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Brain Tumors - An Update最新文献

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Primary Brain Tumors in Childhood 儿童原发性脑肿瘤
Pub Date : 2018-08-22 DOI: 10.5772/INTECHOPEN.74510
R. Richterová, B. Kolarovszki
This chapter offers literary review of most frequently observed brain tumors in child - hood. It offers basics of epidemiology, clinical presentation and diagnostics of most often occurring types of tumors according to new WHO classification of brain tumors from 2016 and emphasizes molecular biological characteristics and role of altered genes and genetic pathways in brain tumor etiology, classification and treatment. This review not only concentrates on gliomas, medulloblastomas and ependymomas, but also offers characterization of other less frequently observed lesions. Each tumor characteristics also contains basics of therapeutical possibilities of these lesions with focus on targeted and individually designed therapy according to molecular and genetic alterations found in tumor tissue sample.
本章提供了最常见的儿童脑肿瘤的文献综述。它根据2016年世卫组织新的脑肿瘤分类,提供最常发生的肿瘤类型的流行病学、临床表现和诊断基础知识,并强调分子生物学特征以及改变的基因和遗传途径在脑肿瘤病因、分类和治疗中的作用。这篇综述不仅集中于胶质瘤、髓母细胞瘤和室管膜瘤,而且还提供了其他不常观察到的病变的特征。每个肿瘤特征还包含这些病变治疗可能性的基础知识,重点是根据肿瘤组织样本中发现的分子和遗传改变进行靶向和单独设计的治疗。
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引用次数: 3
Neuropsychiatry: Aspects of Childhood Cranial Tumours 神经精神病学:儿童颅内肿瘤的各个方面
Pub Date : 2018-08-22 DOI: 10.5772/INTECHOPEN.75679
Alexander Hegarty and Yulia Furlong
More than 90 years have passed since Baily and Cushing first introduced a histogenetic classification for tumours of the cranial nervous system (CNS). More recently, our knowl edge of the genetic and molecular basis of tumorigenesis has caused a major paradigm shift towards defining tumours genetically, thus allowing greater diagnostic accuracy and prog nostication to better guide tumour management. Correspondingly, successes in integrated management and improved survival rates have shifted attention towards overall quality of life studies, where psychosocial sequelae and adjustment implications are of particular interest to mental health professionals. To date, research relevant to this field has focused on the identification of neuropsychiatric symptoms at manifestation of illness. Such studies indicate that mood, cognition and psychosocial functioning are important factors in early diagnosis, mediating health outcomes, especially following radical and risk-adapted anti- neoplastic treatment. In addition to psychological burden, the neuropsychiatric aspects of childhood CNS tumours, including posterior fossa syndrome and cerebellar cognitive affective syndrome, are increasingly recognised as crucial causes of poor outcomes. The chapter ahead will initially address the shifting landscape of neuro-oncology, and then provide an overview of the neuropsychiatric aspects of CNS tumours in childhood, high lighting the underlying neurobiological and pathogenic mechanisms, whenever possible. syndrome, posterior fossa syndrome, cerebellar mutism, neuropsychiatric presentation, neuropsychiatric
自从Baily和Cushing首次提出颅神经系统(CNS)肿瘤的组织遗传学分类以来,90多年过去了。最近,我们对肿瘤发生的遗传和分子基础的知识已经引起了肿瘤遗传定义的重大范式转变,从而允许更高的诊断准确性和预后,以更好地指导肿瘤管理。相应地,综合管理和提高存活率方面的成功将注意力转移到总体生活质量研究上,心理社会后遗症和调整影响是心理健康专业人员特别感兴趣的。迄今为止,与该领域相关的研究主要集中在疾病表现时神经精神症状的识别上。这些研究表明,情绪、认知和社会心理功能是早期诊断、调节健康结果的重要因素,特别是在根治性和风险适应性抗肿瘤治疗后。除了心理负担外,儿童中枢神经系统肿瘤的神经精神方面,包括后窝综合征和小脑认知情感综合征,越来越多地被认为是不良预后的关键原因。接下来的章节将首先讨论神经肿瘤学的变化,然后提供儿童中枢神经系统肿瘤的神经精神方面的概述,并尽可能强调潜在的神经生物学和致病机制。症候群,后窝症候群,小脑性缄默症,神经精神症候群
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引用次数: 0
Vestibular Schwannoma: Microsurgery or Radiosurgery 前庭神经鞘瘤:显微外科或放射外科
Pub Date : 2018-08-22 DOI: 10.5772/INTECHOPEN.74508
A. Rizk
A vestibular schwannoma (VS) is a benign tumor that arises from the neurilemmal sheath of the vestibular nerve. VSs make up to 6–8% of all intracranial tumors and 70–80% of all cerebellopontine angle tumors. Three therapeutic options are currently considered for VS: expectant treatment, microsurgical resection, and radiosurgery. No class I evidence exists to support one treatment over the others, and some clinical aspects are usually taken into consideration in the decision-making process. Very few comparative studies published so far have addressed the clinical aspects supporting any one treatment modality. The pathology, diagnosis and treatment of VS are discussed in this chapter. Moreover, we aim in this chapter to discuss the results of the most recent clinical studies performed on different treatment strategies for VS. In addition, the results of the comparative studies between microsurgical and radiosurgical treatments for VS are discussed.
前庭神经鞘瘤(VS)是一种良性肿瘤,起源于前庭神经的神经鞘。VSs占颅内肿瘤的6-8%,占脑桥小脑角肿瘤的70-80%。目前考虑有三种治疗方案:期待治疗、显微外科手术切除和放射外科手术。没有一级证据支持一种治疗优于其他治疗,在决策过程中通常会考虑一些临床方面的因素。迄今为止发表的比较研究很少涉及支持任何一种治疗方式的临床方面。本章主要讨论VS的病理、诊断和治疗。此外,我们在本章的目的是讨论最新的临床研究的结果对不同的治疗策略VS.此外,显微外科和放射外科治疗VS的比较研究的结果进行了讨论。
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引用次数: 2
Trigeminal Schwannomas 三叉神经鞘瘤
Pub Date : 2018-08-22 DOI: 10.1097/01.cne.0000530178.41097.7e
Breno Nery, Marcelo Nery Silva, Rodrigo Antônio Fernandes Costa, Leandro César Tângari Pereira, Eduardo Quaggio, Fred Bernardes Filho, George Peter Stevens
Trigeminal schwannomas (TS) are rare entities occurring in various trigeminal nerve locations and present a peak incidence between the fourth and fifth decades of life, being more common in women. Patients usually present with symptoms of trigeminal nerve dysfunction. Depending on the tumor’s topography, various approaches might be used to obtain its gross total resection. Trigeminal schwannoma’s classification, nuances of the approaches, pathology, postoperative care, and outcomes are revised as follows. In conclusion, anatomical knowledge and the disease’s comprehension are essential when dealing with such lesions, and despite their rarity, we must be obstinately committed to the surgical technique and devoted to the patient’s functional postoperative outcome.
三叉神经鞘瘤(TS)是发生在三叉神经各个部位的罕见疾病,发病率在40岁至50岁之间达到高峰,在女性中更为常见。患者通常表现为三叉神经功能障碍。根据肿瘤的地形,可以使用不同的方法来获得肿瘤的总切除。三叉神经鞘瘤的分类,方法的细微差别,病理,术后护理和结果修订如下。总之,在处理这类病变时,解剖学知识和对疾病的理解是必不可少的,尽管它们很少见,但我们必须坚持手术技术,并致力于患者的术后功能结果。
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引用次数: 0
Modern Management of Craniopharyngioma 颅咽管瘤的现代治疗
Pub Date : 2018-08-22 DOI: 10.5772/INTECHOPEN.74512
Anirudh Penumaka and Ekkehard Kasper
Craniopharyngiomas (CPs) have had a prominent place in neurosurgery due to both the technical difficulty and controversy regarding the optimal treatment of these benign tumors. Harvey Cushing famously described craniopharyngiomas in 1936 as “the most forbidding of the intracranial tumors.” Seventy years later, Rutka still wrote: “There is no other primary brain tumor that evokes more passion, emotion, and as a result, controversy than does the CP.” Craniopharyngiomas comprise 1–2% of all brain tumors and occur in a bimodal distribution, with 40% of cases occurring between age 5–15 years and 60% occurring at ages >55 years. The differential diagnosis for craniopharyngioma can include a variety of entities, including pituitary macroadenoma, metastasis, Rathke’s cleft cyst, colloid cyst, glioma, meningioma, germinoma, abscess, sarcoid, or aneurysm. Imaging characteristics usually include a solid cystic lesion, speckled with calcifications in 50– 80% of craniopharyngiomas (especially pediatric patients), as well a presentation with hypopituitarism and diabetes insipidus, which influence clinical thinking toward establishing this diagnosis.
颅咽管瘤(CPs)在神经外科中占有突出的地位,这是由于技术上的困难和关于这些良性肿瘤的最佳治疗的争议。1936年,哈维·库欣(Harvey Cushing)将颅咽管瘤描述为“最可怕的颅内肿瘤”。70年后,Rutka仍然写道:“没有任何一种原发性脑肿瘤比CP更能引起人们的热情、情感和争议。颅咽管瘤占所有脑肿瘤的1-2%,呈双峰分布,40%的病例发生在5-15岁之间,60%发生在55岁以上。”颅咽管瘤的鉴别诊断包括多种类型,包括垂体大腺瘤、转移瘤、Rathke裂隙囊肿、胶质囊肿、胶质瘤、脑膜瘤、生殖细胞瘤、脓肿、肉瘤或动脉瘤。50% - 80%颅咽管瘤(尤其是儿童患者)的影像学特征通常为实性囊性病变,伴有斑点状钙化,并伴有垂体功能低下和尿崩症,这影响了临床对这种诊断的判断。
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引用次数: 1
Role of an Alternatively Spliced KCNMA1 Variant in Glioma Growth KCNMA1突变体在胶质瘤生长中的作用
Pub Date : 2018-08-22 DOI: 10.5772/INTECHOPEN.74509
D. Khaitan, N. Ningaraj, L. B. Joshua
Gliomas develop genetic traits to rapidly form aggressive phenotypes. Hence, man- agement of gliomas is complicated and difficult. Besides genetic aberrations such as oncogenic copy number variation and mutations, alternative mRNA splicing triggers prooncogenic episodes in many cancers. In gliomas, we found alternative splicing at the KCNMA transcription process. KCNMA1 encodes the pore forming α-subunit of large-conductance calcium-activated voltage-sensitive potassium (BK Ca ) channels. These channels play critical role in glioma invasion and proliferation. We identified a novel KCNMA1 mRNA splice variant with a deletion of 108 base pairs ( KCNMA1v ) mostly overexpressed in high grade gliomas. We found that KCNMA1 alternative pre-mRNA splicing enhanced glioma growth, progression and diffusion. The role of KCNMA1 and its splicing as a critical posttranscriptional regulator of BK Ca channel expression is pre- sented in this chapter. Our research implies that high grade gliomas express KCNMA1v and BK Ca channel isoform to accelerate growth and transformation to glioblastoma multiforme (GBM). We demonstrated that tumors hardly develop in mice injected with KCNMA1v transfected cell line expressing short-hairpin RNA (shRNA) compared to mice injected with KCNMA1v transected glioma cells. We conclude that targeting the KCNMA1 variants may be a clinically beneficial strategy to prevent or at least slow down glioma transformation to GBM .
胶质瘤发展遗传特征,迅速形成侵袭性表型。因此,胶质瘤的治疗是复杂和困难的。除了基因畸变,如致癌拷贝数变异和突变,可选的mRNA剪接在许多癌症中引发致癌事件。在胶质瘤中,我们在KCNMA转录过程中发现了选择性剪接。KCNMA1编码大电导钙激活电压敏感钾(bkca)通道成孔α-亚基。这些通道在胶质瘤的侵袭和增殖中起关键作用。我们发现了一种新的KCNMA1 mRNA剪接变体,缺失108个碱基对(KCNMA1v),主要在高级别胶质瘤中过表达。我们发现KCNMA1替代pre-mRNA剪接促进胶质瘤的生长、进展和扩散。本章介绍了KCNMA1及其剪接作为BK Ca通道表达的关键转录后调节剂的作用。我们的研究表明,高级别胶质瘤通过表达KCNMA1v和BK Ca通道异构体来加速多形性胶质母细胞瘤(GBM)的生长和转化。我们证明,与注射KCNMA1v转染的短发夹RNA (shRNA)细胞系的小鼠相比,注射KCNMA1v转染的胶质瘤细胞的小鼠几乎没有肿瘤发生。我们得出结论,靶向KCNMA1变异可能是一种临床有益的策略,可以预防或至少减缓胶质瘤向GBM的转化。
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引用次数: 3
Medulloblastoma 成神经管细胞瘤
Pub Date : 2018-08-22 DOI: 10.5772/intechopen.76783
Asifur Rahman
Among the pediatric brain tumors, medulloblastoma (MB) is the most common solid variety and entirely occur in the posterior fossa with tendency to seed into CSF spaces. Despite innovations in technological developments and understanding of tumor biology, modern imaging facilities, advances in surgical practices, and newer chemotherapeutic and radiation techniques, this malignant type of tumor continues to be a formidable entity. Even though, the outcome in terms of survival rate is better than any time before, the overall result is still disappointing. With advances in management strategy, chances of survival with good quality of life have been amplified, where newer targeted thera pies and rehabilitation plays an immense role. While the adverse effects of surgery and adjuvant therapies are still on play, researchers are trying ceaselessly to minimize those to give maximum wellbeing to these unfortunate children.
在儿童脑肿瘤中,髓母细胞瘤(MB)是最常见的实性肿瘤,完全发生于后窝,有向脑脊液间隙播散的趋势。尽管在技术发展和对肿瘤生物学的理解、现代成像设备、外科实践的进步以及更新的化疗和放疗技术方面有了创新,这种恶性肿瘤仍然是一个令人生畏的实体。尽管在存活率方面的结果比以往任何时候都好,但总体结果仍然令人失望。随着管理策略的进步,生活质量良好的生存机会已经扩大,其中新的针对性治疗和康复发挥了巨大的作用。虽然手术和辅助治疗的副作用仍在发挥作用,但研究人员正在不断努力将其最小化,以最大限度地为这些不幸的孩子带来幸福。
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引用次数: 0
Current Trends in Glioblastoma Treatment 胶质母细胞瘤治疗的当前趋势
Pub Date : 2018-03-15 DOI: 10.5772/INTECHOPEN.75049
L. Tătăranu, V. Ciubotaru, T. Cazac, OanaAlexandru, O. Purcaru, D. Tache, S. Artene, A. Dricu
Glioblastoma (also called glioblastoma multiforme – GBM) is a primary brain neoplasm, representing about 55% of all gliomas. It is a very aggressive and infiltrative tumor. Glioblastoma is usually highly malignant, with more than 90% 5-year mortality and a median survival of about 14.6 months. Compared to other cancers, the survival rate has not greatly changed over time and no current treatment is curative for this disease. Because the tumor has a heterogeneous cell population containing several types of cells, the treatment for GBM is one of the most challenging in clinical oncology. This chapter will discuss the current approaches in glioblastoma treatment, including resection techniques, chemotherapy and radiation GBM, postoperative reactive changes and parenchymal damage as a result of surgery. Postoperative contrast-enhancing tumor mass is typically used to delineate residual GBM and completeness of removal. It is better to use volumetric analysis of the preopera tive and postoperative tumor to accurately measure EOR and residual volume (RV). Reactive postoperative changes can be seen as early as 18 hours on MRI, but usually does not appear in the first 3–4 days. The EOR was identified as a strong prognostic factor for survival in GBM, together with patient’s age and patient’s functional status. Surgical removal has a critical role in GBM management because the only potentially modifiable risk factor associated with survival is EOR. The gross-total resection is not always possible. Thus, several studies have been conducted to evaluate EOR threshold which may serve as minimum surgical goal to achieve. Other studies demonstrated that EOR is not an ideal indicator to the success of the surgery, because it is a percentage value, reported to initial volume of the tumor, which can vary widely. Contrast-enhancing RV is considered a more clinically relevant measure and a stronger predictor of survival than EOR, representing the tumor mass existing prior to starting medical therapy. Chaichana et al. in 2014 evaluated newly diagnosed GBM patients who
胶质母细胞瘤(也称为多形性胶质母细胞瘤- GBM)是一种原发性脑肿瘤,约占所有胶质瘤的55%。它是一种非常具有侵袭性和浸润性的肿瘤。胶质母细胞瘤通常是高度恶性的,5年死亡率超过90%,中位生存期约为14.6个月。与其他癌症相比,这种疾病的存活率并没有随着时间的推移而发生很大的变化,目前也没有治疗方法可以治愈这种疾病。由于肿瘤具有包含多种类型细胞的异质性细胞群,因此GBM的治疗是临床肿瘤学中最具挑战性的治疗之一。本章将讨论目前胶质母细胞瘤的治疗方法,包括切除技术、化疗和放疗、术后反应性改变和手术引起的实质损伤。术后对比增强肿瘤肿块通常用于描述残留的GBM和切除的完整性。术前和术后肿瘤体积分析能准确测量EOR和残留体积(RV)。术后反应性改变最早可在MRI上看到18小时,但通常在最初的3-4天内不会出现。EOR与患者的年龄和患者的功能状态一起被认为是GBM生存的一个重要预后因素。手术切除在GBM治疗中起着关键作用,因为与生存相关的唯一潜在可改变的风险因素是EOR。总切除并不总是可行的。因此,已经进行了几项研究来评估EOR阈值,该阈值可以作为实现的最低手术目标。其他研究表明,EOR并不是手术成功的理想指标,因为它是一个百分比值,报告肿瘤的初始体积,差异很大。对比增强RV被认为是比EOR更具有临床相关性和更强的生存预测指标,代表了开始药物治疗前存在的肿瘤肿块。Chaichana等人在2014年评估了新诊断的GBM患者
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引用次数: 6
Stem Cell Research for the Treatment of Malignant Glioma 干细胞治疗恶性胶质瘤的研究
Pub Date : 2017-12-20 DOI: 10.5772/INTECHOPEN.72504
R. Tamura, M. Toda
Glioblastoma is the most aggressive brain tumor. Gene therapies, such as cytokine-based, suicide gene, and oncolytic virus therapies, are different types of treatments from chemo therapy such as using temozolomide as a standard treatment. However, overall survival was not prolonged in some clinical trials because of the low efficiency of gene transduc tion and viral infection. Neural stem cells (NSCs) have tumor trophic migratory capacity and can be cellular delivery vehicles of cytokines, suicide genes, and oncolytic virus. NSCs can be differentiated from embryonic stem cells. In addition, mesenchymal stem cells can be another cellular delivery vehicle. Recently, induced pluripotent stem cells (iPSCs) have been established. iPSCs are multipotent; hence, they can efficiently differentiate to NSCs and can possibly overcome ethical and practical issues in clinical application. In this study, current topics about stem cell therapy for malignant glioma are reviewed.
胶质母细胞瘤是最具侵袭性的脑肿瘤。基因疗法,如细胞因子、自杀基因和溶瘤病毒疗法,是不同于化疗的治疗方法,如使用替莫唑胺作为标准治疗方法。然而,在一些临床试验中,由于基因转导效率低和病毒感染,总生存期没有延长。神经干细胞(NSCs)具有肿瘤营养迁移能力,可以作为细胞因子、自杀基因和溶瘤病毒的细胞递送载体。NSCs可以从胚胎干细胞中分化出来。此外,间充质干细胞可以作为另一种细胞传递载体。近年来,诱导多能干细胞(iPSCs)已被建立。多能干细胞是多能的;因此,它们可以有效地分化为NSCs,并有可能克服临床应用中的伦理和实际问题。本文就干细胞治疗恶性胶质瘤的研究现状进行综述。
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引用次数: 0
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Brain Tumors - An Update
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