Chinese Neurosurgical Journal最新文献

BACKGROUND : Chondrosarcoma is a rare and malignant tumor in the sellar region. Due to the limited understanding of its oncological behavior, it is often misdiagnosed as other lesions, such as chordoma or invasive pituitary adenoma. In the past, craniotomy was considered the primary treatment option. However, with the advancement of neuroendoscopic techniques, many centers have begun adopting endoscopic approaches for this disease. In this article, we summarized our case series and reviewed the previous papers to evaluate the clinical outcomes of neuroendoscopic resection for sellar chondrosarcomas.

Methods: Four patients with sellar chondrosarcomas who underwent tumor resection by endonasal endoscopic approach (EEA) in our institute from 2017 to 2021 were reviewed. In addition, we reviewed the current literatures on sellar chondrosarcomas.

Results: Our series included 4 patients, and 8 cases of sellar chondrosarcomas were reported in previous literatures. In the pooled cohort, there were 6 males and 6 females. The median age at diagnosis was 28.5 years (interquartile range, 22.8-39.3). The most common clinical presentation was blurring of vision (66.7%) and headache (50%). The incidence of preoperative endocrine disorder in such patients was 33.3%; these abnormalities could return to normal after surgery. Complete resection and incomplete resection were achieved in 7 (58.3%) and 5 (41.7%) cases, respectively. Among the 12 patients, only one patient was diagnosed with chondrosarcoma preoperatively; other patients were misdiagnosed with chordoma (n = 5; 41.7%), invasive non-functioning pituitary adenoma (INPA) (n = 4; 33.3%), or craniopharyngioma (n = 2; 16.7%).

Conclusions: The preoperative diagnosis of sellar chondrosarcoma remains challenging and often requires differentiation from chordoma, INPA, or craniopharyngioma. When a calcified mass in the sellar region presents with intact or slightly disturbed anterior pituitary function, heterogeneous enhancement and no diffusion restriction on Magnetic Resonance Imaging(MRI) sequences, and surrounding bony destruction and bony attachment on Computed Tomography(CT) scans, a chondrosarcoma should be suspected preferentially. Complete resection is the optimal goal for the management of sellar chondrosarcoma, but adjuvant radiotherapy and periodic follow-up should be highlighted.

Background: The increased permeability of the blood-brain barrier (BBB) is related to the occurrence and development of diseases such as acute ischemic stroke, chronic ischemia, or small vessel disease. Patients with carotid artery stenosis have chronic ischemia. The exact effect of carotid endarterectomy on the blood-brain barrier is still unclear. The aim of the study was to assess the effect of carotid endarterectomy on basic perfusion parameters and permeability surface area-product (PS).

Methods: The study included a total of 17 subjects (13 men), of which bilateral carotid artery stenosis was greater than 70%. All patients underwent unilateral carotid endarterectomy. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after operation: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material.

Results: Before surgery, the operative side exhibited significantly lower CBF (p = 0.001) and prolonged MTT (p = 0.002) and TTP (p = 0.001) compared to the nonoperative side, while PS and CBV showed no significant differences. After carotid endarterectomy, only the operative side demonstrated improvements, with CBV increasing by 9.4%, MTT decreasing by 20.3%, TTP decreasing by 14.1%, and PS decreasing by 27.5% (all p < 0.01). No significant changes were observed on the nonoperative side.

Conclusions: Carotid endarterectomy augmented BBB permeability can be controlled by carotid endarterectomy in patients with carotid artery stenosis.

Background: Previous studies on the risk factors and prognosis of acute stroke in pregnancy and puerperium (ASPP) mainly used European and American national healthcare databases, lacking detailed patient-level data and precise event timing.

Aim: (1) To identify the risk factors and prognostic factors for ASPP, (2) to assess the risk of recurrent stroke, particularly during subsequent pregnancies, and (3) to evaluate offspring prognosis.

Design: This study is a retrospective, observational, nationwide, multicenter research project planned to include 400 ASPP patients from 36 centers across 22 provinces in China, from 2015 to 2024. ASPP is defined as acute ischemic or hemorrhagic stroke during pregnancy or within 6 weeks postpartum, confirmed by neuroimaging. Two matched groups will be included for comparison: 400 pregnant/puerperal participants without a stroke history and 400 nonpregnant/puerperal participants with a recent stroke, matched by age and/or stroke etiology.

Methods: All participants will be followed up through telephone interviews. The initial follow-up is scheduled to take place between December 2024 and February 2025. The follow-up phase will consist of three rounds, each lasting 3 months and conducted every 3 years. Primary outcomes include unfavorable functional outcomes (mRS > 2 or EQ-5D index score < 0.7) at follow-up for Aim 1, recurrent strokes (neuroimaging-confirmed) for Aim 2, and neonatal asphyxia (Apgar scoring) and future development (ASQ-3) of offspring for Aim 3.

Discussion: The ASPP study is the first nationwide multicenter study to systematically evaluate the risk factors, prognosis, and risk of recurrent stroke in ASPP patients, particularly during subsequent pregnancies. This research may offer new insights into the long-term impacts of pregnancy-related stroke.

Trial registration: ClinicalTrials.gov (NCT06527807).

Glioblastoma (GBM) is the most aggressive and common primary brain malignancy in adults, characterized by poor prognosis and treatment resistance. Despite advancements in treatment options, the median survival is roughly 15 months, underlining the need for novel and effective treatments. Artificial intelligence (AI) has emerged as a transformative technology in healthcare, offering outstanding capabilities in data analysis, pattern recognition, and helping in decision-making. This review explores the current and potential role of AI in GBM care, focusing on its applications in diagnosis, treatment planning, prognostication, and drug discovery. AI-based algorithms have demonstrated promising potential in enhancing diagnostics through imaging analysis, radiomics, and tumor segmentation. These technologies could enable non-invasive molecular profiling and early detection of GBM. In treatment planning, AI could improve approaches by optimizing surgical resection, radiotherapy regimen, and chemotherapy protocols. Furthermore, machine learning models can integrate multimodal data to develop personalized treatments. They can also enhance prognostication by predicting survival, recurrence, and treatment responses, helping clinicians to make more informed decisions. AI is also revolutionizing pharmacotherapy by identifying novel molecular targets and optimizing combination therapies. Despite notable progress, challenges persist. Limited data quality and quantity, algorithm interpretability, integration problems, and ethical considerations, remain significant challenges to clinical implementation. This review emphasizes the need for continued research and interdisciplinary collaboration to overcome many barriers and realize the transformative potential of AI in GBM care.

Background: Gliomas represent the most prevalent primary neoplasm in the adult central nervous system. Despite advancements in therapeutic modalities, such as surgical intervention, radiotherapy, chemotherapy, and tumor treatment, the 5-year survival rate of glioma patients remains low. Therefore, there is an urgent need to develop additional treatment methods. Recent studies have suggested that FAM111B is involved in DNA repair, cell cycle regulation, and apoptosis. FAM111B mutations and overexpression are related to cancer.

Methods: We found that FAM111B was significantly overexpressed in glioma tissues compared to the adjacent tissues by analyzing data from the TCGA_GBM&LGG and CGGA databases. Moreover, overexpression of FAM111B was associated with shorter overall survival, and disease-specific survival and tended to increase with disease stage progression. Cellular experiments confirmed these results. These results suggest that overexpression of FAM111B promotes the proliferation, migration, and invasion of glioma cells, whereas the knockdown of FAM111B inhibits these activities. We also found that FAM111B regulated glioma cell proliferation, migration, and invasion via the PI3K/AKT pathway.

Results: FAM111B is capable of enhancing the proliferation, invasion, and migration capabilities of glioma cells and promotes the malignant progression of glioma via the PI3K/Akt signaling pathway.

Conclusions: This is the first study to demonstrate that FAM111B plays a crucial role in the proliferation, migration, and invasion of glioma cells. The malignant phenotype of FAM111B has also been shown to be closely associated with the PI3K/AKT pathway. FAM111B may be a predictive biomarker and a potential therapeutic target for gliomas.

Background: Intracranial aneurysm is a leading cause of subarachnoid hemorrhage and affects approximately 7% of the Chinese population, posing a significant public health concern. Due to the lack of a national cohort of unruptured intracranial aneurysms (UIAs) in China, optimal surgical management for UIAs remain insufficiently explored.

Methods: The China Treatment Trial for Unruptured Intracranial Aneurysm (ChTUIA) is a national, prospective, observational, multi-center registry study designed to identify optimal surgical management for UIAs in the Chinese population. Eligible patients were recruited from 83 regional neurological centers in China between December 2021 and December 2022. All patients will be followed up routinely for at least two years.

Results: A total of 25,438 patients with UIAs have been enrolled in the study, of whom 9794 (38.5%) were male, with a median age of 59 years (interquartile range: 52-67 years). The mean follow-up period was 4.28 years (interquartile range: 2.86-6.37 years). Among the patients, 6,712 (26.4%) patients underwent microsurgical clipping, and 18,726 (73.6%) patients underwent endovascular treatment, including 3,017 (16.1%) receiving coil alone or balloon-assisted coiling, 11,431 (61.1%) underwent stent-assisted coiling, and 4,278 (22.8%) treated with flow diverters. Comprehensive data collection encompassed 874,890 demographic and clinical records, 42,109 radiological records, 13,528 hemodynamic records, and 12,727 biological records, with a lost-to-follow-up rate of 5.4% and a data-missing rate of 8.3%.

Conclusions: The ChTUIA study represents the first national prospective investigation into surgical management protocols and treatment trends toward UIAs in the Chinese population. This study will provide critical evidence to guide the clinical management of UIA patients.

Trial registration: NCT05844163 ( https://clinicaltrials.gov/study/NCT05844163 ).

Background: Most cases of acute subdural hematoma (ASDH) require emergency surgery; only a few patients can survive without surgery in the early stages and then develop into subacute subdural hematoma (sASDH). However, the optimal conservative treatment has not yet been established for these sASDH patients. Based on our previous studies, atorvastatin plus dexamethasone may be safe and effective for them. This article aims to document such cases and analyze the possible mechanisms.

Case presentation: We selected five patients with sASDH who received a treatment regimen of atorvastatin plus low-dose dexamethasone without surgery. We then observed the clinical and radiological features during treatment and follow-up. The PubMed database and Google Scholar were retrieved for literature regarding the efficacy and safety of conservative treatment in patients with ASDH/sASDH. We extracted information including authors, sample size, gender, number of patients (death, poor prognosis, delayed surgery), and risk factors.

Results: Of the five patients, all patients who refused surgery for various reasons were resolved after treatment with atorvastatin plus low-dose dexamethasone for their conditions. No hematomas recurred or progressed during an at least 6-month follow-up. We identified 6 studies after searching the database; a total of 1374 patients (F:M = 3:7) with ASDH/sASDH received initial conservative treatment. The pooled results showed that 13.1% of patients who initially received conservative treatment deteriorated and required delayed surgical treatment. Of 1374, the overall incidence of poor prognosis was 19.2%, and 7% of patients eventually died.

Conclusions: It is essential to establish an optimal conservative treatment for patients with sASDH who cannot undergo surgery in an emergency for various reasons. Atorvastatin plus dexamethasone may be an alternative treatment in such a subgroup of sASDH, although a randomized proof-of-concept clinical trial is needed.

Background: Leukemia complicated by central nervous system (CNS) lesions (LCNSL) includes leukemia involving the CNS (CNSL) and CNS secondary lesions related to leukemia treatment (e.g., CNS infections, leukoencephalopathy, inflammatory demyelination, and vascular diseases). The clinical manifestations and imaging characteristics of different types of LCL are similar, increasing the possibility of misdiagnosis. This study aimed to enhance our understanding and management of LCL.

Methods: We retrospectively collected clinical data from 22 patients with LCL and analyzed their magnetic resonance imaging and pathological characteristics. Pathological diagnoses were made using stereotactic intracranial puncture biopsy.

Results: Between April 2003 and December 2023, 22 patients with LCL were admitted, including 18 males and 4 females aged 7-71 years. Bone marrow aspiration identified 14 cases of acute lymphoblastic leukemia (ALL), one of chronic lymphoblastic leukemia, six of acute myeloid leukemia (AML), and one of chronic myelomonocytic leukemia (CMML). Most patients presented with non-specific symptoms, including headache, nausea, vomiting, limb convulsions, and changes in mental status. A few patients had localized neurological deficits, such as limb weakness and blurred vision. Common systemic symptoms included fever, night sweats, and weight loss. The pathological diagnoses of the 22 patients were CNSL in 13 patients, CNS infections in five patients, and neurodegenerative diseases in four patients. Discrepancies were found between the clinical and pathological diagnoses in eight cases.

Conclusions: Stereotactic intracranial lesion biopsy is minimally invasive, safe, convenient, and critical in the early and differential diagnosis of LCL. Early identification of the lesions' nature and timely implementation of accurate and precise treatments can improve patient prognosis.

Background: Tumor-treating fields (TTFields) therapy and radiotherapy may have synergistic anti-glioma effect based on preclinical studies. The combination of chemoradiation therapy (CRT) with TTFields therapy has noticeably attracted clinicians' attention. This study aimed to provide insights into the clinical outcomes of patients with newly diagnosed glioblastoma who received either concurrent CRT and TTFields therapy or adjuvant TTFields therapy following CRT. The findings were based on a cohort of patients who were treated at Huashan Hospital (Shanghai, China).

Methods: This retrospective study analyzed ndGBM patients' clinical outcomes who were treated at Huashan Hospital and received TTFields therapy. Patients were categorized into two groups: one group received adjuvant TTFields therapy after completing CRT (referred to as the A-TTF group), while the other received TTFields therapy concurrently with CRT and continued TTFields after treatment (referred to as the CA-TTF group). The study evaluated treatment efficacy and toxicities, comparing outcomes between the two groups. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. To mitigate confounding factors, efficacy was assessed using the Cox proportional hazards regression model, propensity score matching, and inverse probability of treatment weighting (IPTW) based on the propensity score.

Results: A total of 72 patients with ndGBM were included in the study. Among them, 41 patients received concurrent and adjuvant TTFields therapy in combination with CRT (CA-TTF group), and 31 patients received adjuvant TTFields therapy with temozolomide (A-TTF group). The median follow-up time was 18.0 months. No significant differences were observed in median PFS (14.2 vs. 15.0 months, P = 0.92) or OS (20.8 vs. 20.0 months, P = 0.92) between the CA-TTF and A-TTF groups. Skin toxicity was common, while manageable, with no significant difference between the two groups. Following IPTW adjustment, the hazard ratios for PFS and OS indicated a potential advantage for the CA-TTF group, although this difference was not statistically significant.

Conclusion: Concurrent CRT and TTFields therapy emerged safe for newly diagnosed GBM patients. Although no significant survival differences were found between the CA-TTF and A-TTF groups, the potential benefit of concurrent TTFields warrants further investigation through large-scale clinical trials.

Background: Although stent-assisted coiling has become a standard approach for treating intracranial aneurysms (IAs), there are limited reports on its safety and effectiveness in parent artery less than 2.5 mm in diameter. This study evaluates the feasibility, safety, and short-term outcomes of using Neuroform Atlas stent-assisted coiling for IAs with small parent vessels.

Methods: This study reviewed and analyzed the clinical data of 50 IAs in 50 patients with a parent artery diameter of ≤ 2.5 mm, treated with Neuroform Atlas stent-assisted coiling at a single center between November 2020 and April 2024. Immediate postoperative angiographic outcomes were assessed using the modified Raymond-Roy classification. Follow-up imaging included computed tomographic angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). Clinical outcomes were evaluated using the modified Rankin Scale (mRS).

Results: The procedures achieved a 100% success rate. Immediately after treatment, 24 cases were classified as Raymond-Roy grade I, 11 as grade II, and 15 as grade III. Follow-up angiography in 28 cases revealed three instances of aneurysm recurrence, with a secondary procedure performed in one case. One patient reported poor neurological status, and two cases experienced procedure-related adverse events during telephone or clinical follow-up. Conclusions the Atlas stent demonstrated favorable outcomes in the treatment of aneurysms in small parent arteries (< 2.5 mm), with a low complication rate. The timely postoperative use of tirofiban may further reduce the risk of ischemic complications.