Brain tumor research and treatment最新文献

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.

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.

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.

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.

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.

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.

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.

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

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.

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.