Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190203-00035
F. Yuan, Xiaoguang Fan, Zhen Yang, Tao Li, L. Yi, Yihan Yang, Hao-lang Ming, Bingcheng Ren, Sheng-ping Yu
Objective To investigate the molecular and clinical features of PDK1 (pyruvate dehydrogenase kinase 1) in gliomas based on the Cancer Genome Atlas (TCGA) by bioinformatics analysis. Methods The clinical data of 641 glioma patients in TCGA database were retrospectively analyzed. The online analysis website of GEPIA (http: //gepia.cancer-pku.cn/) was used to analyze PDK1 expression in glioma patients. Pearson correlation analysis was performed to create a gene list related to PDK1. The online analysis tool STRING was used to analyze the interaction network of the differential genes. According to the degree of confidence, the top key proteins were screened. The function of PDK1-related differential genes and its relationship with the kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were explored by gene ontology (GO) analysis. According to PDK1 protein expression, all patients were divided into PDK1 protein low expression group (380 cases) and PDK1 protein high expression group (261 cases). Kaplan-Meier survival curves were used to compare the survival differences between the two groups of patients. Univariate and multivariate Cox regression analysis were used to determine the effect of PDK1 protein expression on the prognosis of patients with glioma. Results The expression of PDK1 protein in 641 glioma patients in TCGA database showed that the expression level in the World Health Organization(WHO) Ⅳ glioma (8.86±0.90) was higher than that in grade Ⅱ (7.24±0.60) and grade Ⅲ (7.34±0.80)(P 0.05). The cumulative survival rate of glioma patients in the PDK1 high-expression group was significantly lower than that in the PDK1 low-expression group (P<0.05). Pearson correlation test analysis revealed that 96 genes were closely related to PDK1 expression, of which 69 were positively correlated and 27 were negatively correlated. GO analysis and KEGG pathway analysis showed that PDK1 participated in many important biological processes, which were closely related to the hypoxia microenvironment, reaction to organic cyclic compounds, reaction to organic nitrogen compounds, response to cAMP and the HIF-1 signaling pathway. Multivariate analysis showed that age (HR=1.579, 95% CI: 1.085-2.299, P=0.017), WHO grade (HR=12.106, 95% CI: 6.521-22.474, P<0.001) and radiotherapy (HR=0.502, 95% CI: 0.325-0.775, P=0.002) were independent influencing factors for the survival of glioma patients (all P <0.05) and could be used independently to explore the prognosis of patients.However, PDK1 protein expression does not affect the prognosis of glioma patients. Conclusion PDK1 expression is different in glioma patients with different WHO pathological levels, and mainly related to hypoxia and HIF-1 signaling pathway. Key words: Glioma; Prognosis; The cancer genome atlas; Pyruvate dehydrogenase kinase 1
{"title":"Expression and clinical significant of pyruvate dehydrogenase kinase 1 in gliomas based on the Cancer Genome Atlas by bioinformatics analysis","authors":"F. Yuan, Xiaoguang Fan, Zhen Yang, Tao Li, L. Yi, Yihan Yang, Hao-lang Ming, Bingcheng Ren, Sheng-ping Yu","doi":"10.3760/CMA.J.CN112050-20190203-00035","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190203-00035","url":null,"abstract":"Objective \u0000To investigate the molecular and clinical features of PDK1 (pyruvate dehydrogenase kinase 1) in gliomas based on the Cancer Genome Atlas (TCGA) by bioinformatics analysis. \u0000 \u0000 \u0000Methods \u0000The clinical data of 641 glioma patients in TCGA database were retrospectively analyzed. The online analysis website of GEPIA (http: //gepia.cancer-pku.cn/) was used to analyze PDK1 expression in glioma patients. Pearson correlation analysis was performed to create a gene list related to PDK1. The online analysis tool STRING was used to analyze the interaction network of the differential genes. According to the degree of confidence, the top key proteins were screened. The function of PDK1-related differential genes and its relationship with the kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were explored by gene ontology (GO) analysis. According to PDK1 protein expression, all patients were divided into PDK1 protein low expression group (380 cases) and PDK1 protein high expression group (261 cases). Kaplan-Meier survival curves were used to compare the survival differences between the two groups of patients. Univariate and multivariate Cox regression analysis were used to determine the effect of PDK1 protein expression on the prognosis of patients with glioma. \u0000 \u0000 \u0000Results \u0000The expression of PDK1 protein in 641 glioma patients in TCGA database showed that the expression level in the World Health Organization(WHO) Ⅳ glioma (8.86±0.90) was higher than that in grade Ⅱ (7.24±0.60) and grade Ⅲ (7.34±0.80)(P 0.05). The cumulative survival rate of glioma patients in the PDK1 high-expression group was significantly lower than that in the PDK1 low-expression group (P<0.05). Pearson correlation test analysis revealed that 96 genes were closely related to PDK1 expression, of which 69 were positively correlated and 27 were negatively correlated. GO analysis and KEGG pathway analysis showed that PDK1 participated in many important biological processes, which were closely related to the hypoxia microenvironment, reaction to organic cyclic compounds, reaction to organic nitrogen compounds, response to cAMP and the HIF-1 signaling pathway. Multivariate analysis showed that age (HR=1.579, 95% CI: 1.085-2.299, P=0.017), WHO grade (HR=12.106, 95% CI: 6.521-22.474, P<0.001) and radiotherapy (HR=0.502, 95% CI: 0.325-0.775, P=0.002) were independent influencing factors for the survival of glioma patients (all P <0.05) and could be used independently to explore the prognosis of patients.However, PDK1 protein expression does not affect the prognosis of glioma patients. \u0000 \u0000 \u0000Conclusion \u0000PDK1 expression is different in glioma patients with different WHO pathological levels, and mainly related to hypoxia and HIF-1 signaling pathway. \u0000 \u0000 \u0000Key words: \u0000Glioma; Prognosis; The cancer genome atlas; Pyruvate dehydrogenase kinase 1","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"288-293"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45022108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma. Methods A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate. Results Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection. Conclusion Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma . Key words: Glioma; Neuronavigation; Fluorescence staining; Neurosurgical procedures; Extent of resection
{"title":"Application of neuronavigation combined with yellow fluorescence staining in the resection of supratentorial glioma","authors":"Fugang Yang, Yu-hang Zhao, Wen-Hong Huang, Chao Yang, Chao Ma, Cheng-shi Xu","doi":"10.3760/CMA.J.CN112050-20190921-00406","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190921-00406","url":null,"abstract":"Objective \u0000To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate. \u0000 \u0000 \u0000Results \u0000Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection. \u0000 \u0000 \u0000Conclusion \u0000Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma . \u0000 \u0000 \u0000Key words: \u0000Glioma; Neuronavigation; Fluorescence staining; Neurosurgical procedures; Extent of resection","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"253-257"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43372491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190929-00418
Dongze Guo, Xing Fan, Jiajia Ma, S. Gui, Jian-gua Jia, N. Qiao, H. Qiao
Objective To analyze the methodology parameters of intraoperative monitoring of flash visual evoked potential (F-VEP) and to explore its application value in the operation of sellar region tumors. Methods The clinical data of 117 patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2018 to August 2019 were retrospectively analyzed. A total of 86 patients with intraductal space-occupying lesions were enrolled as A group (112 eyes) for the study of intraoperative F-VEP parameters. The stable parameters obtained from the parameter study were applied to 31 patients with sellar region tumors (B group, 62 eyes). All patients underwent tumor resection and intraoperative F-VEP monitoring under general intravenous anesthesia. F-VEP amplitudes under various electrode channels and different stimulus frequencies (0.7-1.2 Hz) were compared. Results In the A group, at any stimulation frequencies, the amplitude between N75 and P100 wave (A1) of O2-Fz channel and Oz-Fz channel were significantly higher than those of O1-Fz channel (all P<0.05). At various stimulus frequencies within the range of 0.7-1.0 Hz, the amplitude of A2 of O2-Fz channel and Oz-Fz channel was significantly higher than those of O1-Fz channel (all P<0.05). In any electrode channel, A1 obtained at various stimulus frequencies within the range of 0.7-1.2 Hz did not vary significantly, while A2 at the frequency of 0.7 Hz was significantly higher than that at any other frequency (all P<0.05). In the B group, the stable F-VEP waveform was obtained in 61 eyes with an extraction rate of 98.4% (61/62). There was no change in F-VEP waveform in 19 patients in the B group, of which 13 had the same visual function as that before operation, and 6 of them had improved visual function. In the B group, among the 12 patients with reversible F-VEP waveform, 4 had the same visual function as that before surgery, 7 had improved visual function, and only 1 had decreased visual function. Conclusions After selecting appropriate stimulus parameters, stable and reliable F-VEP waveform can be obtained during operation. By means of preliminary application of F-VEP monitoring in sellar region tumor surgery, it has been preliminarily confirmed that intraoperative F-VEP monitoring could be used to predict the prognosis of postoperative visual function in patients. Key words: Brain Neoplasms; Monitoring, intraoperative; Evoked potentials, visual; Sellar region; Prognosis
{"title":"Methodology analysis of flash visual evoked potential and its preliminary application in intraoperative monitoring during operation of sellar region tumors","authors":"Dongze Guo, Xing Fan, Jiajia Ma, S. Gui, Jian-gua Jia, N. Qiao, H. Qiao","doi":"10.3760/CMA.J.CN112050-20190929-00418","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190929-00418","url":null,"abstract":"Objective \u0000To analyze the methodology parameters of intraoperative monitoring of flash visual evoked potential (F-VEP) and to explore its application value in the operation of sellar region tumors. \u0000 \u0000 \u0000Methods \u0000The clinical data of 117 patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2018 to August 2019 were retrospectively analyzed. A total of 86 patients with intraductal space-occupying lesions were enrolled as A group (112 eyes) for the study of intraoperative F-VEP parameters. The stable parameters obtained from the parameter study were applied to 31 patients with sellar region tumors (B group, 62 eyes). All patients underwent tumor resection and intraoperative F-VEP monitoring under general intravenous anesthesia. F-VEP amplitudes under various electrode channels and different stimulus frequencies (0.7-1.2 Hz) were compared. \u0000 \u0000 \u0000Results \u0000In the A group, at any stimulation frequencies, the amplitude between N75 and P100 wave (A1) of O2-Fz channel and Oz-Fz channel were significantly higher than those of O1-Fz channel (all P<0.05). At various stimulus frequencies within the range of 0.7-1.0 Hz, the amplitude of A2 of O2-Fz channel and Oz-Fz channel was significantly higher than those of O1-Fz channel (all P<0.05). In any electrode channel, A1 obtained at various stimulus frequencies within the range of 0.7-1.2 Hz did not vary significantly, while A2 at the frequency of 0.7 Hz was significantly higher than that at any other frequency (all P<0.05). In the B group, the stable F-VEP waveform was obtained in 61 eyes with an extraction rate of 98.4% (61/62). There was no change in F-VEP waveform in 19 patients in the B group, of which 13 had the same visual function as that before operation, and 6 of them had improved visual function. In the B group, among the 12 patients with reversible F-VEP waveform, 4 had the same visual function as that before surgery, 7 had improved visual function, and only 1 had decreased visual function. \u0000 \u0000 \u0000Conclusions \u0000After selecting appropriate stimulus parameters, stable and reliable F-VEP waveform can be obtained during operation. By means of preliminary application of F-VEP monitoring in sellar region tumor surgery, it has been preliminarily confirmed that intraoperative F-VEP monitoring could be used to predict the prognosis of postoperative visual function in patients. \u0000 \u0000 \u0000Key words: \u0000Brain Neoplasms; Monitoring, intraoperative; Evoked potentials, visual; Sellar region; Prognosis","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"248-252"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42651097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190928-00416
Huawei Huang, Guobin Zhang, Xiaokang Zhang, Chun-Mei Wang, Jingran Chen, Yu-Mei Wang, Ming Xu, Song Lin, Jian-Xin Zhou
Objective To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD. Methods A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored. Results In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. Conclusions The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases. Key words: Glioma; Neurosurgical procedures; Delirium; Neoplasm grading; Compensa-tory neuroplasticity
{"title":"Relationship between tumor grade and postoperative delirium in adult patients with glioma","authors":"Huawei Huang, Guobin Zhang, Xiaokang Zhang, Chun-Mei Wang, Jingran Chen, Yu-Mei Wang, Ming Xu, Song Lin, Jian-Xin Zhou","doi":"10.3760/CMA.J.CN112050-20190928-00416","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190928-00416","url":null,"abstract":"Objective \u0000To analyze the incidence and risk factors of postoperative delirium (POD) in patients with glioma and to explore the association between WHO (World Health Organization) tumor grades and POD. \u0000 \u0000 \u0000Methods \u0000A second analysis of clinical data from 113 adult glioma patients in a single-center, prospective cohort study of 800 neurosurgery patients was conducted from March 2017 to February 2018 at Department of Critical Medicine (ICU), Beijing Tiantan Hospital, Capital Medical University. Patients were assessed for delirium on the first to third days post surgery (twice a day) using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). The patient was divided into delirium group (43 cases) and non-delirium group (70 cases) by whether the patient had had delirium. We collected the patient’s general preoperative information, preoperative condition, early postoperative clinical data, and neurosurgical specialty data (including WHO grades) as potential risk factors that may be associated with the occurrence of POD. The independent risk factors of POD were identified using multivariate logistic regression analysis. In particular, the relationship between WHO glioma grade and POD was explored. \u0000 \u0000 \u0000Results \u0000In 113 glioma patients who were admitted to the ICU for routine postoperative monitoring, the incidence of POD was 38.1% (43/113). The incidence of POD in patients with WHO grade Ⅰ-Ⅳ gliomas increased with the increase of the WHO grade: 7.7% (1/13), 14.3% (3/21), 22.7% (5/22) and 63.0% (34/57). Among the potential risk factors, age (OR=1.08, 95% CI: 1.04-1.13, P<0.001), GCS (Glasgow coma scale) score at admission to ICU (OR=0.80, 95% CI: 0.71-0.90, P<0.001) and the WHO grade of tumor (OR=2.01, 95% CI: 1.03-3.92, P=0.041) was independent risk factors for POD. \u0000 \u0000 \u0000Conclusions \u0000The WHO grade of glioma is an independent risk factor for POD. With the increase of tumor grade, the incidence of POD also increases. \u0000 \u0000 \u0000Key words: \u0000Glioma; Neurosurgical procedures; Delirium; Neoplasm grading; Compensa-tory neuroplasticity","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"258-263"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44118602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190221-00059
Wei Gao, Yongfeng Bi, Ming Ye, Chaoqun Wu, Zhong Wang, Zhengquan Yu
Objective To address the value of multimodal image-based virtual reality technology in preoperative evaluation of resection of brain tumor in central cortex and adjacent areas. Methods A retrospective study was conducted on the clinical data of 36 patients with brain tumor in central cortex and adjacent areas who were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University from December 2015 to April 2018. All patients underwent preoperative 3.0T MRI scan. Multimodal MRI images were then co-registered with the software iPlan followed by three-dimensional image reconstruction to generate virtual reality images. Evaluation of the relationship between tumor, brain vessels and eloquent areas was then performed according to the virtual reality model and compared with intra-operative findings. The brain tumors were resected under craniotomy microscope. Medical imaging examination and follow-up were performed after operation. Results For prediction of the relationship between tumor, eloquent area and vessels, multimodal image-based virtual reality showed the sensitivity of 94.4% (34/36). Among all 36 patients, total resection of glioma was achieved in 16 cases and subtotal resection in 2; total resection of meningioma was performed in 9 cases and subtotal resection in 1; total resection was achieved in 5 cases of cavernous hemangioma, 2 cases of metastatic tumor and 1 case of lymphoma. After surgery, 3 patients developed different degrees of limb motor impairment, of which 2 returned to normal after 3 months. One case developed transient speech disorders after surgery and returned to normal after 1 week. All patients were followed up for 20.2±5.4 months (10-38 months), and there were 3 patients showing recurrence in imaging examination. Conclusion The use of virtual reality technology is helpful to make an accurate assessment of the relationship between tumor and eloquent area as well as blood vessels near the tumor before surgery, and can help to improve the preoperative plan and improve the rate of total removal of tumor, thereby reducing the occurrence of postoperative complications. Key words: Brain neoplasms; Microsurgery; Eloquent area; Virtual reality; Multimodel
{"title":"Application of virtual reality technology in the operation of brain tumors in central cortex and adjacent areas","authors":"Wei Gao, Yongfeng Bi, Ming Ye, Chaoqun Wu, Zhong Wang, Zhengquan Yu","doi":"10.3760/CMA.J.CN112050-20190221-00059","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190221-00059","url":null,"abstract":"Objective \u0000To address the value of multimodal image-based virtual reality technology in preoperative evaluation of resection of brain tumor in central cortex and adjacent areas. \u0000 \u0000 \u0000Methods \u0000A retrospective study was conducted on the clinical data of 36 patients with brain tumor in central cortex and adjacent areas who were admitted to Neurosurgery Department of the First Affiliated Hospital of Soochow University from December 2015 to April 2018. All patients underwent preoperative 3.0T MRI scan. Multimodal MRI images were then co-registered with the software iPlan followed by three-dimensional image reconstruction to generate virtual reality images. Evaluation of the relationship between tumor, brain vessels and eloquent areas was then performed according to the virtual reality model and compared with intra-operative findings. The brain tumors were resected under craniotomy microscope. Medical imaging examination and follow-up were performed after operation. \u0000 \u0000 \u0000Results \u0000For prediction of the relationship between tumor, eloquent area and vessels, multimodal image-based virtual reality showed the sensitivity of 94.4% (34/36). Among all 36 patients, total resection of glioma was achieved in 16 cases and subtotal resection in 2; total resection of meningioma was performed in 9 cases and subtotal resection in 1; total resection was achieved in 5 cases of cavernous hemangioma, 2 cases of metastatic tumor and 1 case of lymphoma. After surgery, 3 patients developed different degrees of limb motor impairment, of which 2 returned to normal after 3 months. One case developed transient speech disorders after surgery and returned to normal after 1 week. All patients were followed up for 20.2±5.4 months (10-38 months), and there were 3 patients showing recurrence in imaging examination. \u0000 \u0000 \u0000Conclusion \u0000The use of virtual reality technology is helpful to make an accurate assessment of the relationship between tumor and eloquent area as well as blood vessels near the tumor before surgery, and can help to improve the preoperative plan and improve the rate of total removal of tumor, thereby reducing the occurrence of postoperative complications. \u0000 \u0000 \u0000Key words: \u0000Brain neoplasms; Microsurgery; Eloquent area; Virtual reality; Multimodel","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"264-268"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49665092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190929-00422
Qiaowei Wu, Li Li, Qiuji Shao, Tianxiao Li, Yingkun He, Hang Li
Objective To evaluate the safety and efficacy of flow diverter (FD) in the treatment of large (maximum diameter≥10 mm) unruptured intracranial aneurysms. Methods A total of 92 patients harboring 95 large unruptured intracranial aneurysms who underwent treatment with FD (Pipeline + Tubridge) at Department of Cerebrovascular Intervention, Zhengzhou University People's Hospital, Henan Provincial People's Hospital from February 2015 to July 2019 were enrolled into this retrospective study. The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at follow-up, and O′Kelly-Marotta (OKM) grading scale was used to evaluate the occlusion of aneurysm. Multivariate logistic regression analysis was used to explore the influencing factors which could affect the aneurysm occlusion rate at 6-month follow-up. Results A total of 101 devices of FD were employed in 92 patients with 95 aneurysms, all of whom underwent successful operation. The incidence of neurological complications was 4.3% (4/92), which included 1 case of thromboembolic complication, 2 hemorrhagic events (1 death) and 1 case of postoperative irritability. Seventy-seven patients obtained clinical follow-up with a median of 12 (1-51) months. The mRS was 0 in 70 patients, 1 in 5, 2 in 1 and 3 in 1. There were 55 patients with 56 aneurysms who underwent the latest follow-up at a median of 6 (3-29) months post operation, and the complete occlusion (Grade D of OKM grading scale) rate was 71.4% (40/56), the in-stent stenosis rat was 7.1%(4/56). There were 52 patients with 53 aneurysms who obtained the 6-month imaging follow-up and the complete occlusion rate was 64.2% (34/53), the in-stent stenosis rat was 7.5%(4/53). Multivariate logistic regression showed that adjunctive coiling was the independent factor which affected the aneurysm occlusion rate at 6-month follow-up significantly (OR=8.98, 95% CI: 1.87-43.22, P=0.006). Conclusions The use of FD seems safe in the treatment of large unruptured intracranial aneurysms with a high procedure success rate. However, serious complications remain to be noted. Meanwhile, adjunctive coiling could promote the complete occlusion of intracranial aneurysms. Key words: Intracranial aneurysm; Treatment outcome; Postoperative complications; Large; Flow diverter
{"title":"Clinical efficacy analysis of flow diverter in the treatment of large unruptured intracranial aneurysms","authors":"Qiaowei Wu, Li Li, Qiuji Shao, Tianxiao Li, Yingkun He, Hang Li","doi":"10.3760/CMA.J.CN112050-20190929-00422","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190929-00422","url":null,"abstract":"Objective \u0000To evaluate the safety and efficacy of flow diverter (FD) in the treatment of large (maximum diameter≥10 mm) unruptured intracranial aneurysms. \u0000 \u0000 \u0000Methods \u0000A total of 92 patients harboring 95 large unruptured intracranial aneurysms who underwent treatment with FD (Pipeline + Tubridge) at Department of Cerebrovascular Intervention, Zhengzhou University People's Hospital, Henan Provincial People's Hospital from February 2015 to July 2019 were enrolled into this retrospective study. The modified Rankin scale (mRS) was used to evaluate the clinical outcomes at follow-up, and O′Kelly-Marotta (OKM) grading scale was used to evaluate the occlusion of aneurysm. Multivariate logistic regression analysis was used to explore the influencing factors which could affect the aneurysm occlusion rate at 6-month follow-up. \u0000 \u0000 \u0000Results \u0000A total of 101 devices of FD were employed in 92 patients with 95 aneurysms, all of whom underwent successful operation. The incidence of neurological complications was 4.3% (4/92), which included 1 case of thromboembolic complication, 2 hemorrhagic events (1 death) and 1 case of postoperative irritability. Seventy-seven patients obtained clinical follow-up with a median of 12 (1-51) months. The mRS was 0 in 70 patients, 1 in 5, 2 in 1 and 3 in 1. There were 55 patients with 56 aneurysms who underwent the latest follow-up at a median of 6 (3-29) months post operation, and the complete occlusion (Grade D of OKM grading scale) rate was 71.4% (40/56), the in-stent stenosis rat was 7.1%(4/56). There were 52 patients with 53 aneurysms who obtained the 6-month imaging follow-up and the complete occlusion rate was 64.2% (34/53), the in-stent stenosis rat was 7.5%(4/53). Multivariate logistic regression showed that adjunctive coiling was the independent factor which affected the aneurysm occlusion rate at 6-month follow-up significantly (OR=8.98, 95% CI: 1.87-43.22, P=0.006). \u0000 \u0000 \u0000Conclusions \u0000The use of FD seems safe in the treatment of large unruptured intracranial aneurysms with a high procedure success rate. However, serious complications remain to be noted. Meanwhile, adjunctive coiling could promote the complete occlusion of intracranial aneurysms. \u0000 \u0000 \u0000Key words: \u0000Intracranial aneurysm; Treatment outcome; Postoperative complications; Large; Flow diverter","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"269-273"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42902578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190526-00226
Lin Ma, Ming Wei, H. Ren, Bao-shang Liu, L. Yin
Objective To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) in stenosis stenting for symptomatic middle cerebral artery. Methods The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery (MCA) M1 segment who were treated with stenting therapy (stenting angioplasty) at Department of Neurosurgery, Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively. HRMR-VWI results were used to evaluate the location, composition and stability of plaques before operation. The mortality and morbidity at 30 days post operation were determined by clinical follow-up. The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up. Results The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall, those in 12 on the inferior, and those in 8 on the upper vessel wall. Seven patients had unstable plaques in the M1 segment of MCA. The stents were successfully placed in 35 patients and well adhered with smooth blood flow. Technical complications occurred in 2 (5.7%) patients. One patient (2.8%) died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery, although decompressive craniectomy and hematoma clearing were performed. One patient (2.8%) had residual neurological dysfunction. Twelve months after the operation, no ischemic stroke occurred in 34 patients, and no restenosis occurred in the 5 patients who were followed up by imaging. Conclusion HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA, which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis. Key words: Middle cerebral artery; Endovascular procedures; Stents; Atherosclerotic stenosis; High resolution magnetic resonance vessel wall imaging
{"title":"Application value of preoperative high-resolution magnetic resonance vessel wall imaging evaluation on symptomatic middle cerebral artery stenosis stenting","authors":"Lin Ma, Ming Wei, H. Ren, Bao-shang Liu, L. Yin","doi":"10.3760/CMA.J.CN112050-20190526-00226","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190526-00226","url":null,"abstract":"Objective \u0000To investigate the value of preoperative high-resolution magnetic resonance vessel wall imaging (HRMR-VWI) in stenosis stenting for symptomatic middle cerebral artery. \u0000 \u0000 \u0000Methods \u0000The clinical data of 35 patients with atherosclerotic stenosis in middle cerebral artery (MCA) M1 segment who were treated with stenting therapy (stenting angioplasty) at Department of Neurosurgery, Tianjin Huanhu Hospital from August 2011 to May 2019 were analyzed retrospectively. HRMR-VWI results were used to evaluate the location, composition and stability of plaques before operation. The mortality and morbidity at 30 days post operation were determined by clinical follow-up. The ischemic stroke and restenosis rates at 12 months post operation were confirmed by imaging follow-up. \u0000 \u0000 \u0000Results \u0000The preoperative HRMR-VWI of 35 patients showed that the plaques in 15 cases were located on the ventral vessel wall, those in 12 on the inferior, and those in 8 on the upper vessel wall. Seven patients had unstable plaques in the M1 segment of MCA. The stents were successfully placed in 35 patients and well adhered with smooth blood flow. Technical complications occurred in 2 (5.7%) patients. One patient (2.8%) died of cerebral hernia due to reperfusion hemorrhage in 30 days after surgery, although decompressive craniectomy and hematoma clearing were performed. One patient (2.8%) had residual neurological dysfunction. Twelve months after the operation, no ischemic stroke occurred in 34 patients, and no restenosis occurred in the 5 patients who were followed up by imaging. \u0000 \u0000 \u0000Conclusion \u0000HRMR-VWI has a high diagnostic value for the location and stability of plaques in stenotic sites of MCA, which could improve the safety and effectiveness of stenting of MCA M1 segment stenosis. \u0000 \u0000 \u0000Key words: \u0000Middle cerebral artery; Endovascular procedures; Stents; Atherosclerotic stenosis; High resolution magnetic resonance vessel wall imaging","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"274-277"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45739552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20190307-00081
Jiyang An, Lili Zhou, Zhi-feng Zhang, Xianzhi Liu
Objective To investigate the mechanism of matrix stiffness promoting epithelial-mesenchymal transformation (EMT) and vasculogenic mimicry (VM) of glioma cells by yes-related proteins (YAP). Methods Human glioma U87 cell lines were cultured under different matrix stiffness conditions. Matrix stiffness 0.2, 16.0 and 64.0 kPa represented normal brain, glioma and extreme stiffness, respectively. CCK-assay was used to examine the proliferation of U87 cell line.The localization of YAP cells was detected by immunofluorescence staining. The expression of YAP targeting genes including CTGF and CRY61 were detected by real-time quantitative PCR. The expression and phosphorylation expression of YAP, proliferation signal including Akt and ERK1/2 were detected by Western blot. Immunofluorescence and Western blot were used to detect the expression of EMT-related proteins including Vimentin, E-cadherin and Twist. VM formation was detected in soft and stiff substrates under 3D culture. U87 cells were transfected with shYAP lentivirus, and then the expression of EMT proteins and VM formation were examined. Results With the increase of matrix stiffness, the proliferation activity of glioma cells and phosphorylation expression of Akt and ERK1/2 were increased (all P<0.05), the expression of phosphorylated Yap was decreased (P<0.05), while the expression levels of CTGF and CRY61 were increased (both P<0.05) as the nuclear translocation of YAP was increased. The results of immunofluorescence staining and Western blot showed that with the increase of matrix stiffness, the EMT component expression levels of Vimentin and Twist were increased, the epithelial marker E-cadherin was decreased (all P<0.05). Compared with that under soft matrix 3D culture, the formation of VM tubular structure in U87 cells was increased in stiff matrix (P<0.05). Interference with Yap expression inhibited the enhancement of the proliferation of glioma cells, the expression of Vimentin and Twist, and VM formation induced by matrix stiffness (all P<0.05). Conclusions Matrix stiffness promotes the proliferation of glioma cells, EMT and VM formation through YAP. Targeted matrix stiffness and YAP can be used as new strategies for glioma treatment. Key words: Glioma; Matrix stiffness; Yes-associated protein; Epithelial-mesenchymal transition; Vasculogenic mimicry
{"title":"Matrix stiffness promotes epithelial-mesenchymal transition and vasculogenic mimicry formation through YAP in glioma cells","authors":"Jiyang An, Lili Zhou, Zhi-feng Zhang, Xianzhi Liu","doi":"10.3760/CMA.J.CN112050-20190307-00081","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20190307-00081","url":null,"abstract":"Objective \u0000To investigate the mechanism of matrix stiffness promoting epithelial-mesenchymal transformation (EMT) and vasculogenic mimicry (VM) of glioma cells by yes-related proteins (YAP). \u0000 \u0000 \u0000Methods \u0000Human glioma U87 cell lines were cultured under different matrix stiffness conditions. Matrix stiffness 0.2, 16.0 and 64.0 kPa represented normal brain, glioma and extreme stiffness, respectively. CCK-assay was used to examine the proliferation of U87 cell line.The localization of YAP cells was detected by immunofluorescence staining. The expression of YAP targeting genes including CTGF and CRY61 were detected by real-time quantitative PCR. The expression and phosphorylation expression of YAP, proliferation signal including Akt and ERK1/2 were detected by Western blot. Immunofluorescence and Western blot were used to detect the expression of EMT-related proteins including Vimentin, E-cadherin and Twist. VM formation was detected in soft and stiff substrates under 3D culture. U87 cells were transfected with shYAP lentivirus, and then the expression of EMT proteins and VM formation were examined. \u0000 \u0000 \u0000Results \u0000With the increase of matrix stiffness, the proliferation activity of glioma cells and phosphorylation expression of Akt and ERK1/2 were increased (all P<0.05), the expression of phosphorylated Yap was decreased (P<0.05), while the expression levels of CTGF and CRY61 were increased (both P<0.05) as the nuclear translocation of YAP was increased. The results of immunofluorescence staining and Western blot showed that with the increase of matrix stiffness, the EMT component expression levels of Vimentin and Twist were increased, the epithelial marker E-cadherin was decreased (all P<0.05). Compared with that under soft matrix 3D culture, the formation of VM tubular structure in U87 cells was increased in stiff matrix (P<0.05). Interference with Yap expression inhibited the enhancement of the proliferation of glioma cells, the expression of Vimentin and Twist, and VM formation induced by matrix stiffness (all P<0.05). \u0000 \u0000 \u0000Conclusions \u0000Matrix stiffness promotes the proliferation of glioma cells, EMT and VM formation through YAP. Targeted matrix stiffness and YAP can be used as new strategies for glioma treatment. \u0000 \u0000 \u0000Key words: \u0000Glioma; Matrix stiffness; Yes-associated protein; Epithelial-mesenchymal transition; Vasculogenic mimicry","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"294-300"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47787283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20191222-00532
Zhe Han, P. Kang, Zhixian Gao, Song-Nan Lin
Objective To investigate the expression of microchromosome maintenance protein 10(MCM10) in thalamic gliomas and its prognostic value. Methods A retrospective analysis was conducted on the clinical data of 48 patients with thalamic glioma who underwent tumor resection at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from September 2016 to September 2017. At 1 week post operation, the degree of tumor resection was determined according to cranial MRI. After discharge, all patients underwent follow-up by outpatient clinic visits or telephone, which included reexamination of skull enhanced MRI and assessment of Karnofsky performance scale(KPS) score. All tumor tissues were reserved during operation for immunohistochemical staining analysis of MCM10. According to the positive rate of MCM10 expression and comprehensive score of staining intensity, the lower expression of MCM10 was decided as less than 6 points, and the higher expression of MCM10 as at least 6 points. The expression of MCM10 in different grade thalamic gliomas was analyzed. We then compared the clinical data of MCM10 low expression group and high expression group. The survival of two groups was further analyzed using Kaplan-Meier method. Finally, the univariate and multivariate Cox regression analysis methods were used to determine whether MCM10 was an independent risk factor affecting the total survival of thalamic glioma patients. Results In 48 patients, 1 week after surgery, the cranial MRI showed that total resection was achieved in 13 cases (27.1%), near-total resection in 29 cases (60.4%) and partial resection in 6 cases (12.5%). The median follow-up time was 22.6 months (0.3-34.2 months) in 48 patients. Three months after surgery, the median KPS score was 60 points(0-100 points). By the end of the follow-up period, 31 of the 48 patients survived and 17 died. The results of immunohistochemistry showed that the tumor tissue in 48 patients expressed MCM10, of which 23 (47.9%) were low expression and 25 (52.1%) were high expression. Immunohistochemistry analysis in the 48 patients of thalamic gliomas with various World Health Organization (WHO) grades showed that MCM10 had the lowest staining points (3.7±1.2) in grade Ⅰ glioma, middle-level in grade Ⅱ (5.8±2.3) and grade Ⅲ(7.5±3.5), and the highest in grade Ⅳ (7.9±2.8). The difference between groups was statistically significant (P=0.021). The differences in age, sex, WHO grade, preoperative KPS score and postoperative recurrence of MCM10 high expression group and low expression group were not statistically significant (all P>0.05). The survival rate and KPS score improvement were significantly higher in the patients of MCM10 low expression group than those in the high expression group (both P<0.05). The results of univariate and multivariate Cox regression analysis showed that MCM10 high expression was one of the independent risk factors affecting the outcome of patients with thalamic g
{"title":"Expression and clinical significance of microchromosome maintenance protein 10 in thalamic gliomas","authors":"Zhe Han, P. Kang, Zhixian Gao, Song-Nan Lin","doi":"10.3760/CMA.J.CN112050-20191222-00532","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20191222-00532","url":null,"abstract":"Objective \u0000To investigate the expression of microchromosome maintenance protein 10(MCM10) in thalamic gliomas and its prognostic value. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was conducted on the clinical data of 48 patients with thalamic glioma who underwent tumor resection at Neurosurgery Department of Beijing Tiantan Hospital, Capital Medical University from September 2016 to September 2017. At 1 week post operation, the degree of tumor resection was determined according to cranial MRI. After discharge, all patients underwent follow-up by outpatient clinic visits or telephone, which included reexamination of skull enhanced MRI and assessment of Karnofsky performance scale(KPS) score. All tumor tissues were reserved during operation for immunohistochemical staining analysis of MCM10. According to the positive rate of MCM10 expression and comprehensive score of staining intensity, the lower expression of MCM10 was decided as less than 6 points, and the higher expression of MCM10 as at least 6 points. The expression of MCM10 in different grade thalamic gliomas was analyzed. We then compared the clinical data of MCM10 low expression group and high expression group. The survival of two groups was further analyzed using Kaplan-Meier method. Finally, the univariate and multivariate Cox regression analysis methods were used to determine whether MCM10 was an independent risk factor affecting the total survival of thalamic glioma patients. \u0000 \u0000 \u0000Results \u0000In 48 patients, 1 week after surgery, the cranial MRI showed that total resection was achieved in 13 cases (27.1%), near-total resection in 29 cases (60.4%) and partial resection in 6 cases (12.5%). The median follow-up time was 22.6 months (0.3-34.2 months) in 48 patients. Three months after surgery, the median KPS score was 60 points(0-100 points). By the end of the follow-up period, 31 of the 48 patients survived and 17 died. The results of immunohistochemistry showed that the tumor tissue in 48 patients expressed MCM10, of which 23 (47.9%) were low expression and 25 (52.1%) were high expression. Immunohistochemistry analysis in the 48 patients of thalamic gliomas with various World Health Organization (WHO) grades showed that MCM10 had the lowest staining points (3.7±1.2) in grade Ⅰ glioma, middle-level in grade Ⅱ (5.8±2.3) and grade Ⅲ(7.5±3.5), and the highest in grade Ⅳ (7.9±2.8). The difference between groups was statistically significant (P=0.021). The differences in age, sex, WHO grade, preoperative KPS score and postoperative recurrence of MCM10 high expression group and low expression group were not statistically significant (all P>0.05). The survival rate and KPS score improvement were significantly higher in the patients of MCM10 low expression group than those in the high expression group (both P<0.05). The results of univariate and multivariate Cox regression analysis showed that MCM10 high expression was one of the independent risk factors affecting the outcome of patients with thalamic g","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"221-226"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46237898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-28DOI: 10.3760/CMA.J.CN112050-20191014-00445
Chen Jiang, C. Niu, S. Ling, N. Zhang, Xuefei Deng, Hui Han
Objective To explore the clinical study of the extent of pyramidal tract invasion and the postoperative outcome of insular gliomas. Methods The clinical data of 41 patients with insular glioma undergoing surgical treatment from July 2010 to July 2019 at Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) were retrospectively analyzed. Patients were classified into 3 types according to the degree of invasion of pyramidal tracts. The tumor invading only the anterior lower part of the insular lobe was categorized as type Ⅰ, that invading posterior upper part of the insular lobe as type Ⅱ, and that with invasion and destruction of the inner capsule structure as type Ⅲ. The differences of limb motor dysfunction before and after operation, pathological types and postoperative outcome among patients with different types were analyzed. Results Among the 41 patients, 18 were type Ⅰ (43.9%), 20 were type Ⅱ (48.8%), and 3 were type Ⅲ (7.3%). No type Ⅰ patients had motor impairment before or after surgery. Four patients with type Ⅱ tumor had motor dysfunction before surgery, of whom 3 reported improvement after surgery and 1 developed further worsened symptoms. One type Ⅱ patient had new motor dysfunction after surgery. Type Ⅲ patients had motor dysfunction before operation, and their symptoms worsened after operation. There were 11 cases, 5 cases, and 1 case of total resection of type Ⅰ, type Ⅱ, and type Ⅲ tumors, respectively. Compared with the rate of total resection in type Ⅰ patients, that in type Ⅱ+ Ⅲ patients was significantly lower[26.1% (6/23) vs. 11/18, P=0.026]. There were 3 cases, 7 cases, and 3 cases of World Health Organization (WHO) grade Ⅲ-Ⅳ glioma in patients of type Ⅰ, Ⅱ and Ⅲ, respectively. The difference was statistically significant (P=0.015). A total of 29 cases were followed up for 3-72 months (22.7±12.0 months). Thirteen patients with type Ⅰ were followed up, and none of them recurred. Fifteen patients with type Ⅱ were followed up, 7 of whom relapsed. One patient with type Ⅲ was followed up, and the residual tumor increased and the patient died in the third month after operation. Kaplan-Meier survival analysis revealed significant difference in the survival rate among the patients of 3 types (P<0.01). Conclusion The heavier the pyramidal tacts is invaded, the higher the pathological grade of insular glioma, the lower the total surgical resection rate, and the worse the postoperative outcome. Key words: Glioma; Pyramidal tracts; Treatment outcome; Insula; Typing
{"title":"Relationship between the degree of pyramidal tracts invasion and postoperative outcome in patients with insular glioma","authors":"Chen Jiang, C. Niu, S. Ling, N. Zhang, Xuefei Deng, Hui Han","doi":"10.3760/CMA.J.CN112050-20191014-00445","DOIUrl":"https://doi.org/10.3760/CMA.J.CN112050-20191014-00445","url":null,"abstract":"Objective \u0000To explore the clinical study of the extent of pyramidal tract invasion and the postoperative outcome of insular gliomas. \u0000 \u0000 \u0000Methods \u0000The clinical data of 41 patients with insular glioma undergoing surgical treatment from July 2010 to July 2019 at Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) were retrospectively analyzed. Patients were classified into 3 types according to the degree of invasion of pyramidal tracts. The tumor invading only the anterior lower part of the insular lobe was categorized as type Ⅰ, that invading posterior upper part of the insular lobe as type Ⅱ, and that with invasion and destruction of the inner capsule structure as type Ⅲ. The differences of limb motor dysfunction before and after operation, pathological types and postoperative outcome among patients with different types were analyzed. \u0000 \u0000 \u0000Results \u0000Among the 41 patients, 18 were type Ⅰ (43.9%), 20 were type Ⅱ (48.8%), and 3 were type Ⅲ (7.3%). No type Ⅰ patients had motor impairment before or after surgery. Four patients with type Ⅱ tumor had motor dysfunction before surgery, of whom 3 reported improvement after surgery and 1 developed further worsened symptoms. One type Ⅱ patient had new motor dysfunction after surgery. Type Ⅲ patients had motor dysfunction before operation, and their symptoms worsened after operation. There were 11 cases, 5 cases, and 1 case of total resection of type Ⅰ, type Ⅱ, and type Ⅲ tumors, respectively. Compared with the rate of total resection in type Ⅰ patients, that in type Ⅱ+ Ⅲ patients was significantly lower[26.1% (6/23) vs. 11/18, P=0.026]. There were 3 cases, 7 cases, and 3 cases of World Health Organization (WHO) grade Ⅲ-Ⅳ glioma in patients of type Ⅰ, Ⅱ and Ⅲ, respectively. The difference was statistically significant (P=0.015). A total of 29 cases were followed up for 3-72 months (22.7±12.0 months). Thirteen patients with type Ⅰ were followed up, and none of them recurred. Fifteen patients with type Ⅱ were followed up, 7 of whom relapsed. One patient with type Ⅲ was followed up, and the residual tumor increased and the patient died in the third month after operation. Kaplan-Meier survival analysis revealed significant difference in the survival rate among the patients of 3 types (P<0.01). \u0000 \u0000 \u0000Conclusion \u0000The heavier the pyramidal tacts is invaded, the higher the pathological grade of insular glioma, the lower the total surgical resection rate, and the worse the postoperative outcome. \u0000 \u0000 \u0000Key words: \u0000Glioma; Pyramidal tracts; Treatment outcome; Insula; Typing","PeriodicalId":10100,"journal":{"name":"Chinese Journal of Neurosurgery","volume":"36 1","pages":"238-242"},"PeriodicalIF":0.0,"publicationDate":"2020-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48977674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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