retrospectively reviewed. The expression characteristics of S100A11 in different groups were analyzed based on pathological feature of the patient. A total of 611 glioma patients from the cancer genome atlas (TCGA) RNA sequencing database were collected to verify the expression patterns of S100A11. Kaplan-Meier survival curve was used to determine the effect of S100A11 expression on the survival of patients with gliomas. Furthermore, univariate and multivariate Cox regression analyses were conducted to determine whether the S100A11 abundance was the independent influencing factor of the outcomes of patients. In addition, the biological functions of S100A11-related genes were obtained by bioinformatics analysis, and possible mechanisms of S100A11 underlying the malignant progression of gliomas were discussed.

In CGGA database, the expression of S100A11 increased with the increase of WHO pathological grade of glioma (grade Ⅱ: -0.78±0.69, grade Ⅲ: -0.12±0.80, grade Ⅳ: 0.62±0.84, F=96.250, P<0.001). Higher expression of S100A11 was found in the mesenchymal subtype, isocitrate dehydrogenase (IDH) wild-type and O⁶-methylguanine-DNA methyltransferase (MGMT) promoter unmethylated gliomas (all P<0.001). According to the 2016 WHO Classification of Tumors of the Central Nervous System, S100A11 had relatively higher expression inIDH wild-type low-grade glioma and glioblastoma (both P<0.001). Moreover, the cumulative survival rate in S100A11 high-expression group was significantly lower than that in S100A11 low-expression group (P<0.05). The expression characteristics of S100A11 as above were consistent with the results obtained from the TCGA RNA sequencing database. Multivariate analysis showed that S100A11 expression was independent factors for the patient′s outcome (HR=1.227, 95%CI: 0.963-1.538, P=0.014). S100A11 might be related to the immune response, extracellular matrix regulation and other biological processes of glioma.

S100A11 protein seems to be involved in the malignant progression of glioma by affecting the immune response of tumor cells, which may serve as a prognostic factor of glioma patient and potential therapeutic target.

To systematically analyze the factors related to the progression-free survival (PFS) of patients with atypical meningioma (AM).

Literatures regarding postoperative outcomes of AM were searched in the databases of PubMed, Cochrane Library, Medline, CNKI, VIP and WanFang. The time window of literatures searched was from the establishment of the database to October 31, 2019. Based on the inclusion and exclusion criteria, the literatures meeting the criteria were included in the study, and the analytical indicators extracted included: age, sex, preoperative Karnofsky Functional Status (KPS) score, tumor location and diameter, whether the tumor invaded the skull and brain, tumor resection degree, tumor cell proliferation and postoperative radiotherapy. The quality of the literature included was evaluated using the Newcastle-Ottawa Literature Quality Rating Scale (NOS). Stata 14.0 statistical software was used to analyze the relevant factors affecting PFS in AM patients.

A total of 18 papers involving 2 613 patients were included in the study, and the NOS scores were 6-8. The meta-analysis showed that KPS score (HR=0.48, 95%CI: 0.38-0.60, P<0.001), brain invasion of tumor (HR=1.56, 95%CI: 1.23-1.98, P<0.001) and postoperative radiotherapy (HR=0.58, 95%CI: 0.46-0.73, P<0.001) were factors affecting the PFS of AM.

There are multiple factors affecting the PFS in AM patients, among which low KPS score and brain invasion of tumor are associated with relatively higher risk of recurrence, and radiotherapy seems to prolong PFS post surgery. Other factors have yet to be further confirmed by long-term follow-up studies of large samples.