Volume 38 · Issue 06 · 2022

To observe the clinical effect of endovascular therapy for vein of Galen aneurysmal malformation (VGAM) in children.

The clinical data of 10 children with VGAM (aged≤3 years) treated with endovascular therapy in the Department of Pediatric Neurosurgery, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2005 to November 2021 were retrospectively analyzed. The VGAM of single supplying artery was treated with coil combined with Onyx glue embolization. For VGAM with multiple fistulas and multiple supplying arteries, staging embolization was performed. Routine outpatient follow-up was performed at 3, 6, and 12 months after operation. Follow-up contents included assessment of clinical symptoms and Denver developmental screening test, head CT or MRI, and DSA to assess the occlusion situation of VGAM. Complete embolization was defined as complete occlusion of all fistulas without blood flow entry.

DSA results of the 10 children showed that there were 2 cases with single blood supply and 8 cases with multiple blood supply. Endovascular embolization was performed for 1-3 times (1 time in 2 cases, 2 times in 3 cases and 3 times in 5 cases). VGAM was completely embolized in all patients. There were no complications such as intracranial hemorrhage, infection and thrombosis. The median follow-up time of the 10 patients was 34.5 months (2-116 months). The time of DSA review was at 3-12 months post surgery. Ten children had hydrocephalus before surgery, among whom 7 had obvious hydrocephalus relief within 2 months after surgery, and 3 had hydrocephalus relief after ventriculoperitoneal shunt. By the last follow-up, the clinical symptoms of 10 children were relieved. Imaging examination showed that the median maximum diameter of VGAM was 0.3 cm (0-2.3 cm), which was reduced in size (5 cases) or disappeared (5 cases). DSA showed that the fistulas were completely occluded. The Denver developmental screening test results were normal in 8 cases and suspiciously abnormal in 2 cases.

Primary observation has shown that endovascular therapy can completely embolize VGAM, improve the clinical symptoms and growth and development of the children, which has a good effect.

To explore the therapy and its clinical efficacy in children with optic pathway glioma (OPG).

The clinical data of children with OPG admitted to the Pediatrics Department of Beijing Shijitan Hospital, Capital Medical University from September 2014 to October 2019 were retrospectively analyzed. After routine tumor resection or biopsy, the children received chemotherapy with modified German International Society of Pediatric Oncology (SIOP) low-grade glioma (LGG) 2004 regimen. Efficacy evaluation indicators include imaging response (based on the Response Assessment of Pediatric Neuro-Oncology, RAPNO) and improvement of clinical symptoms. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier method. Survival rates between groups were compared by the log-rank test.

A total of 57 children were enrolled, of which 54 underwent tumor resection, 2 underwent biopsy, and 1 underwent conservative treatment. Three patients received vincristine + carboplatin chemotherapy, and 54 patients received vincristine + carboplatin + etoposide chemotherapy (or combined with bevacizumab, radiotherapy or oral targeted drug therapy). All patients were alive at the last follow-up, and the median follow-up time (range) was 3.5 years (2.3-7.1 years). Complete response was achieved in 16 cases, partial response in 33 cases, minor response in 2 cases, stable disease in 4 cases, and disease progression in 2 cases. The median onset time of the 57 patients was 6.0 months, and the 5-year PFS and OS were 73.0%±7.2% and 100.0%, respectively. The PFS of children with spinal dissemination at the time of diagnosis and those without surgical resection was lower than those without spinal dissemination or surgical resection (both P<0.05). At the last follow-up, except for precocious puberty, the clinical symptoms of 57 children were improved to varying degrees, and chemotherapy was well tolerated.

For children with OPG, individualized treatment including surgery and postoperative chemotherapy, radiotherapy, and targeted drugs can achieve relatively good clinical efficacy and increase the children′s PFS. Surgical resection of the tumor and no spinal dissemination of the tumor are associated with a better survival prognosis.

To investigate the clinical characteristics, therapeutic approaches and prognosis of invasive fibromatosis of the scalp in children.

The clinical data of 10 children with scalp invasive fibromatosis admitted to the Department of Neurosurgery of Jiangxi Children′s Hospital from June 2009 to June 2019 were retrospectively analyzed. All 10 children underwent head ultrasonography and CT examination before operation. The tumor diameter was about 1.0-4.0 cm, and all of them showed expansile growth with unclear boundary. All the children were treated with surgery, and the skull bone was removed about 0.5-1.0 cm along the margin of the bone invaded by the tumor. The diagnosis was confirmed by pathological examination after operation. Regular clinical and imaging follow-up was performed after operation to observe the outcomes of the children.

The age of onset of the 10 children ranged from 7 months to 9 years and 2 months. The main clinical manifestations of the children at the time of consultation were scalp soft tissue tumors with progressive enlargement. The skulls of 10 children were damaged to varying degrees, and bone defects were seen, including 5 cases of frontal bone, 4 cases of temporal bone, and 1 case of parietal bone. The median follow-up time of the 10 children was 41 months (16-71 months), of which 8 patients had no tumor recurrence during the follow-up process, 1 patient underwent surgical resection after tumor recurrence, and 1 patient did not undergo surgical treatment after recurrence. No tumor enlargement was found at the last follow-up. All the children were followed up so far without tumor metastasis or related deaths. None of the 10 children received radiotherapy or chemotherapy during the follow-up period.

Invasive fibromatosis of the scalp in children is clinically rare, with local infiltrative growth and frequent destruction of the skull. The diagnosis is mainly based on postoperative pathological examination, and surgical resection is the main treatment method. The disease has a tendency to recur, but the prognosis seems good.

To evaluate the therapeutic effect of biparietal cranial suture expansion and cranioplasty (BCSEC) in the treatment of pediatric sagittal synostosis.

The clinical data of 83 children with sagittal craniosynostosis who were treated with BCSEC in the Department of Neurosurgery of Kunming Children′s Hospital, Kunming Medical University from December 2016 to August 2021 were retrospectively analyzed. Three-dimensional CT examination of the head was performed before and after the operation, and the cephalic index (CI) before and after the operation, as well as the postoperative cranial vault asymmetry index (CVAI; CVAI<3.5 at the third month after surgery was considered symmetrical for the reconstruction of the cranial vault) were calculated based on this. The treatment effect was evaluated based on the appearance of the head and face before and after surgery.

All 83 patients successfully underwent the operation. Among them, 5 cases (6.0%) had intraoperative dural injury, and no cerebrospinal fluid leakage occurred after repair; 62 cases (74.7%) received blood transfusion during the operation, and the blood transfusion volume was 0.5±0.2 U; 59 cases (71.1%) underwent placement of a drainage tube in the surgical area. None of the children suffered from neurological damage caused by cranial osteotomy and secondary damage caused by free bone fragments. The postoperative follow-up time of 83 children was 13.0±1.4 months (6-28 months). Postoperative imaging and craniofacial appearance evaluation showed that the improvement rate of skull morphology was 100%. The CIs M (range) on the 3rd day and 3 months after operation were 0.73(0.68-0.85) and 0.84(0.70-0.92) respectively, which were significantly different compared with that before operation [0.67(0.59-0.81) ](P<0.01). The CVAI at 3 months after operation was 0.20±0.04. Two cases (2.4%) underwent reoperation after the osteotomy area was covered by regenerated skull and healed within 2 months after operation. No significant cranial malunion occurred in the children up to the last follow-up.

BCSEC for the treatment of premature sagittal suture closure in children has a low incidence of surgical complications. The skull shape can be corrected in a short time, and the rate of reoperation is low.

To preliminarily investigate the role of presurgical design based on 3D printed skull model in surgery of non-syndromic craniosynostosis.

The clinical data of 7 children with nonsyndromic craniosynostosis who underwent surgical treatment in the Department of Neurosurgery of Northwestern Women′s and Children′s Hospital from June 2020 to September 2021 were retrospectively analyzed. The age of the children was 4 to 12 months, and the skull shape was obviously deformed, and all were diagnosed by head CT. Among them, there were 1 case of premature closure of the frontal suture, 2 cases of unilateral premature closure of the coronal suture, and 2 cases of unilateral premature closure of the lambdoidal suture, and 2 cases of premature closure of the sagittal suture. A 1 ∶1 3D printed skull model was made preoperatively, surgical planning, simulation and correction were performed based on the model, and a metal guide across the surgical skull area was made as an intraoperative guidance tool. In this series, 6 cases underwent cranial suture reconstruction and skull reconstruction, and 1 case only underwent cranial suture reconstruction. Standard cephalometric measurements were used to measure the most obvious level of deformity on axial CT of each child′s head, and the skull contour diameter distance (SDD) in 19 dimensions in the range of 0° to 180° (interval of 10°) was obtained. The changes of SDD at the same level of head CT between preoperative and postoperative conditions were analyzed, and the degree of postoperative cranial cavity expansion and appearance change were evaluated.

Pos-toperative CT three-dimensional reconstruction of 7 children showed that the head deformities were well corrected and completely matched with the preoperative design of skull reconstruction. There was a statistically significant difference in the SDD between the left and right sides of the children before operation (P=0.017); there was no significant difference in the SDD between the left and right sides after operation (P=0.317), and the left and right cranial symmetry was significantly improved. The SDD of the whole skull (left + right) was significantly increased compared with preoperative (5.541±1.104 cm vs. 5.342±1.180 cm), and the difference was statistically significant (P=0.009). The follow-up time of 7 children was 1 to 15 months. The three-dimensional reconstruction of head CT at the last follow-up showed that the skull shape was stable and symmetrical. The parents′ satisfaction score was 7 points in 2 cases and 9 points in 5 cases.

The preoperative planning based on the 3D printed model of the skull and the production of metal guides across the cranial surface osteotomy area help to achieve accurate matching of intraoperative operations and preoperative design, and the skull deformity can be well corrected after surgery.

To explore the surgical method, effectiveness and prognosis of surgical treatment of ruptured intracranial arachnoid cysts (IACs) in children.

The clinical and imaging data of 8 children with ruptured IACs who underwent surgical treatment in the Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from June 2012 to September 2019 were retrospectively analyzed. The male/female ratio was 7/1 and the age ranged from 5.5 to 18.0 years. All arachnoid cysts in the series were located in the middle cranial fossa (left side: 5 cases, right side: 3 cases). The cysts in five patients were classified as Galassi Ⅲ with an average diameter of 6.2 cm, and three patients had Galassi Ⅱ cysts with an average diameter of 3.9 cm. All patients had symptoms of intracranial hypertension before surgery. Subdural drilling and drainage were performed in 4 cases, and craniotomy and cystectomy was performed in 4 cases. The outcomes of the patients were documented.

All 8 patients underwent smooth operations. Among the children, one receiving burr hole drainage and one receiving craniotomy and cystectomy underwent emergency hematoma evacuation due to postoperative acute epidural hematoma, and none of the children had newly-developed neurological deficit after operation. The mean follow-up time of the 8 patients after operation was 53 months (22-110 months). The clinical symptoms were significantly relieved, and there were no positive findings in the nervous system examination, and the children could live and study normally. Imaging follow-up showed that the cysts of 4 children were significantly reduced compared with those before operation (reduced by 60%-90%), and the cysts of 4 cases had no significant changes compared with those before operation (2 cases in the drilling and drainage group and 2 cases in the group of craniotomy and cystectomy). None of the children needed to undergo shunt surgery again during follow-up.

Individualized surgical treatment of children with ruptured IACs is generally safe and has a good prognosis.

To investigate the clinical effect of flexible neuroendoscopy-assisted drilling irrigation and external drainage in the treatment of subdural effusion complicated with purulent meningitis in infants.

A retrospective analysis was conducted on the clinical data of 40 infants with purulent meningitis complicated with subdural effusion who were admitted to the Department of Neurosurgery, Children′s Hospital of Chongqing Medical University from January 2016 to December 2020. According to the different treatment methods, 40 children were divided into an endoscopy group (treated by burr hole irrigation and external drainage assisted by flexible neuroendoscopy, 20 cases) and a control group (treated by skull burr hole drainage, 20 cases). The general data, clinical manifestations, treatment-related indicators and complications of the two groups were compared.

There was no significant difference between the endoscopy group and the control group in gender, age, course of disease, clinical manifestations, location of effusion, or preoperative cerebrospinal fluid-related indicators (all P>0.05). The improvement time of symptoms and cerebrospinal fluid indicator (the white blood cell count in the cerebrospinal fluid returning to the normal range) in the endoscopy group were earlier than those in the control group (postoperative symptom improvement time: 4.4±2.3 d vs. 8.7±3.0 d; cerebrospinal fluid indicator improvement time: 6.3±3.5 d vs. 13.2±5.2 d). Postoperative anti-infective treatment time [M (Q_1,Q₃)] in the endoscopy group was shorter than that in the control group[11.5 (8.3, 14.0) d vs. 19.0 (14.0, 27.3) d]. All the differences above were statistically significant (P<0.001). In terms of postoperative complications, there were 5 cases (25%) of secondary subarachnoid hemorrhage and cerebral contusion in the control group, and 0 cases (0%) in the endoscopy group.

For purulent meningitis complicated with subdural effusion, infants treated with flexible neuroendoscopy-assisted burr hole irrigation and external drainage can achieve better clinical outcomes compared with skull burr hole drainage.

To investigate the clinical effect of tranexamic acid combined with stepwise pressure regulation of ventriculoperitoneal shunt valve in the treatment of chronic subdural hematoma (CSDH) after ventriculoperitoneal (VP) shunt in children with hydrocephalus.

Retro-spectively analyze the clinical data of 17 children with CSDH post VP shunt for hydrocephalus who were treated with tranexamic acid combined with stepwise pressure regulation of VP shunt valve in the Department of Neurosurgery of the Affiliated Hospital of Southwest Medical University from January 2018 to June 2021. Tranexamic acid daily therapeutic dose (mg) = 750×0.05 × (age + 2). During the same period, all children were tested for the initial pressure of the shunt regulator valve, and the pressure was increased according to the symptoms of the child and the condition of intracranial hematoma. The cranial CT and pressure regulation were reviewed monthly after 3, 7, 14 days and thereafter. Treatment was discontinued when the child′s symptoms improved and the CSDH was mostly absorbed (hematoma volume ≤5 ml), and outpatient follow-up lasted for >6 months which included weekly telephone follow-up and monthly head CT and monthly assessment of neurological function using Markwalder grade. The therapeutic effect was divided into effective and ineffective. Head CT or MRI scan showing hematoma resorption or/and clinical symptom relief was defined as effective. Unchanged or even increase of hematoma amount and/or worsening of clinical symptoms at 1 month post treatment, discontinuation of conservative treatment due to adverse drug effect, or loss to follow-up was defined as ineffective.

Among the 17 children, 1 was lost to follow-up, and 16 completed the follow-up. The follow-up time was 10.1±2.4 months (8-12 months). At the last follow-up, 12 cases were effective and 5 cases were ineffective. The number of times of pressure regulation in the 12 cases of children who received effective treatment during the treatment was 2.1±0.6 times (1-3 times), and the median increase of pressure was 3.0 (2.0-4.5) cm H₂O (1 cm H₂O=0.098 kPa). Headache (10 cases) and weakness of muscle strength (5 cases) were relieved after 2-8 weeks of treatment. All hematomas of 12 children were absorbed after 6 months of treatment. No recurrence was found in the last follow-up, and the Markwalder classification result was grade 0. Among the 5 ineffective children, 1 was lost to follow-up; the treatment procedure was switched to hematoma evacuation in 3; medication was discontinued in 1 due to the patient′s difficulty in taking medication, and the volume of hematoma remained unchanged during the 6-month outpatient follow-up.

Preliminary observation has shown that the use of tranexamic acid combined with stepwise pressure regulation of VP shunt valve in the treatment of CSDH in hydrocephalus children post VP shunt could relieve the symptoms and is associated with good safety and efficacy.

To investigate the application value of propofol provocation test (PT) in endovascular treatment of motor and sensory cortical arteriovenous malformations (AVMs).

A retrospective analysis was conducted on the clinical data of 102 patients with motor or sensory cortical AVMs who underwent transarterial embolization in the Neurovascular Center, the First Affiliated Hospital of Naval Medical University from February 2016 to July 2021. All patients underwent propofol PT before embolization. If the PT was positive, further superselection at the distal end of the feeding artery or replacement of the feeding artery was performed until the PT was negative, and then the embolization was performed. The efficacy and procedure-related ischemic complications were observed retrospectively.

A total of 148 embolizations were performed in 102 patients, and a total of 226 PTs were performed. The median number of PTs per patient was 2 (1-5). Among the 226 PTs, 11 PTs(4.9%) were initially positive, and PT was performed again after the microcatheter was further advanced for superselection or the feeding artery was replaced, all of which were negative. Among the 148 procedures, 7 (4.7%) were complicated with procedure-related ischemic events immediately after surgery or within 72 hours after surgery. Immediate angiography of 102 patients after the last operation showed that 36 patients (35.3%) had complete embolization, 19(18.6%) had subtotal embolization, and 47 (46.1%) had partial embolization. The median clinical follow-up time of all patients was 13 months (1-39 months). At the last follow-up, 2 cases were left with permanent neurological deficits (1 case of grade Ⅲ and 1 case of grade Ⅳ in muscle strength). Among 67 patients who completed DSA follow-up for median 6 months(3 - 39 months), complete obliteration of AVMs were showed in 29 patients, while 1 had recurrence, 2 had progressed.

Propofol PT can guide endovascular treatment of AVMs in the functional areas in improving the safety and effectiveness of transarterial embolization.

To investigate the effectiveness of high-flow intracranial and extracranial vascular bypass in the surgery for middle cranial fossa tumors.

A retrospective analysis was conducted on the clinical data of 5 patients with middle cranial fossa tumors treated by tumor resection combined with high-flow external carotid artery-middle cerebral artery bypass from January 2014 to January 2020 in the Department of Neurosurgery of Tianjin Medical University General Hospital. Among them, 2 cases were primary tumors and 3 cases were recurrent tumors. The bridging vessel was the great saphenous vein in 2 cases and the radial artery in 3 cases. Postoperatively, the degree of tumor resection was evaluated according to the enhanced brain MRI scan, and no tumor enhancement in the surgical area was considered as total tumor resection. Imaging and telephone follow-up was performed 3 months after surgery and annually thereafter. Imaging follow-up included head MRI, digital subtraction angiography (DSA), or CT angiography (CTA). Telephone follow-up was conducted for assessment of Karnofsky performance status score (KPS) and related neurological functions.

All 5 patients underwent successful intracranial and extracranial revascularization of the anterior circulation. Total resection of the tumor on imaging was achieved in all 5 cases. Pathological results showed meningiomas in 4 cases and isolated fibrous tumors in 1 case. Postoperative review of cranial CTA results in all 5 patients suggested patency of the bridging vessels. Two patients with primary tumors developed postoperative damage of cranial nerve Ⅱ, Ⅲ, Ⅳ, and Ⅵ on the affected side and 1 had dysfunction of cranial nerve V; One of the 3 patients with recurrent tumors had blindness in the affected eye. The median postoperative follow-up period was 3 years (1-5 years) for all 5 patients. Neurological deficits in the cavernous sinus improved in 4 patients during follow-up. Five patients had KPS scores of 60-70 at 1 month postoperatively and 80-90 at 12 months postoperatively. By the final follow-up, none of the 5 patients showed tumor progression or recurrence; the results of repeat cranial CTA or DSA indicated patency of the bridging vessels and no significant vascular stenosis.

Preliminary observations have revealed that the use of high-flow external carotid artery-middle cerebral artery bypass followed by tumor resection for the treatment of complex middle cranial fossa tumors could result in high rates of total tumor resection and bridging vessel patency, low rates of severe ischemic stroke events, and good overall clinical outcomes.

To investigate the safety and efficacy of LEO Baby stent in the treatment of acute intracranial wide-neck ruptured aneurysms.

A retrospective analysis was conducted on the clinical data of 15 patients with acute intracranial wide-neck ruptured aneurysms treated with LEO Baby stent in the Neurosurgery Department of Tangshan Gongren Hospital of Hebei Medical University from December 2018 to December 2021. All patients underwent LEO Baby stent-assisted coil embolization. Digital subtraction angiography (DSA) was performed immediately during the operation and at the follow-up, and the embolization of the aneurysm was assessed by Raymond grading system. Postoperative complications were observed in patients to assess the safety of the treatment. Follow-up by DSA or CT angiography (CTA) was performed 6 months after operation to evaluate whether the aneurysm recurred, whether the blood flow in the stent was unobstructed, and whether the distal blood vessels were missing. Postoperative neurological recovery was evaluated using the modified Rankin scale (mRS).

The LEO Baby stents of the 15 patients were all opened well, and they were all successfully released after satisfactory placement. Immediate postoperative DSA showed that all 15 aneurysms were completely embolized (Raymond grade I). A total of 4 patients developed postoperative complications, all of which were thromboembolic complications. The follow-up time of 15 patients was 8.3±2.7 months (5-12 months). A total of 11 patients were followed up by imaging at 6 months after surgery, of which 6 patients were followed up by DSA and 5 patients were followed up by CTA. Aneurysm recurrence was not identified. Clinical follow-up at 1 month post operation showed that 14 patients had good outcomes (mRS ≤ 2), and 1 patient had poor outcome (mRS = 5).

The LEO Baby stent has a high success rate of embolization of intracranial wide-neck ruptured aneurysms in the acute stage. However, the thrombosis rate in the perioperative period seems relatively high, with certain risks.

To observe the clinical efficacy of surgical clipping of aneurysm in the ophthalmic artery segment of internal carotid artery (ICA) via Dolenc approach.

A retrospective analysis was conducted on the clinical data of 32 patients (38 aneurysms) with ICA ophthalmic artery segment aneurysms surgically treated at the Department of Neurosurgery, the Affiliated Brain Hospital of Nanjing Medical University from June 2017 to January 2020.Among them, 24 patients had unruptured aneurysms, and 8 had ruptured aneurysms (5 cases of Hunt-Hess gradeⅠ, 1 case of grade Ⅱ, 1 case of grade Ⅲ, and 1 case of grade Ⅳ). All patients were treated with trans-Dolenc approach to clip the ophthalmic artery segment aneurysms using different surgical strategies depending on the types of aneurysms. The patients were observed for surgery-related complications and followed up for clinical outcomes.

All 32 patients successfully underwent the aneurysm clipping. Intraoperative fluoroscopy confirmed that the aneurysm was not visualized, and the parent artery and perforating vessels were unobstructed. A cranial contrast examination 1 week postoperatively confirmed that the aneurysm was completely clipped and there was no stenosis of parent artery. Five patients (15.6%) developed surgery-related complications. Among them, there were 1 case of intraoperative venous hemorrhage, 2 cases of ipsilateral vision loss after surgery out of which 1 case did not recover and 1 recovered, and 2 cases of oculomotor nerve palsy which recovered well after 3 months. The clinical follow-up period of 32 patients was 19.6±6.4 months (3 to 32 months), and none of the patients had the need for cerebrospinal fluid shunting surgery due to hydrocephalus. At the last follow-up based on Glasgow outcome scale, there were 29 cases of grade Ⅴ, 2 cases of grade Ⅳ, and 1 case of grade Ⅲ. Angiography of 31 patients (96.9%) performed at 12 months after surgery showed that none of the aneurysms had recurred.

Surgical clipping of aneurysm in the ophthalmic artery segment of ICA via the Dolenc approach is associated with few complications and definite efficacy.

To evaluate the safety and accuracy of stereotaxic biopsy of intracranial lesions using the new CR neurosurgical robot system.

A retrospective analysis was conducted on the clinical data of 60 patients who underwent intracranial lesion biopsy in the Neurosurgery Department of Aerospace Central Hospital from October 2018 to June 2020. Three-dimensional, T1-weighted magnetization-prepared gradient-echo imaging was performed 1 to 2 days before surgery. Spiral CT thin-slice scanning was performed on the day of surgery. CT and MRI data were imported into the new CR neurosurgery robot operation planning system, CT-MRI fusion and positioning were performed, the coordinates of the puncture target were calculated, and an individualized puncture trajectory was designed according to the location of the lesion and neuroimaging characteristics, which was followed by tissue biopsy. The accuracy of target localization was evaluated postoperatively, and postoperative complications were documented.

All 60 patients underwent successful frameless stereotaxic biopsy. Postoperative pathological results were as follows: 25 cases of diffuse astrocytic and oligodendroglial tumor, 1 case of neuronal and mixed neuronal-glial tumors, 16 cases of lymphoma, 4 cases of metastatic tumor, 2 cases of inflammatory granuloma, 1 case of haemangioma, 6 case of inflammatory demyelination, 1 case of acute lymphoblastic leukemia with intracranial infiltration, 1 case of seminoma, 1 case of primitive neuroectodermal tumor, 1 case of Langerhans cell histiocytosis and 1 case of the central nervous system vasculitis. The positive rate of diagnosis was 100% (60/60). The results of postoperative target accuracy evaluation showed that the target error of 60 patients was 1.36±0.42 mm(0.55-1.99 mm). Postoperative puncture-related bleeding occurred in 2 cases, which improved after treatment; 1 patient who received brainstem biopsy developed unilateral facial palsy after operation, which improved after conservative treatment.

The new CR brain surgery robot can carry out surgical planning according to the shape of intracranial lesions. It has the advantages of less trauma, high positioning accuracy, flexible and simple operation, etc. It is suitable for biopsy of intracranial lesions at multiple sites.

To investigate the transcriptome characteristics and clinical significance of molecular classes of gliomas based on Chinese cohorts.

The clinical information and transcriptome sequencing data of 932 patients with gliomas were retrospectively analyzed in the Chinese Glioma Genome Atlas (CGGA) daatabase. The patients were divided into isocitrate dehydrogenase (IDH, include IDH1 and IDH2) mutation with chromosomal 1p/19q co-deletion (Mut_Co) type (182 cases), IDH mutation with chromosomal 1p/19q co-deletion (Mut_nCo) type (315 cases) and IDH wild (WT) type (435 cases). The age of diagnosis, gender, histopathological type, TCGA (The Cancer Genome Atlas) subtype, CpG island methylation phenotype (G-CIMP) and tumor purity were compared among patients with three molecular classes of gliomas. We explored the transcriptome characteristics of three molecular types of gliomas, the biological pathways involved and their differences in cancer marker scores. A total of 885 patients with transcriptomic data and complete follow-up data were included for survival analysis and Kaplan-Meier curves were drawn to compare the difference in median survival of patients with three molecular classes of gliomas.

Compared with Mut_Co and Mut_nCo, the proportion of WT patients with diagnosis age ≥43 years, WHO grade Ⅳ, glioblastoma, TCGA classical type and G-CIMP type was higher, and the tumor purity was the lowest, the differences were statistically significant (all P<0.001). Compared with Mut_Co and Mut_nCo, the intra- and local- invasion scores of WT glioma were higher, and the proportion of cell cycle in DNA synthesis phase (S phase) was higher, with statistical significance (all P<0.001). In WT type, the transcription factor PAX3 was highly expressed and the p53 signaling pathway was lowly expressed. Pathway functional enrichment analysis of Kyoto Encyclopedia of Genes and Genomes (KEGG) showed that Mut_Co and Mut_nCo types were widely involved in the interaction of ligand receptors stimulating neural tissue and long-term depression, which were also widely involved in Hedgehog protein signal, WNTβ CATENIN signal and other cancer markers; WT type was mainly involved in p53 signaling pathway, adhesion plaque, apoptosis and other biological pathways and cancer hallmarkers. The log-rank test showed that the median survival time of Mut_Co patients was the longest (most of them survived), followed by Mut_nCo (1 258 d), and WT with the shortest survival time (415 d), and the difference was statistically significant (P<0.001).

The three molecularly classified gliomas based on the Chinese cohorts are associated with different clinical features, different prognosis of patients, specific transcriptomic features, and involve specific biological pathways and cancer hallmarkers.