ObjectiveTo analyze the electro-clinical characteristics and surgical outcome of low-grade developmental tumors in temporal lobe. MethodsThe onset age, seizure duration, seizure types, electroencephalogram and surgical outcome of 49 patients with low-grade developmental tumor of temporal lobe were analyzed retrospectively. ResultsTwo groups of the seizure types were divided. The first group was spasm, the other was focal onset. There were 12 cases in spasm group, with an average onset age of (1.00±0.59) years. The discharge was extensive and multi-brain-area locaded, especially in the temporal montages and the ipsilateral posterior montages. There were 37 cases in second group, with an average onset age of (8.90±8.84) years, mainly including autonomic seizure, tonic seizure and automotor seizure. In this group, the discharge was mainly recorded in the temporal montages, which could spread to the frontal montages and less locaded in posterior montages. The difference of onset age between the two groups was statistically significant (P<0.01). The average follow-up of spasm group was (2.80±1.57) years, and the surgical outcome of all patients in this group were all Engel I (100.00%, 12/12). The focal onset group was followed up for an average of (6.50±4.78) years, and the rate of Engel I was 91.80% (34/37). There was no significant difference between the two groups (P>0.05). ConclusionsFor low-grade developmental tumors in temporal lobe, there are two seizure types, including spasm and focal onset. The onset age of spasm is earlier, while patients with focal onset mostly start at childhood or older, rare in infancy. Surgery has a good effect on the treatment of temporal lobe developmental tumor epilepsy.
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.
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.
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.
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.
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.
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.
Focus on the inconsistency of the shape, location and size of brain glioma, a dual-channel 3-dimensional (3D) densely connected network is proposed to automatically segment brain glioma tumor on magnetic resonance images. Our method is based on a 3D convolutional neural network frame, and two convolution kernel sizes are adopted in each channel to extract multi-scale features in different scales of receptive fields. Then we construct two densely connected blocks in each pathway for feature learning and transmission. Finally, the concatenation of two pathway features was sent to classification layer to classify central region voxels to segment brain tumor automatically. We train and test our model on open brain tumor segmentation challenge dataset, and we also compared our results with other models. Experimental results show that our algorithm can segment different tumor lesions more accurately. It has important application value in the clinical diagnosis and treatment of brain tumor diseases.
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’.