ObjectiveTo systematically review the value of intra-operative ultrasound in diagnosis of tumor residue after resection of intracranial gliomas. MethodsSuch databases as PubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP were electronically searched for the diagnostic test about intra-operative ultrasound in diagnosis of tumor residue after resection of intracranial gliomas by March 31st, 2013. Meanwhile, search engines such as Google, Baidu were also used for relevant search. According to the inclusion and exclusion criteria, the literature was screened and the data were extracted. The methodological quality was evaluated in accordance with the quality assessment tool for diagnostic accuracy studies (QUADAS) and then meta-analysis was conducted using Meta-DiSc 1.4 software. ResultsA total of 10 studies involving 423 patients were included. The results of meta-analysis showed that the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio (DOR) were 0.78 (95%CI 0.74 to 0.82), 0.90 (95%CI 0.88 to 0.90), 5.12 (95%CI 2.86 to 9.16), 0.29 (95%CI 0.21 to 0.39) and 25.00 95%CI (13.27 to 47.10), respectively; and the AUC was 0.89. In the subgroup analysis, for low grade intracranial gliomas, the results of meta-analysis showed that the sensitivity, specificity and DOR were 0.87 (95%CI 0.77 to 0.94), 0.88 (95%CI 0.78 to 0.94) and 28.93 (95%CI 7.46 to 112.14), respectively, and the AUC was 0.92. For high grade gliomas, the results of meta-analysis showed that the sensitivity, specificity and DOR were 0.80 (95%CI 0.72 to 0.87), 0.67 (95%CI 0.53 to 0.79) and 7.20 (95%CI 3.04 to 17.09), respectively, and the AUC was 0.80. ConclusionIntra-operative ultrasound is useful for the diagnosis of tumor residue after resection of intracranial gliomas, especially for low grade gliomas.
【摘要】 目的 探讨高级别胶质瘤患者放射、化学治疗后假性进展的临床特点、诊断与处理。 方法 分析2008年6月-2009年6月接受综合治疗的31例高级别胶质瘤患者临床资料，对假性进展的患者进行回顾分析，按照实体瘤疗效评判标准应用磁共振进行疗效评价。 结果 31例术后病理诊断为高级别胶质瘤的患者，替莫唑胺（TMZ）同期放射、化学治疗后维持TMZ辅助化学疗法，放射治疗后早期发生假性进展4例（14%)。 结论 对于TMZ同期放射、化学治疗后早期出现的影像学疑似进展，不要急于下结论，了解假性进展的临床特点，结合功能影像学检查可能会有助于临床医生的判断与处理。【Abstract】 Objective To discuss the clinical feature, diagnosis, and management of pseudoprogression after radiochemotherapy of high-grade glioma patients. Methods The clinical data of 31 high-grade glioma patients who underwent postoperative radiochemotherapy from June 2008 to June 2009 were reviewed. Pseudoprogression cases were analyzed. The treatment response was assessed through magnetic resonance imaging (MRI) according to the established response evaluation criteria in solid tumors. Results All the 31 high grade gioma patients received postoperative fractioned radiotherapy with concomitant TMZ chemotherapy, followed by TMZ maintenance chemotherapy. Four cases of pseudoprogression occurred after radiotherapy (14%). Conclusion Doctors should be careful in making early diagnosis for the suspected early progression after TMZ concomitant radiochemotherapy. It would be helpful for management to combine the clinical features of pseudoprogression with functional imaging technology.
ObjectiveTo summarize the surgical experiences of low-grade glioma on functional areas. MethodsFifty-four patients with low-grade glioma on functional areas were treated in our department from December 2009 to December 2012. We retrospectively analyzed their clinical data. ResultsThirty-six cases were located preoperatively by diffusion tensor imaging, 13 patients underwent intraoperative B ultrasound tumor localization, and 5 underwent intraoperative wake-up anesthesia. Total resection of tumors was performed on 42 patients, subtotal resection on 10, and partial resection on 2, and no patient died during the operation. The follow-up ranged from 6 to 24 months averaging 12. There was no significant difference in Karnofsky performance scale before and after surgery (P>0.05). ConclusionThe comprehensive application of various localization methods can protect function to the best advantage and resect tumor to the largest degree, and thus improves patients' quality of life.
ObjectiveTo investigate the molecular mechanism by which metastasis-associated protein 3 (MTA3) participates in glioma resistance through reactive oxygen species. Methods Protein expression in glioma stem cells (GSCs) and non-GSCs was detected using Western blotting. GSCs included U87 and SHG44 cells, while non-GSCs included U87s and SU-2 cells. After overexpressing MTA3, U87 and SHG44 cells were divided into Lv-scr and Lv-MTA3 groups. The self-renewal capacity of glioma cells was assessed through a neurosphere formation assay. Cell survival fractions were examined following exposure to 0, 2, 4, 6, 8, and 10 Gy X-ray irradiation under normoxic or hypoxic conditions. Apoptosis and reactive oxygen species expression were analyzed using flow cytometry. Immunofluorescence staining was performed to detect the stem cell markers CD133 and nestin, as well as the differentiation markers glial fibrillary acidic protein (GFAP, for astrocytes) and neuronal class Ⅲ β-tubulin. Results In GSCs, MTA3 expression was lower in the U87s and SU-2 groups. After MTA3 overexpression, Lv-MTA3 expression was higher in U87s and SU-2 compared to the Lv-scr group. Under normoxic or hypoxic conditions, U87 and SU-2 showed greater radioresistance compared to glioma cell lines U87 and SHG44. Compared to non-GSCs, basal reactive oxygen species formation was reduced in GSCs, while reactive oxygen species generation was increased in non-GSCs. Following exposure to different doses of X-rays under normoxic or hypoxic conditions, GSCs with MTA3 overexpression exhibited greater radiosensitivity than those with stable integration. Additionally, MTA3 overexpression slightly increased the oxygen enhancement ratio (OER) in GSCs. MTA3 overexpression reduced the immunoreactivity of CD133 and nestin in both stem cell lines, and increased immunofluorescence staining of GFAP and neuronal class Ⅲ β-tubulin, with statistically significant differences (P<0.05). Conclusions MTA3 is downregulated in GSCs. Overexpression of MTA3 reduces the radioresistance and stemness of GSCs both in vitro and in vivo. MTA3 plays a crucial role in regulating the radiosensitivity and stemness of GSCs through reactive oxygen species.
Objective To summarize the latest developments in neurosurgical treatments for neurofibromatosis type 1 (NF1) and explore therapeutic strategies to provide comprehensive treatment guidelines for clinicians. Methods The recent domestic and international literature and clinical cases in the field of NF1 were reviewed. The main types of neurological complications associated with NF1 and their treatments were thorough summarized and the future research directions in neurosurgery was analyzed. Results NF1 frequently results in complex and diverse lesions in the central and peripheral nervous systems, particularly low-grade gliomas in the brain and spinal canal and paraspinal neurofibromas. Treatment decisions should be made by a multidisciplinary team. Symptomatic plexiform neurofibromas and tumors with malignant imaging evidence require neurosurgical intervention. The goals of surgery include reducing tumor size, alleviating pain, and improving appearance. Postoperative functional rehabilitation exercises, long-term multidisciplinary follow-up, and psychosocial interventions are crucial for improving the quality of life for patients. Advanced imaging guidance systems and artificial intelligence technologies can help increase tumor resection rates and reduce recurrence. Conclusion Neurosurgical intervention is the primary treatment for symptomatic plexiform neurofibromas and malignant peripheral nerve sheath tumors when medical treatment is ineffective and the lesions progress rapidly. Preoperative multidisciplinary assessment, intraoperative electrophysiological monitoring, and advanced surgical assistance devices significantly enhance surgical efficacy and safety. Future research should continue to explore new surgical techniques and improve postoperative management strategies to achieve more precise and personalized treatment for NF1 patients.
Optic nerve glioma (ONG) is a rare central nervous system tumor that occurs in children and adolescents. It’s main pathological type is low-grade pilocytic astrocytoma. It is divided into sporadic ONG and neurofibromatosis type 1 (NF-1) related ONG. Due to the close relationship between ONG and the optic nerve, there is its particularity in diagnosis and treatment. The diagnosis of ONG mainly relies on medical history, symptoms and signs, as well as imaging examinations such as MRI and CT. ONG should be differentiated from optic nerve sheath meningioma, optic neuritis, optic nerve metastasis and other diseases. In recent years, newly discovered molecular targeted therapy and anti-vascular endothelial growth factor drugs are a powerful supplement to ONG. When chemotherapy is not sensitive or resistant, radiotherapy can be considered, but it is only recommended for patients over 7 years of age. Surgery can be considered when the patient’s visual impairment is severe and the appearance of the eye is significantly affected. In addition, due to the susceptibility of NF-1 patients to tumors, the chemotherapy regimen should take into account the risk of secondary leukemia caused by the drug, and the timing of radiotherapy should be after the age of 10. We look forward to further ONG clinical research, which will bring more references for future clinical work.