Classification of unilateral thalamic gliomas predicts tumor resection and patient's survival: a single center retrospective study.

BACKGROUND: To propose our classification about unilateral thalamic gliomas, and to describe relationship between the classification and clinical characteristics including symptoms, surgical approaches and survival, which should contribute to the treatment and the prognostic prediction of unilateral thalamic gliomas. METHODS: A total of 66 adult unilateral thalamic glioma patients with pathologic confirmation between January 2010 and December 2018 were retrospectively investigated. RESULTS: Unilateral thalamic gliomas could be divided into quadrigeminal cistern and ventricle extension type (Type Q), lateral type (Type L) and anterior type (Type A) according to tumor location, extensive polarity and location of ipsilateral posterior limb of internal capsule. Each subtype of QLA classification could match with one kind of corresponding approach. Preoperative symptoms including headache, dyskinesia, aphasia, hydrocephalus and KPS scores, and pathological features including H3K27M mutation and P53 expression were correlated with QLA classification. Further analysis confirmed that Type Q tumors had a higher rate of total resection and a significantly longer survival time compared to Type L and Type A tumors, with similar improved and deteriorated rates of symptoms. Univariate and multivariate analysis demonstrated QLA classification was remarkedly associated with overall survival and could be considered as an independent prognostic factor in patients with unilateral thalamic gliomas. CONCLUSIONS: Unilateral thalamic glioma could be divided into 3 subtypes by imaging characteristics, symptoms and survival. QLA classification could predict tumor resection and the prognosis and could contribute to the planning of therapeutic strategy in patients with unilateral thalamic gliomas.

Membrane Retraction Technique in Bypass Surgery for the Treatment of Adult Moyamoya Disease with Deep-Seated Recipient Artery.

OBJECTIVE: To introduce a membrane retraction technique that can provide good exposure of deep-seated recipient arteries in cortical sulci and simplify the anastomosis procedure. METHODS: Only those adult patients with moyamoya disease who underwent superficial temporal artery to middle cerebral artery bypass surgery during which the suitable recipient arteries were located deep in cortical sulci were included in this retrospective study. By placing 10-0 prolene sutures to the arachnoid membrane of the 2 banks of sulcus, arachnoid retraction was applied to pull the sulcus apart and then the deep-seated recipient arteries were exposed. Standard end-to-side anastomosis was completed. The mean occlusion time and successful rate were recorded and compared with those of the normal procedure. RESULTS: From June to November 2019, 124 superficial temporal artery to middle cerebral artery bypass surgeries for the treatment of moyamoya disease were performed in Nanfang Hospital. The membrane retraction technique was used in 5 patients (5/110, 4.5%) and the success rates were 100%. The mean temporary occlusion time was 27.2 minutes. No procedure-related complications were observed. All patients recovered uneventfully. The postoperative angiograms confirmed good patency of bypass grafts in all 5 cases. CONCLUSIONS: The membrane retraction technique is an effective and safe method for the treatment of adult patients with moyamoya disease with deep-seated recipient arteries within the sulci.

A Hybrid Strategy for Patients With Complex Cerebral Aneurysm: STA-MCA Bypass in Combination With Endovascular Embolization.

Objective: This work aims to present our experience of patients with complex cerebral aneurysm treated with a hybrid approach: superficial temporal artery-middle cerebral artery (STA-MCA) bypass in combination with endovascular exclusion of the aneurysm. Method: Patients with aneurysms deemed unclippable and uncoilable were included. All patients were treated with a hybrid approach. After STA-MCA bypass, the parent artery was temporarily occluded. If the intraoperative motor evoked potential (MEP) and somatosensory evoked potential (SEP) waveforms remain normal and last for 30 min, the aneurysm and te parent artery will be embolized permanently with detachable balloons or coils. Results: A total of 20 patients with 22 aneurysms were included in this study. There were 13 women and 7 men, with an average age of 42.5 years. Intraoperative angiography showed the good patency of all the STA grafts, and neither SEP nor MEP abnormalities were detected. After the parent artery and the aneurysm were occluded, the intraoperative angiography showed an immediately successful exclusion of the aneurysm in 20 aneurysms and immediate contrast stasis in two. All patients recovered uneventfully without ischemic or hemorrhagic complication. Angiography at 6-month follow-up showed the total obliteration in 20 aneurysms. Two aneurysms showed residuals and were recoiled. All STA grafts showed a good patency, and the mean graft flow was 124.2 ml/min. Conclusion: STA-MCA bypass in combination with endovascular exclusion is an appropriate option for patients with complex cerebral aneurysms that are not amenable to direct surgical clipping or endovascular embolization.

[Preliminary clinical evaluations of bevacizumab for recurrent malignant glioma in Chinese patients].

OBJECTIVE: To explore the clinical efficacies of bevacizumab (BEV) for high-grade glioma (HGG) in Chinese patients and evaluate its profiles of adverse events and usage safety. METHODS: A total of 15 HGG cases, including glioblastoma multiform (GBM) (n = 12) and anaplastic astrocytoma (AA) (n = 3), were selected to receive the treatments of BEV (10 mg/kg, q2w) and temozolomide (TMZ, 150 mg/m(2), 5 d/28 d). Their radiological responses, clinical status, progression-free survival (PFS) and overall survival (OS) were evaluated. Also their adverse events and severity were recorded and analyzed. RESULTS: According to the RANO criteria, during the short period (<3 months), 11 cases had significant radiological and clinical responses. However, only 4 cases responded during a follow-up period of beyond 3 months. Three cases had retrogression after BEV chemotherapy. At 6 months post-treatment, 8 cases (53.3%) survived without lesion progression and the median PFS was 8 ± 5 months. During a longer follow-up (>6 months), 8 patients had tumor retrogression, including 5 deaths. The median overall survival period was 24 ± 10 months. The adverse events included hypertension (n = 2), wound-healing complication (n = 1), vomiting (n = 2) and cerebro-spinal fluid leakage (n = 1). All complications were cured by activate supportive measures. CONCLUSION: After BEV treatment, most patients obtain more significant short-term responses with good toleration. For re-operative cases, the usage of BEV should be deferred to one month post-operation so as to avoid the occurrence of wound-healing complications.