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Facial Nerve Outcomes Following Microsurgical Resection of Large Cerebellopontine Angle Tumors: Experience From a Tertiary Care Center in Pakistan.
Pub Date : 2026-01-01 DOI: 10.14791/btrt.2025.0005
Shah Khalid, Salaar Ahmed, Komal Naeem, Ahmad Hassan, Mehar Masroor, Altaf Ali Laghari, Syed Ather Enam

Background: Cerebellopontine angle (CPA) tumors present surgical challenges due to their proximity to the facial nerve. Despite preservation efforts, facial nerve paresis is a major issue. This study aims to identify key factors affecting facial nerve preservation during microsurgical resection of large CPA tumors in a low- and middle-income countries (LMIC) setting.

Methods: This retrospective cross-sectional study, conducted at Aga Khan University, included patients who underwent microsurgical resection of large (>3 cm) CPA tumors with House-Brackmann (HB) grades 1-4. Postoperative facial nerve function was assessed using the HB grading system. Data was extracted from medical records and analyzed using SPSS 22.

Results: This study analyzed 95 patients (M:F=1:1.16, mean age 44.24±13.71 years) with CPA tumors who underwent microsurgical resection. Common presenting complaints included a complete hearing loss (57.9%), headache (52.6%), and abnormal gait (40%). Preoperative facial nerve function was normal (HB grade I) in 75%, with 19%, 7%, and 2% having HB grades II, III, and IV, respectively. Schwannoma (69.5%), meningioma (16.8%), and epidermoid cyst (10.5%) were the most common diagnoses. Postoperative preservation of facial nerve function was achieved in 73.7% of patients. At six months, HB grades I and II were observed in 64% and 11.5%, respectively, while none had complete facial nerve palsy. On univariate analysis, larger tumor size and higher HB grade correlated with worse facial nerve outcomes (p=0.02). Complications were more frequent in patients with worsened outcomes (72% vs. 38.6%, p=0.004). However, in multivariate analysis, only preoperative HB grade was identified as a predictor.

Conclusion: Facial nerve preservation during CPA tumor resection is influenced by intrinsic tumor characteristics, surgical complexity, and patient-specific factors. Detailed preoperative counseling is crucial to set realistic expectations.

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引用次数: 0
Current Perspectives on Pediatric Low-Grade Gliomas: Focus on BRAF and MEK Inhibition.
Pub Date : 2026-01-01 DOI: 10.14791/btrt.2025.0026
Jin Kyung Suh, Kyung-Nam Koh

Pediatric low-grade gliomas (pLGGs) are the most common childhood central nervous system tumors and are frequently driven by alterations in the RAS/mitogen-activated protein kinase (RAS/MAPK) signaling pathway. Advances in molecular profiling have revealed key genetic drivers, including BRAF mutations, BRAF fusions, and other kinase gene rearrangements, enabling the development of genotype-guided targeted therapies. First-generation BRAF inhibitors and mitogen-activated protein kinase kinase (MEK) inhibitors have demonstrated significant clinical benefit in molecularly selected patient subgroups, prompting FDA approvals and a paradigm shift away from traditional chemotherapy. However, challenges such as resistance mechanisms, treatment durability, and long-term toxicities persist. This review summarizes the molecular landscape of pLGG, highlights current and emerging targeted therapies, and discusses unresolved issues including optimal treatment duration, toxicity management, and future directions for individualized care.

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引用次数: 0
Spontaneous Regression of Incidental Meningioma in the Posterior Cranial Fossa: A Case Report and Literature Review. 后颅窝偶发性脑膜瘤自发性消退1例报告及文献复习。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0012
Min Seok Kim, So Hee Park, Youngbeom Seo

We report a rare case of spontaneous regression of a meningioma located in the posterior cranial fossa. A 60-year-old female patient presented with a headache. Both physical and neurological examinations were normal. Her medical history included type 2 diabetes mellitus. MRI showed a homogeneously enhancing mass in the left cerebellopontine angle. The volume of the tumor was 1.673 cm³. Radiological features, including the dural tail sign and the cerebrospinal fluid cleft sign, suggested the presence of a meningioma. Given these characteristics, we recommended serial follow-up MRI examinations. Unfortunately, the patient was lost to follow-up. Ten years later, she returned with a headache to reevaluate the previously diagnosed tumor. The follow-up MRI revealed significant regression and increased intratumoral calcification, with the tumor now measuring only 0.256 cm³. This report illustrates that meningiomas diagnosed incidentally can undergo spontaneous regression, a phenomenon that clinicians should be aware of.

我们报告一例罕见的脑膜瘤自发性消退位于颅后窝。60岁女性患者,以头痛为主诉。身体和神经检查均正常。她的病史包括2型糖尿病。MRI显示左侧桥小脑角均匀增强肿块。肿瘤体积1.673 cm³。影像学表现,包括硬脑膜尾征和脑脊液裂征,提示脑膜瘤的存在。鉴于这些特点,我们建议进行连续随访MRI检查。不幸的是,患者未能随访。十年后,她带着头痛回来重新评估先前诊断的肿瘤。随访MRI显示肿瘤明显消退,瘤内钙化增加,目前肿瘤尺寸仅为0.256 cm³。本报告说明偶然诊断的脑膜瘤可发生自发消退,这是临床医生应注意的现象。
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引用次数: 0
Resolution of Hyperprolactinemia Caused by Pituitary Stalk Compression After Transsphenoidal Surgery for Pituitary Tumors. 垂体瘤经蝶窦手术后垂体柄受压所致高催乳素血症的解决。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0028
Myungsuk Oh, Eui Hyun Kim

Background: Hyperprolactinemia caused by pituitary stalk compression is common in patients with pituitary tumors. There is a lack of studies investigating the resolution patterns or time course of hyperprolactinemia after surgery. We aimed to demonstrate the time course of changes in prolactin levels following successful surgical decompression of the pituitary stalk.

Methods: We retrospectively examined 201 patients with preoperative hyperprolactinemia caused by the pituitary stalk compression effect who underwent transsphenoidal surgery. Postoperative prolactin levels were assessed at the time points of 1 week; 1, 3, and 6 months; and 1 year following the surgery. As a subgroup analysis, 115 individuals underwent serial prolactin level measurements at 6, 12, 18, 24, 48, and 72 hours after surgery.

Results: Hyperprolactinemia caused by pituitary stalk compression was resolved in 71.64% of patients 1 week after surgery, 84.84% after 1 month, 89.30% after 3 months, and 92.67% after 6 months, and 92.74% eventually reached normalization 1 year after surgery. Among the 35 patients whose prolactin levels were measured in the immediate postoperative period, 26 patients (72.49%) reached remission status within 72 hours. The immediate postoperative prolactin level was most predictive at 72 hours after surgery, with an optimal cutoff of 23.10 ng/mL.

Conclusion: The postoperative resolution of hyperprolactinemia caused by stalk compression was possible in 90% within a year. The decline in serum prolactin levels typically began within the first 72 hours after surgery, indicating that the hormonal response to surgical decompression is very prompt and effective.

背景:垂体柄受压引起的高催乳素血症在垂体肿瘤患者中很常见。手术后高泌乳素血症的消退模式和时间过程缺乏研究。我们旨在证明垂体柄成功手术减压后催乳素水平变化的时间过程。方法:回顾性分析201例术前垂体柄压迫致高泌乳素血症患者行经蝶窦手术。术后1周时间点评估泌乳素水平;1、3、6个月;手术后1年。作为亚组分析,115名患者在手术后6、12、18、24、48和72小时接受了催乳素水平的连续测量。结果:垂体柄压迫引起的高催乳素血症在术后1周、1个月、3个月、6个月分别有71.64%、84.84%、89.30%和92.67%的患者得到缓解,92.74%的患者在术后1年最终恢复正常。术后即刻检测催乳素水平的35例患者中,26例(72.49%)在72小时内达到缓解状态。术后即刻催乳素水平在术后72小时最具预测性,最佳临界值为23.10 ng/mL。结论:茎部压迫引起的高催乳素血症在术后一年内有90%的可能性得到缓解。血清催乳素水平的下降通常在手术后72小时内开始,表明激素对手术减压的反应是非常迅速和有效的。
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引用次数: 0
Sonodynamic Therapy With Orally Absorbable Nanomedicine for Brain Tumor. 口服可吸收纳米药物对脑肿瘤的声动力治疗。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0023
Chaerim Yoo, Jihyeon Kim, Dong Yun Lee

Glioblastoma (GBM) is an aggressive and treatment-resistant brain tumor with poor prognosis despite surgery, radiotherapy, and chemotherapy. Sonodynamic therapy (SDT), which combines low-intensity focused ultrasound with systemically or orally administered sonosensitizers, has emerged as a promising non-invasive approach to achieve localized tumor cell killing via reactive oxygen species. Recent advances in nanomedicine have enabled the development of orally absorbable, blood-brain barrier permeable delivery systems that enhance tumor targeting and ultrasound responsiveness. Preclinical studies have demonstrated consistent anti-tumor efficacy and immune activation, while early clinical trials suggest SDT is safe, feasible, and potentially effective in recurrent GBM. This review outlines recent progress in SDT-based strategies for GBM, with emphasis on mechanistic insights, delivery innovations, and clinical translation.

胶质母细胞瘤(GBM)是一种侵袭性和治疗耐药的脑肿瘤,尽管手术、放疗和化疗,预后都很差。声动力疗法(SDT)将低强度聚焦超声与系统或口服超声增敏剂相结合,已成为一种有前途的非侵入性方法,可通过活性氧实现局部肿瘤细胞杀伤。纳米医学的最新进展使口服可吸收、血脑屏障可渗透的给药系统得以发展,从而增强肿瘤靶向性和超声反应性。临床前研究显示出一致的抗肿瘤疗效和免疫激活,而早期临床试验表明SDT对复发性GBM是安全、可行和潜在有效的。本综述概述了基于sdt的GBM治疗策略的最新进展,重点是机制见解、交付创新和临床转化。
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引用次数: 0
Neural Vulnerabilities in Glioblastoma: Rethinking Therapy Through Neuroactive Drug Repurposing. 胶质母细胞瘤的神经脆弱性:通过神经活性药物再利用重新思考治疗。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0024
Paola Onate Colobon, Sohyon Lee

Glioblastoma, the most common and highly aggressive brain cancer, remains challenging to treat with limited gains in patient survival despite decades of research. Significant obstacles in developing new effective therapies for glioblastoma include the blood-brain barrier impeding drug delivery, inter- and intra-tumoral patient heterogeneity, and the lack of predictive preclinical models. Emerging insights from cancer neuroscience suggest that leveraging the neurodevelopmental and neurophysiological properties of glioblastoma may offer a new therapeutic window. In this context, neuroactive drugs (NADs) that are already approved for other central nervous system indications and can readily cross the blood-brain barrier may target these neural properties of glioblastoma through still unknown mechanisms. This review discusses existing preclinical models for glioblastoma drug discovery, explores how the tumor's neural-like behavior opens new therapeutic opportunities, and highlights the recent evidence supporting the repositioning of NADs as a paradigm shift in glioblastoma treatment.

胶质母细胞瘤是最常见和高度侵袭性的脑癌,尽管数十年的研究,但治疗仍然具有挑战性,患者生存率有限。开发胶质母细胞瘤新有效疗法的重大障碍包括血脑屏障阻碍药物输送,肿瘤间和肿瘤内患者异质性,以及缺乏预测性临床前模型。来自癌症神经科学的新见解表明,利用胶质母细胞瘤的神经发育和神经生理特性可能提供一个新的治疗窗口。在这种情况下,已经被批准用于其他中枢神经系统适应症并且可以轻易穿过血脑屏障的神经活性药物(NADs)可能通过尚不清楚的机制靶向胶质母细胞瘤的这些神经特性。这篇综述讨论了胶质母细胞瘤药物发现的现有临床前模型,探讨了肿瘤的神经样行为如何开辟新的治疗机会,并强调了最近支持NADs重新定位为胶质母细胞瘤治疗范式转变的证据。
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引用次数: 0
Erdheim-Chester Disease Mimicking a Malignant Pituitary Stalk Tumor With Ventricular Dissemination: A Case Report. 厄德海姆-切斯特病模拟恶性垂体柄瘤伴室性播散一例报告。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0029
Myungsuk Oh, Se Hoon Kim, Eui Hyun Kim

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis characterized by multi-organ involvement, most commonly affecting the long bones, retroperitoneum, heart, lungs, skin, and central nervous system (CNS). Approximately half of reported cases exhibit CNS involvement, which may affect both intra- and extra-axial compartments. On MRI, ECD typically presents as a strongly enhancing mass lesion, often mimicking neoplastic or infectious conditions. With advances in genetic understanding, ECD is now recognized as a hematologic malignancy of histiocytic origin, driven by mutations in key components of the MAPK signaling pathway. Among these, the BRAF mutation is the most frequently observed genetic alteration and often provides a valuable clue for differential diagnosis. However, in cases lacking typical clinical features and the absence of BRAF mutation, diagnosis becomes significantly more challenging. We report the case of a 32-year-old man who presented with a pituitary stalk mass and ventricular dissemination, ultimately diagnosed with BRAF wild-type ECD harboring a CSF1R mutation, which has recently been implicated as a potential driver within the MAPK pathway. A deeper understanding of the molecular pathogenesis of ECD may not only aid in accurate diagnosis but also contribute to improved clinical outcomes.

Erdheim-Chester病(ECD)是一种罕见的非朗格汉斯细胞组织细胞增多症,其特征是多器官受累,最常影响长骨、腹膜后、心脏、肺、皮肤和中枢神经系统(CNS)。大约一半的报告病例表现出中枢神经受累,这可能影响轴内和轴外室。在MRI上,ECD通常表现为强烈增强的肿块病变,通常模仿肿瘤或感染性疾病。随着遗传学理解的进步,ECD现在被认为是一种起源于组织细胞的血液恶性肿瘤,由MAPK信号通路关键成分的突变驱动。其中,BRAF突变是最常见的基因改变,通常为鉴别诊断提供有价值的线索。然而,在缺乏典型临床特征和没有BRAF突变的病例中,诊断变得更具挑战性。我们报告了一名32岁男性的病例,他表现为垂体柄肿块和心室播散,最终被诊断为BRAF野生型ECD,其中包含CSF1R突变,该突变最近被认为是MAPK通路的潜在驱动因素。更深入地了解ECD的分子发病机制不仅有助于准确诊断,而且有助于改善临床结果。
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引用次数: 0
Correction of Content, Table, and Funding Statement of the Article "Intraoperative Language Area Mapping: Cortico-Cortical Evoked Potential". 对“术中语言区映射:皮质-皮质诱发电位”这篇文章的内容、表格和经费声明进行了更正。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0008e
Tae-Min Cheon, Soo-Hyun Yoon, Myoung-Jeong Kim, Kyung-Min Kim

This corrects the article on p. 39 in vol. 13, PMID: 40347125.

这是对第13卷第39页的文章的更正,PMID: 40347125。
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引用次数: 0
Spontaneous Cranial Epidural Inflammatory Granuloma Mimicking Brain Tumor: A Case Report. 自发性脑硬膜外炎性肉芽肿模拟脑瘤1例报告。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0027
Ho-Shin Gwak, June Young Chun, Na Young Han, So Hyeon Ji, Soyoung Choi, Young Joo Choi

Here, we report a case of spontaneous cranial epidural inflammatory granuloma occurring in an 87-year-old female patient. The patient had a longstanding history of diabetes, which was managed with insulin. She developed reading and speech difficulties 1 month prior to presentation, and on the day of her visit to the ER, she had a partial seizure. Non-contrast CT results showed an ill-defined iso- to mild hyperdense lesion on the left frontal lobe with severe perilesional edema, giving the impression of a brain tumor. Subsequent MRI results showed an irregular, rim-enhancing lesion involving the brain parenchyma and epidural space without diffusion restriction, suggestive of an infectious granuloma. An initial workup was performed, including various cultures and chest CT to rule out possible infectious sources, but all results were negative. Thus, an excisional biopsy was performed, and intraoperative findings revealed an epidural granulomatous lesion invading the dura and extending to the pial surface. Intraoperative tissue 16s rRNA polymerase chain reaction (PCR) was positive for Staphylococcus aureus, and tissue cultures later confirmed the strain to be methicillin-resistant S. aureus. After the PCR, the patient was additionally given vancomycin. She improved completely, regaining her previous average daily living function.

在此,我们报告一例自发性脑硬膜外炎性肉芽肿发生在一位87岁的女性患者。患者有长期的糖尿病病史,一直使用胰岛素治疗。在就诊前1个月,她出现了阅读和语言障碍,在她去急诊室的当天,她出现了部分癫痫发作。非对比CT结果显示左侧额叶有一模糊的等至轻度高密度病变,伴严重的病灶周围水肿,表现为脑肿瘤。随后的MRI结果显示不规则,边缘增强病变累及脑实质和硬膜外间隙,无扩散限制,提示感染性肉芽肿。进行了初步检查,包括各种培养和胸部CT以排除可能的感染源,但所有结果均为阴性。因此,进行了切除活检,术中发现硬膜外肉芽肿病变侵入硬脑膜并延伸到颅底。术中组织16s rRNA聚合酶链反应(PCR)金黄色葡萄球菌阳性,组织培养证实该菌株为耐甲氧西林金黄色葡萄球菌。PCR结束后,患者加用万古霉素。她完全好转了,恢复了以前的日常生活功能。
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引用次数: 0
Postoperative Seizures Can Predict Overall Survival of Patients With Newly Diagnosed Supratentorial Isocitrate Dehydrogenase-Wild Glioblastoma Treated With Radiotherapy Plus Concomitant and Adjuvant Temozolomide. 术后癫痫发作可以预测新诊断的幕上异柠檬酸脱氢酶野生胶质母细胞瘤患者放疗加伴随和辅助替莫唑胺治疗的总生存率。
Pub Date : 2025-10-01 DOI: 10.14791/btrt.2025.0022
Kengo Yamada, Ryosuke Matsuda, Ryota Sasaki, Ryosuke Maeoka, Tsutomu Nakazawa, Takayuki Morimoto, Yudai Morisaki, Shohei Yokoyama, Masashi Kotsugi, Yasuhiro Takeshima, Shuichi Yamada, Fumihiko Nishimura, Young-Soo Park, Ichiro Nakagawa

Background: We aimed to evaluate the correlation between postoperative seizures (POS) and overall survival in patients with newly diagnosed supratentorial isocitrate dehydrogenase (IDH)-wild glioblastoma treated with radiotherapy plus concomitant and adjuvant temozolomide.

Methods: This study included 122 patients with newly diagnosed supratentorial IDH-wild glioblastoma who were treated at our hospital between May 2007 and September 2022. Seizures occurring within 7 days after surgery were defined as immediate POS (iPOS). Moreover, seizures from the 8th day after the surgery were defined as delayed POS (dPOS).

Results: The median follow-up period and median survival time (MST) from surgery in the entire cohort were 19.3 and 20.4 months, respectively. The rates of iPOS and dPOS in this study were 6.6% (n=8) and 38.5% (n=47), respectively. The MST of patients with iPOS and without iPOS was 27.6 and 20 months, respectively. There was no significant difference between with iPOS and without iPOS. The median time to onset of dPOS was 126 days after surgery. The MST of patients with dPOS and without dPOS was 25.9 and 18.4 months, respectively. Patients with dPOS showed significantly longer survival than those without dPOS (p=0.024). Occurrence of seizures at the initial manifestation of disease was found to be significantly more likely to cause dPOS (p=0.044).

Conclusion: Among patients with newly diagnosed supratentorial IDH-wild glioblastoma, the prognosis of patients with seizures in the postoperative course was better than that of patients without dPOS.

背景:我们的目的是评估新诊断的幕上异柠檬酸脱氢酶(IDH)野生胶质母细胞瘤患者术后癫痫发作(POS)与总生存率的相关性,这些患者接受放疗加伴随和辅助替莫唑胺治疗。方法:本研究纳入2007年5月至2022年9月在我院治疗的122例新诊断的幕上idh野生胶质母细胞瘤患者。术后7天内癫痫发作定义为立即性POS (iPOS)。术后第8天的癫痫发作被定义为延迟性POS (dPOS)。结果:整个队列手术后的中位随访期和中位生存时间(MST)分别为19.3个月和20.4个月。本研究中ipo和dPOS的发生率分别为6.6% (n=8)和38.5% (n=47)。有iPOS和无iPOS患者的MST分别为27.6个月和20个月。参与ipo与未参与ipo之间无显著差异。dPOS发病的中位时间为术后126天。有dPOS和无dPOS患者的MST分别为25.9个月和18.4个月。dPOS患者的生存期明显长于无dPOS患者(p=0.024)。发现在疾病最初表现时发生癫痫发作更容易引起dPOS (p=0.044)。结论:在新诊断的幕上idh野生胶质母细胞瘤患者中,术后出现癫痫发作的患者预后优于无dPOS的患者。
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引用次数: 0
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Brain tumor research and treatment
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