Adult Central Neurocytomas: Clinical Features and Long-Term Treatment Outcomes in Different Age Groups.

BACKGROUND: Central neurocytomas (CNs) usually occur in young adults, and the clinical characteristics and surgical outcomes of patients in different age groups may be different. METHODS: This study was undertaken to compare the clinical and long-term treatment outcomes of patients with CNs in younger and older adult age groups. RESULTS: Eighty consecutive adults with CNs were included, with a mean presentation age of 28.4±7.6 years (range: 19-66 years). Thirty (37.5%) patients were <27 years old, and they tended to manifest with multiple symptoms (P = 0.002), increased intracranial pressure (ICP) symptoms (P = 0.036), an acute clinical course (P = 0.037), worse preoperative neurologic function (P = 0.023), and a larger lesion size and volume (P = 0.004 and 0.007, respectively) than their older age counterparts (≧27 years). An older onset age (P = 0.005) or age ≧27 years (P = 0.014) and worsened Karnofsky Performance Status (KPS) scale (P = 0.040) immediately after microsurgery were associated with unimproved long-term outcomes. CONCLUSIONS: CNs in younger adult patients behave differently from those in the older age group. Surgery can halt neurologic deterioration and ensure satisfactory outcomes.

Pediatric atypical extraventricular neurocytoma: Clinical features and survival outcomes.

BACKGROUND: Extraventricular neurocytoma (EVN) in children is an extremely rare encountered tumor. Little information is available about the treatment and prognosis of this rare disease in children. This study was undertaken to elucidate the clinical-radiological characteristics and treatment outcomes of pediatric patients with atypical EVN. METHODS: A retrospective review of patients' demographic features, treatment modalities, and outcomes in our institution from January 2011 to December 2019 was conducted. RESULTS: Seven consecutive children harboring atypical EVN in our center were included, with a male predominance (n = 5, 71.4%) and a mean age of 11.8 ± 4.9 years (range: 2-18 years). The lesions mainly involved the frontal (n = 4, 57.1%) and temporal lobes (n = 4, 57.1%). Gross total resection (GTR) was achieved in 6 patients (85.7%), and subtotal resection (STR) was achieved in the remaining patient (14.3%). All lesions demonstrated a high Ki-67 index (≧5%) and atypical features pathologically. Five patients (71.4%) received radiotherapy and/or chemotherapy after surgery. During follow-up, 5 patients (71.4%) experienced lesion progression, and 2 (14.3%) of them died. The median progression-free survival was 48 months. CONCLUSIONS: The prognosis of pediatric patients with atypical EVN was dismal after aggressive treatment. Most tumors progressed, and this progression was positively correlated with the Ki-67 index. Surgical excision is the main treatment modality for atypical EVN, and radiation/chemotherapy should also be introduced after surgery.

Regioselective and Diastereoselective Halofunctionalization of Alkenes Promoted by Organophotocatalytic Solar Catalysis.

A visible-light metal-free photocatalytic regioselective and enantioselective alkene halofunctionalization reaction under mild conditions is reported. Various terminal and internal alkenes were transformed to their α-halogenated and α,ß-dibrominated derivatives in good to excellent yields within reaction time as short as 5 min. Water can be used as the "green" nucleophile and solvent in the halohydroxylation and halo-oxidation reactions. Different types of products can be obtained by adjusting the reaction conditions. In addition, sunlight is proved to produce products with similar yields, representing a practical example of solar synthesis and providing an opportunity for solar energy utilization.

Central neurocytomas in children: Clinicopathologic features and long-term surgical outcomes.

PURPOSE: Pediatric central neurocytomas (PCNs) is an extremely rare entity, and very few reports have exclusively focused on the clinicopathologic features and surgical outcomes of PCNs. METHODS: This study was undertaken to elucidate the clinical and pathological characteristics and long-term surgical outcomes of PCNs. RESULTS: Fourteen consecutive patients with pathologically verified PCNs were identified, including 9 girls and 5 boys, with a mean age of 15.2 ± 3.9 years (range 3-18 years). Children tended to present with symptoms of increased intracranial pressure (ICP) (p = 0.003), an acute clinical course (p = 0.044), and a shorter duration of symptoms (p = 0.019) than their adult counterparts. Surgery was performed under the guidance of a neuronavigation system and intraoperative ultrasound; gross total resection (GTR) was achieved in 12 patients (85.7%), and subtotal resection (STR) was achieved in two patients (14.3%). One child received adjuvant radiotherapy (RT) owing to the atypical features of the lesion. During a mean follow-up of 90.2 ± 37.0 months (range 42-156 months), one patient (7.1%) with atypical features experienced lesion relapse 2 years after surgery and received RT, and the symptoms of all children were relieved. CONCLUSION: Surgery can benefit children with CNs and ensure relatively long-term progression-free survival. RT can be administered to patients with residual or relapsed lesions.

A Potential Prognostic Biomarker for Glioma: Aldo-Keto Reductase Family 1 Member B1.

Aldo-keto reductase family 1 member B1 (AKR1B1) plays a vital role in tumor development and is involved in the tumor immune process. However, its role in glioma cell is poorly studied. This study's aim was to assess the role of AKR1B1 in glioma through bioinformatics analysis. The AKR1B1 expression data and corresponding clinical data of glioma were collected from the Cancer Genome Atlas (TCGA) database. The R packages were used for data integration, extraction, analysis, and visualization. According to the median value of the risk score, all patients were divided into high-risk and low-risk groups to draw the Kaplan-Meier (KM) survival curves and to explore the level of immune infiltration. The expression of AKR1B1 was significantly elevated in glioma tissues compared to normal tissues (P < 0.001). The high expression of AKR1B1 was significantly associated with WHO grade (P < 0.001), IDH status (P < 0.001), 1p/19q codeletion (P < 0.001), primary therapy outcome (P = 0.004), and age (P < 0.05). Kaplan-Meier survival analysis found that OS (HR = 3.75, P < 0.001), DSS (HR = 3.85, P < 0.001), and PFI (HR = 2.76, P < 0.001) were lower in patients with glioma with high AKR1B1 expression than in the group with low AKR1B1 expression. Based on GESA, six pathways (including interferon gamma signaling, signaling by interleukins, cell cycle checkpoints, cytokine receptor interaction, cell adhesion molecules (CAMs), and cell surface interactions) at the vascular wall were identified as significantly different between the two groups. Moreover, highly expressed AKR1B1 was associated with immune cell infiltration. AKR1B1 plays a key role in glioma progression and prognosis and, therefore, serves as a potential biomarker for prediction of patients' survival.

Free Flap Transfer, a Safe and Efficient Method for Reconstruction of Composite Skull Base Defects After Salvage Resection of Advanced Intracranial and Extracranial Communicating Tumors.

OBJECTIVE: Surgical treatment of advanced intracranial and extracranial communicating skull base tumors is challenging, especially for the reconstruction of the large composite defect left by tumor resection. The aim of the study is to evaluate the utility of the free flap reconstruction of the defects resulting from radical resection of these tumors in a single institution. METHODS: The clinical data of 17 consecutive patients who underwent free flap reconstruction for defect left by salvage resection of advanced intracranial and extracranial communicating tumors from 2013 to 2019 were retrospectively collected and analyzed. RESULTS: There were 5 squamous cell carcinomas, 4 adenoid cystic carcinomas, 2 basal cell carcinomas, 2 meningiomas, 1 anaplastic hemangiopericytoma, 1 pleomorphic adenoma, 1 osteosarcoma, and 1 chondrosarcoma. All patients had recurrent neoplasms, 2 of whom had pulmonary metastasis. A modified radical cervical dissection was performed in 6 patients. The anterolateral thigh myocutaneous flap and rectus abdominis myocutaneous flap were used in 15 patients (88.2%) and 2 patients (11.8%), respectively. Complications were seen in 3 of 17 patients (17.6%) with 1 total flap loss. The median progression-free survival duration was 31 months. The 3- and 5-year progression-free survival rates were 0.47 and 0.24, respectively. The mean overall survival duration was 66 months. The 3- and 5-year overall survival rates were 0.85 and 0.68, respectively. CONCLUSIONS: Free flap transfer is a safe and effective method with acceptable complications, useful for reconstruction of large composite skull base defects after salvage resection of advanced intracranial and extracranial communicating tumors. The functional and cosmetic results are satisfying.

Clinial Features, Individualized Treatment and Long-Term Surgical Outcomes of Skull Base Meningiomas With Extracranial Extensions.

Object: Skull base meningiomas with extracranial extensions are rarely described. This study describes the clinical features, surgical management and clinical outcomes of these rare tumors and investigates risk factors associated with progression-free survival (PFS). Methods: The clinical data of 34 consecutive patients who underwent surgery for skull base meningiomas with extracranial extensions from 2007 to 2018 were retrospectively collected and analyzed. Results: The mean patient age was 47.9 ± 13.9 years; 50.0% were male. The most common symptoms on admission were ophthalmic. All patients underwent a multidisciplinary consultation before surgery, and received individualized surgical management. The gross total resection (GTR) rate was 55.9% (19/34). Twelve patients received post-operative adjuvant radiotherapy (RT). Twelve patients experienced tumor recurrence during the follow-up period. The median PFS duration was 54 months. The mean overall survival (OS) duration was 111 months. By univariate analysis, a higher histological grade (WHO grade II and III), Ki-67 LI ≥ 5 and the extent of resection (EOR) were significantly associated with tumor recurrence. Multivariate analysis revealed Ki-67 LI ≥ 5, the EOR and adjuvant RT as prognostic factor of PFS. Conclusions: These relatively rare meningiomas are difficult to resect and have a poor prognosis; they are more common in males and have a higher histological grade than intracranial meningiomas. Multidisciplinary collaboration and individualized surgical strategies are crucial for surgically managing these complex tumors. Total removal of the tumor remains challenging. Subtotal resection (STR) or partial resection (PR) followed by RT is a reasonable strategy when radical resection is infeasible. Adjuvant RT should be recommended especially for tumors with histopathological risk factors (Ki-67 LI ≥ 5 or high histological grade).

Anticancer effects of FL34 through the inhibition of GLI1 in glioblastoma.

BACKGROUND: The hedgehog (HH) signaling pathway is abnormally activated in glioblastoma (GBM); thus, its downstream effector GLI1 may be a suitable target for the treatment of GBM. The aim of the present study was to evaluate the antitumor activities of a novel compound, FL34, in GBM through the inhibition of GLI1. METHODS: The effect of FL34 on suppressing the proliferation, angiogenesis, and invasion of GBM cells was investigated in vitro using proliferation, invasion, tube formation, flow cytometry, GLI1 dual luciferase, reverse transcription-quantitative polymerase chain reaction, and western blot assays. A subcutaneously transplanted and orthotopic U-87 MG GBM cell xenograft model was used to study the effect of FL34 on tumor growth in vivo. RESULTS: The results of the present study demonstrated that FL34 markedly inhibited the proliferation, invasion, and angiogenesis of GBM, in addition to decreasing the transcriptional activity and expression of GLI1, resulting in the downregulation of GLI1 target genes, including B-cell lymphoma-2, vascular endothelial growth factor, and matrix metalloproteinases. Furthermore, FL34 inhibited the activation of GLI1 without influencing upstream canonical HH/Smoothened signaling or through crosstalk with other oncogenic pathways, including Ras/ERK and AKT signaling. At a dose of 30.0 mg/kg, FL34 suppressed tumor growth by 78.74% in tumor weight in subcutaneously transplanted U-87 MG xenograft models and by 64.24% in volume in orthotopic U-87 MG GBM xenograft models. CONCLUSIONS: These data suggested that FL34 exerted antitumor activity mediated by the inhibition of GLI1 and that FL34 may be a potential antitumor candidate compound that could be used to develop new antitumor drugs for the treatment of GBM.

Heterogeneity of tumor-infiltrating lymphocytes ascribed to local immune status rather than neoantigens by multi-omics analysis of glioblastoma multiforme.

Hypothetically, intratumoral genomic heterogeneity has the potential to foster tumor-infiltrating lymphocyte (TIL) diversity; however, no study has directly tested this hypothesis by simultaneously investigating somatic mutations, TIL diversity, and immune response activity. Thus, we performed whole-exome sequencing, immune repertoire sequencing and gene expression on ten spatially separated tumor samples obtained from two tumor masses excised from a glioblastoma multiforme (GBM) patient, and we included peripheral blood as control. We found that although the multi-region samples from one tumor shared more common mutations than those from different tumors, the TIL populations did not. TIL repertoire diversity did not significantly correlate with the number of non-synonymous mutations; however, TIL diversity was highly correlated with local immune activity, as the pathways were all immune-related pathways that highly positive correlated with local TIL diversity. Twenty-three genes with expression largely unaffected by the intratumor heterogeneity were extracted from these pathways. Fifty GBM patients were stratified into two clusters by the expression of these genes with significant difference in prognosis. This finding was validated by The Cancer Genome Atlas (TCGA) GBM dataset, which indicated that despite the heterogeneity of intra-tumor immune status, the overall level of the immune response in GBM could be connected with prognosis.

Dumbbell-Shaped Jugular Foramen Tumors Extending to the Neck: Surgical Considerations Based on Imaging Findings.

OBJECTIVE: Dumbbell-shaped jugular foramen tumors (DSJFTs) extending to the neck present diagnostic and management difficulties because of their rarity, various pathologies, and multidisciplinary involvement. Accurate imaging findings are of great importance for surgical planning and clinical outcomes. However, few articles have discussed this issue to date. METHODS: Thirty-one patients with DSJFTs extending to the neck were surgically treated in a single stage at our institute. Their clinical and radiologic features, operative procedures, and outcomes were retrospectively reviewed. RESULTS: Preoperative correct diagnosis of DSJFTs extending to the neck was made in all cases of benign tumor and in only 3 cases of malignant tumors in this series. All tumors were removed via a craniocervical approach by a multidisciplinary skull base team because of both their intracranial and neck extensions. Total removal was achieved in 26 patients (83.9%). Preoperative symptoms were improved in 18 patients, whereas new or worsening lower cranial nerve deficits occurred in 4 patients postoperatively. Follow-up (1-132 months, mean 64.4 months) was available in 90.3% of the patients. No clinical or radiologic signs of tumor recurrence were observed. CONCLUSIONS: Preoperative radiologic evaluation of DSJFTs extending to the neck is essential for differential diagnosis, patient selection, and surgical planning. Favorable surgical outcomes can be achieved via a craniocervical approach, and some detailed imaging findings are helpful to increase the safety of tumor resection and reduce the morbidity of lower cranial nerve deficits and cerebrospinal fluid leakage.

Nonylphenol induces pancreatic damage in rats through mitochondrial dysfunction and oxidative stress.

The organic alkylphenol 4-nonylphenol (NP) is regarded to be an endocrine disrupting chemical (EDC), one of the widely diffused and stable environmental contaminants. Due to its hydrophobicity and long half-life, NP can easily accumulate in living organisms, including humans, where it displays a series of toxic effects. It has been widely reported that NP affects male reproduction. In addition, there is increasing evidence suggesting that NP is detrimental to various organs, including the pancreas. This study investigated the adverse effects of NP exposure on the pancreas. Sprague-Dawley rats were treated with different doses of NP for 90 consecutive days. The data suggested that the body weights of the rats treated with NP decreased, and the highest dose of NP treatment (180 mg kg-1) dramatically increased water consumption by rats. Meanwhile, H&E staining and immunohistochemistry indicated that islets in the pancreases shrunk when the rats were treated with the indicated doses of NP. TUNEL staining demonstrated that NP exposure up-regulated the level of apoptosis in the pancreases in a dose-dependent manner. Besides this, NP exposure inhibited the secretion of insulin and disrupted glucose tolerance. The levels of reactive oxygen species (ROS) and intracellular calcium ([Ca2+]i) in the islets were up-regulated in the groups of rats treated with NP, but the levels of Mitochondrial Membrane Potential (MMP) were down-regulated. These results suggest that NP-induced pancreatic damage in rats occurs through mitochondrial dysfunction and oxidative stress, which causes disruption of glucose tolerance and decrease in insulin secretion.

[Clinical features and comprehensive treatment of skull base osteosarcoma].

OBJECTIVE: To analyze the clinical features and treatment of skull base osteosarcoma. METHODS: The clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification. RESULTS: Nine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months. CONCLUSIONS: To compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.

A proposed scheme for the classification and surgical planning of falcine meningioma treatment.

Falcine meningiomas (FM) represent a surgical challenge even in the microsurgical era. An individualised surgical approach to different FM is indispensable, but there have been few reports in this regard. Thus, based on our series of 20 patients with FM who underwent surgery between October 2001 and June 2010, we propose a classification scheme for FM removal and demonstrate its effectiveness. FM in our series were classified into four types, according to tumour growth patterns on coronal MRI: Type I, hemispheroid-shaped tumours invaginating deeply into one hemisphere without shifting the falx (10 patients); Type II, olive-shaped tumours shifting the falx substantially to the contralateral side (six patients); Type IIIA, globular- or dumbbell-shaped tumours extending into both hemispheres, but to different extents (one patient); and Type IIIB, globular- or dumbbell-shaped tumours extending into both hemispheres to approximately equal extent (three patients). An ipsilateral interhemispheric approach was performed for Type I tumours, and a contralateral transfalcine approach for Type II. Type IIIA tumour was approached from the side where the smaller tumour was located. Type IIIB tumours were approached from the non-dominant hemisphere. Simpson grade I resection was achieved in all 20 patients. The follow-up ranged from 12 months to 114 months. There was no postoperative mortality, serious neurological deficits, or tumour recurrence. The preliminary results suggest that the proposed scheme can facilitate surgical planning and accomplish complete tumour resection with minimal invasion.

Triple dumbbell-shaped jugular foramen schwannomas.

PURPOSE: Triple dumbbell-shaped jugular foremen schwannomas (DSJFSs) have high cervical extension according to Bulsara's classification. One-stage, single-discipline, total removal of triple DSJFSs is not always possible due to their both intracranial and cervical extensions. We evaluated our experience in one-stage resection of triple DSJFSs by using a combined neurosurgical and head and neck approach. METHODS: Between October 2004 and May 2009, eight patients with triple DSJFSs were treated surgically at our institute. The clinical and radiological features, operative procedures and outcomes are retrospectively reviewed. RESULTS: Total tumour removal was achieved in seven patients and near total in one. New cranial nerve (CN) paresis occurred after surgery in one patient and worsening of preoperative CN deficits was noted in three. Two patients experienced cerebrospinal fluid leakage and one of them had a repeated operation with closure of the dural deficit. Follow-up period ranged from 23 to 60 months (mean 38 months). All CN dysfunction had improved considerably at the last follow-up examination. There have been no clinical or radiological signs of tumour recurrence. CONCLUSIONS: One-stage total resection of triple DSJFSs can be achieved by a multidisciplinary cranial base team composed of neurosurgeons and head and neck surgeons via a craniocervical approach.

[Lateral cervical approach for resection of cervical dumbbell-shape neurogenic tumors].

OBJECTIVE: To study the indication and character of the lateral-cervical approach for treating dumble-shape neurogenic tumors in cervical spine. METHODS: Retrospectively review the clinical data of 14 dumble-shape neurogenic tumors in cervical spine, from October 2005 to October 2011. Among them 8 were males and 6 were females, range from 11 to 60 years old. The maximum tumor diameter range from 3.0 to 8.0 cm, with an average of 4.8 cm; the intraspinal tumor diameter range from 1.3 to 3.8 cm, with an average of 2.1 cm. According to Asazuma classification, 9 cases were type IIc, 2 cases were type IIIb, 2 cases were type IV, 1 case was type VI. Involving the neck segment C(1)-C(2) in 1 case, C(2)-C(3) in 1 case, C(3)-C(4) in 2 cases, C(4)-C(5) in 2 cases, C(5)-C(6) in 3 cases, C(6)-C(7) in 4 cases and C(2)-C(4) in 1 case. All cases performed surgery with general anethesia. The head and neck surgeon performed surgery with lateral cervical approach, in the space between the anterior and the medius scalenus, exposed the transverse process and the intervertebral foramen as the anatomy marker, resected the extraspinal tumor part. The neurosurgery expanded the intervertebral foramen, and resected the intraspinal tumor with microscope, and repaired the dura. Then head and neck surgeon closed the wounds. RESULTS: Pathology proved 3 neurolimmoas and 11 Schwannomas, 12 cases received gross total resection, 2 cases received subtotal resection, the average blood loss during operation was 292 ml, the average operation time was 129 minutes, the average stay in hospital days was 7.1 days. The vertebral artery were exposed in 2 cases, and no vertebral artery injury occurred, there were 3 cases dissect the cervical nerve roots. No cerebrospinal fluid leakage, hematoma, newly branchial plexus injury, sympathic nerve injury or tracheal edema occurred. In 3 to 24 months, with an average of 13.5 months follow-up period, 2 cases with subtotal resection had no tumor progression, and 12 cases with gross total resection had no tumor recurrence. CONCLUSIONS: Lateral-cervical approach is minimal invasive, easily to perform and recovery fine. It can be adopt for Asazuma type IIc, IIIb and IV tumors which not grow over the midline in spine and expand to deep layer of the deep cervical fascia out spine.

[Microneurosurgical treatment of massive tuberculum sellae meningiomas].

OBJECTIVE: To summarize the characteristics of the pathological anatomy and blood supply model of massive tuberculum sellae meningiomas (MTSM) and explore its corresponding microneurosurgical strategies. METHODS: The clinical data of 16 MTSM patients were reviewed retrospectively. From January 1998 to January 2010, according to their unique pathological anatomy and blood supply model, all patients underwent microneurosurgical removal with induced hypotension through tumor corridor by the bi-subfrontal anterior longitudinal fission (n = 14), right frontolateral approach (n = 1) and pterional approach (n = 1). There were 5 males and 11 females with a mean age of 48.5 years old (range: 26 - 65). But the mean follow-up period was 74.9 months (range: 4 - 132) in 2/4 cases. RESULTS: Among all cases, the mean tumor diameter was 58.9 mm (range: 51.1 - 76.2 mm). Simpson grade I, II, III, IV removal of MTSMs were accomplished in 3, 9, 3 and 1 case respectively. One case died within 4 postoperative days. Visual acuity improved in 10 patients, remained unchanged in 2 and deteriorated in 2. Transient postoperative diabetes insipidus occurred in 9 cases. CONCLUSION: It is critical to understand the unique characteristics of pathological anatomy and blood supply model of MTSM so as to adopt proper microneurosurgical strategies to remove it in situ.

[Surgical treatment of lateral sellar compartment cavernoma].

OBJECTIVE: To summarize and analyze the surgical treatment of lateral sellar compartment cavernoma (LSCC). METHODS: The clinical data of 102 patients with LSCC who underwent surgical treatment from 1958 to 2006, 2 males and 80 females, aged 43.5 (11 approximately 69), were collected and analyzed. The operation patterns were divided into 4 stages based on the understanding of LSCC: first stage (1958 approximately 1988, with 32 cases) during which diagnosis was mainly bases on X-ray plain films, CT, and ordinary cerebral angiography, and most of the tumors were partially excised; second stage (1989 approximately 1997, with 18 cases) during which MRI, DSA, and microsurgery were widely used; third stage (1998 approximately 2003, with 36 cases) during which the neurological anatomy of the LSC and pathology of LSCC made headway, however, intra-operational bleeding was still a problem, and fourth stage (2004 approximately 2006, with 16 cases) during which relevant models were basically understood. RESULTS: Post-operative MRI shed that the tumor complete resection rates of the 4 stages were 4/32, 5/18, 17/36, and 12/16, and the subtotal resection rates were 3/32, 4/18, 10/36, and 2/16 respectively. The rest of the tumors were all partially removed. Not only the intra-operative blood loss but also the cranial nerve morbidity rate decreased dramatically in the 4th stage. The main postoperative complications included oculomotor nerve paralysis, abducent nerve palsy, and trigeminal nerve damages. No operation-related death occurred. CONCLUSION: Following the progress of LSCC study, the treatment of LSCC becomes mature. Radical removal of LSCC may be the best choice for LSCC patients by epidural approach via the skull base craniotomy with induced hypotension.

[The angiographic classification and sclerotherapy of cavernous hemangiomas of maxilloface].

OBJECTIVE: To explore the factors that affect the curative effect and the best method of treatment for the patients with maxillofacial cavernous hemangiomas. METHODS: 102 cases of maxillofacial cavernous hemangiomas were performed DSA examination and taken serial photography. According to the diameter, number and draining speed of efferent veins of the tumor, the cavernous hemangiomas were classified into two types-the high efferent speed and low efferent speed type. For all of them, were randomly performed embolization of efferent veins with absolute ethanol plus bleomycin-A5 intratumor injection (group I) and bleomycin-A5 intratumor injection alone (group II). RESULTS: The cure rate and general effective rate has significant difference (P < 0.01) between two groups in 70 patients with high efferent speed veins, while no significant difference (P > 0.05) in 32 patients with low efferent speed veins. CONCLUSIONS: This new classification is beneficial for seeking method of treatment. The embolization of efferent veins is an effective method for cavernous hemangioma with high efferent speed veins; but for the type with low efferent speed veins, bleomycin-A5 intratumor injection alone could acquire a good results.