ObjectiveTo explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.ConclusionsTo the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.
ObjectiveTo evaluate the clinical features of the retroperitoneal paralangliomas. MethodClinical data of 34 patients with retroperitoneal paragangliomas who underwent surgery in our hospital between January 2005 and January 2015 were enrolled, all patients diagnosed by pathological examination. ResultsClinical manifestation: hypertension (n=4) and headache (n=1) were the main symptoms in all 5 patients with functional tumor. Abdominal distension (n=14) or abdominal pain (n=11) were the initial symptoms in patients with nonfunctional tumor, gastrointes-tinal obstruction was observed in 1 patient, the other 3 patients were diagnosed accidently among the 29 patients with nonfunctional tumors. Blood and urine catecholamines increased notly in 5 patients with functional tumor, increased mildly in 2 patients with nonfunctional tumor; and remained at a normal level in the other patients. All the 34 patients underwent surgery, 4 patients with nonfunctional tumors who suffered from vessel wrapped needed tumor resection combining with main vessel resection or reconstruction, 1 of the 4 patients presented with vascular wall invasion. Two patients presented with lymph-vascular invasion of patients didn't received vessel resection or reconstruction. The mean value of diameter of these tumors was (9.5±5.1) cm (3.5-18.5 cm). Twenty four tumors had complete capsule, the other 10 had partial capsule; 32 tumors were well differentiated, and other 2 patients had apparent strange nucleus. Among the 34 patients, G1 tumors were confirmed in 14 patients and G2 tumors were confirmed in 20 patients. All the 34 patients were followed up with a mean value of follow-up time of 52 months (1-105 months). During the follow-up period, 6 patients suffered from recurrence and 6 patients died. The 1-year and 5-year survival rates were 86.0% and 81.5%, respectively. ConclusionsRadical resection may be the only measure to cure retroperitoneal paragangliomas. Tumor combining with vascular resection or reconstruction provide a chance for patients with ‘unresectable tumors’.
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.
High-grade gliomas are the most common malignant primary central nervous system tumors with poor prognosis. The operation based on the principle of maximum safe resection of tumors, combined with radiation therapy and chemotherapy, is the primary treatment method. This treatment only delays the progression of high-grade gliomas, and almost all patients eventually develop disease progression or relapse. With the development of molecular biology, immunology, and genomics, people have a deeper understanding of the pathogenesis of gliomas. Targeted therapy, immunotherapy, and other comprehensive treatments are expected to become potential treatments for high-grade gliomas. This article reviews the current status of medical treatment of primary and recurrent high-grade gliomas, and the research progress of high-grade gliomas in targeted therapy and immunotherapy.
ObjectiveTo explore the clinical features and prognostic factors of diffuse brain stem glioma in children. MethodsA retrospective analysis was conducted on pediatric diffuse brain stem glioma diagnosed by pathology in West China Hospital of Sichuan University between January 2016 and May 2019. The demographic data, clinical manifestations, MRI findings, pathological results, and treatment were included in the prognosis study.ResultsA total of 39 cases of pediatric diffuse brain stem glioma confirmed by pathology were enrolled, including 21 males and 18 females aged between 3 and 14 years with an average of (8.1±2.8) years and mostly between 5 and 10 years (29 cases). The mean maximum diameter of gliomas was (4.46±0.81) cm. Among the 39 cases, there were 15 cases complicated with hydrocephalus and 16 cases whose tumors completely surrounded the basilar artery. The median survival time was 6 months. The one-year survival rate was 15.4%, and the two-year survival rate was 5.1%. Univariate analyses showed that the tumor enhancement and completely enclosed basilar artery had significant impact on the prognosis (P<0.05). Multiple Cox regression analysis showed that whether the basilar artery was completely wrapped was related to the prognosis [hazard ratio=4.596, 95% confidence interval (1.839, 11.488), P=0.001]. ConclusionsPediatric diffuse brain stem gliomas are common in children aged 5-10 years with poor prognosis. Whether the tumor completely surrounds the basilar artery is closely related to the short overall survival time.
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.
Glioma is one of the most common primary tumors in the human brain with poor prognosis. The local and systemic immunosuppressive environment created by glioma cells enables them to evade immunosurveillance. Myeloid-derived suppressor cells (MDSCs) are a critical component of the immunosuppression system. They are a heterogeneous cell population composed of early myeloid progenitor cells and precursor cells. Although the cells are diverse in phenotypes and functions, they all have strong immunosuppressive functions. MDSCs are extensively infiltrated into tumor tissues and play an important role in the glioma immunosuppressive microenvironment, which also hinders the immunotherapeutic effects of glioma. This article will review the phenotypic characteristics of MDSCs in the glioma microenvironment and their role in the progression of glioma. It is of positive significance to better understand the pathogenesis of glioma and explore effective comprehensive treatments.
Glioma is the most common malignant brain tumor and classification of low grade glioma (LGG) and high grade glioma (HGG) is an important reference of making decisions on patient treatment options and prognosis. This work is largely done manually by pathologist based on an examination of whole slide image (WSI), which is arduous and heavily dependent on doctors’ experience. In the World Health Organization (WHO) criteria, grade of glioma is closely related to hypercellularity, nuclear atypia and necrosis. Inspired by this, this paper designed and extracted cell density and atypia features to classify LGG and HGG. First, regions of interest (ROI) were located by analyzing cell density and global density features were extracted as well. Second, local density and atypia features were extracted in ROI. Third, balanced support vector machine (SVM) classifier was trained and tested using 10 selected features. The area under the curve (AUC) and accuracy (ACC) of 5-fold cross validation were 0.92 ± 0.01 and 0.82 ± 0.01 respectively. The results demonstrate that the proposed method of locating ROI is effective and the designed features of density and atypia can be used to predict glioma grade accurately, which can provide reliable basis for clinical diagnosis.
ObjectiveTo apply a multimodal preoperative evaluation system to guide the operation of patients with low-grade glioma with focal cortical dysplasia epilepsy.MethodsThe clinical data of 5 patients with glioma complicated with focal cortical dysplasia who underwent surgical treatment at the Second Hospital of Lanzhou University were collected. The perioperative evaluation was performed using a multimodal evaluation system—multidisciplinary discussion, multi-image combination and multi-method evaluation, so as to improve the total resection rate of epileptic foci and achieve the goal of complete remission. After a follow-up of more than 5 months, the Engel I was defined as a good prognosis and Engel II-IV was defined as a poor prognosis according to the Engel assessment method.ResultsThe postoperative examination of 5 patients showed 4 cases of ganglion cell glioma and 1 case of diffuse astrocytoma, the 5 cases were all found with focal cortical dysplasia. Two of the patients had a small amount of bleeding in the operation area and disappeared at the time of discharge. One lesion was located in the left occipital cortex, one in the upper frontal lobe, two in the temporal lobe and hippocampus, and one in the insula. Five cases of epileptic foci were followed up for 5~16 months without seizures, all graded as Engel I.ConclusionsMultimodal assessment system can improve the prognosis of patients with low-grade intracranial tumors with focal cortical dysplasia. In the development of surgical strategies for patients with epilepsy secondary to intracranial tumors, attention should not be paid only to the tumor itself, dysplasia may be associated with tumors, often the underlying cause of epilepsy.
Catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma (PPGL) is a potential fatal cardiovascular complication caused by excessive secretion of catecholamines by PPGL, leading to structural changes and functional abnormalities in the heart. According to the morphology and function of the heart, it is clinically divided into three types: dilated cardiomyopathy, Takotsubo cardiomyopathy, and hypertrophic cardiomyopathy. The treatment of catecholamine-induced cardiomyopathy in PPGL requires attention to drug selection, application of life support equipment, and perioperative management. Most patients with cardiac dysfunction can effectively improve after tumor resection. This article mainly reviews the diagnosis and treatment of catecholamine-induced cardiomyopathy in PPGL.