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Objective:To evaluate clinical efficacy of adjuvant radiotherapy (RT) for central neurocytoma (CN) after surgical resection.Methods:Clinical data of 136 CN patients admitted to Beijing Tiantan Hospital and Xuanwu Hospital from January 2001 to December 2020 were retrospectively analyzed. Preliminary interventions consisted of craniotomy (gross total resection, subtotal resection and partial resection, the latter two belonging to incomplete resection) and postoperative radiotherapy. Three-dimensional conformal or intensity-modulated radiotherapy was adopted, with a median radiotherapy dose of 54 Gy. Post-recurrence treatment included salvage surgery and radiotherapy. The overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Univariate analysis was performed by log-rank test to evaluate the effect of each prognostic factor on OS and PFS. The effects of multiple prognostic factors on PFS and OS were assessed by Cox regression model.Results:The median age was 28 years (range: 6-66 years). The median follow-up was 94.5 months (12-237 months). Among all patients, 79 cases underwent total resection, and 68 of them received adjuvant radiotherapy. Thirty-eight patients underwent subtotal resection, and 37 of them were treated with adjuvant radiotherapy. Sixteen patients received partial resection and adjuvant radiotherapy. Three cases received biopsy and postoperative radiotherapy. Among all patients, 3 cases died, including 2 from tumor recurrence and 1 from postoperative complication. Eight patients had recurrences during follow-up. Among them, 7 patients had recurrences at the primary site,1 had tumor dissemination to the spinal cord. The 5- and 10-year OS rates were 98.5% and 96.8%, and the 5- and 10-year PFS rates were 95.3% and 91.6% for the in the entire cohort. In the gross total resection without radiotherapy group, the 5- and 10-year PFS rates were 90.9% and 90.9%, and 96.6% and 96.6% in the gross total resection + radiotherapy group ( P=0.338). The 5- and 10-year OS rates were 100% and 100% in the gross total resection without radiotherapy group, and 98.5% and 98.5% in the gross total resection + radiotherapy group ( P=0.693). The 10-year PFS rates between the gross total resection±radiotherapy group and the incomplete resection+radiotherapy group was 95.8% vs. 90.3% ( P=0.368), and the 10-year OS rate was 98.6% vs. 94.7% ( P=0.436). Multivariate analysis showed that tumor site, degree of surgical resection, adjuvant radiotherapy and age exerted no significant effects on PFS and OS. A total of 81 patients had late neurotoxicities, including 69 cases at grade 1, 9 cases at grade 2, and 3 cases at grade 3. And 64.2% (52/81 cases) of patients suffered from short-term memory impairment. Conclusions:Gross total resection alone yields high efficacy for CN. Postoperative radiotherapy is not required. Incomplete resection combined with postoperative adjuvant radiotherapy can achieve equivalent clinical efficacy to gross total resection.
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Objective:To summarise the effect of free perforator flap of radial collateral artery on reconstruction of first web contracture after hand injury.Methods:Retrospective analysis was conducted based on the clinical data of patients with first web contracture after hand injury in the Department of Hand and Foot Surgery and Rehabilitation, Guangdong Work Injury Rehabilitation Hospital from November 2019 to June 2022. Ten patients, 8 males and 2 females aged between 27 and 51 years old with an average of 40.5 years old were included. There were 6 left hands and 4 right hands. Width and the included angle of first web were measured before surgery. Four hands were classified as severe first web contracture, and the rest of 6 hands had moderate first web contracture. After release scars of the first web, the areas of wound were 5.5 cm × 2.0 cm - 10.5 cm × 3.0 cm. The flaps sized were 6.0 cm×2.5 cm - 11.0 cm × 3.5 cm. All of flaps carried the posterior cutaneous nerve of forearm. Donor sites were closed directly. All patients were included in postoperative follow-up regularly through outpatient clinic or via WeChat reviews. The colour, texture, process in change of the transferred flaps, donor and recipient sites healing and complications were observed.Results:All 10 flaps survived and the wound healed by first intention. The patients received 7 to 15 months (10.5 months in average) of postoperative follow-up. The flaps were not bulky, texture and colour were satisfactory and without pigmentation. Protective sensations restored in 6 patients. At the last follow-up, average included angle of the first webs was 47.14°±1.68°, in comparison with 35.43°±3.60° before surgery. The average width of first webs was 5.34 cm±0.52 cm, in comparison with 3.17 cm±0.75 cm before surgery, the differences were statistically significant ( P<0.01). Eight hands were rated excellent, and 2 were good. There were only linear scars left at the donor sites, without sign of radial nerve injury. Conclusion:The free perforator flap of radial collateral artery is a safe and effective method for repair of first web contracture after hand injury.
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Objective:To investigate the efficacy and safety of fractionated stereotactic radiotherapy (FSRT) based on linear accelerator for small volume brain metastases.Methods:A total of 21 patients with small volume brain metastases who received FSRT from August 2020 to June 2022 were enrolled as subjects, including 45 lesions. Small-volume brain metastases were defined as ≤3 cm in diameter and ≤6 cm 3 in volume, and the dose/fractionation scheme was 27-30 Gy/3 F or 30-40 Gy/5 F. Three months after radiotherpy, the efficacy of FSRT in small brain metastases and the incidence of radiation brain injury were evaluated, and the incidence of radiation brain injury in subgroup analysis was performed according to the diameter, volume, dose/fractionation scheme, biological effective dose (BED) 10, and location of lesions. Results:Twenty-four lesions (53.33%, 24/45) were evaluated as complete response, another 13 lesions (28.89%, 13/45) were evaluated as partial response, and in the remaining 8 lesions (17.78%, 8/45) were evaluated as stable disease. The local control rate was 100% (45/45), the objective remission rate was 82.22% (37/45), and the intracranial distant progression rate was 23.81% (5/21). During the treatment and follow-up, there were 7 lesions (15.56%, 7/45) of radiation-induced brain injury, and the incidence of symptomatic radiation-induced brain injury was 11.11% (5/45). Subgroup analysis showed that the incidence of radiation brain injury in the group with a lesion diameter of 2-3 cm was higher than that with a lesion diameter of <2 cm group, with a statistically significant difference [80.00% (4/5) vs. 7.50% (3/40), χ2=12.69, P<0.001]; the incidence rate of radiation brain injury in the group with lesion volume of 4-6 cm 3 was higher than that with lesion volume of <4 cm 3 group, with a statistically significant difference [57.14% (4/7) vs. 7.89% (3/38), χ2=7.49, P=0.006]. There was no significant difference in the incidence of radiation brain injury between the dose/fractionation scheme of lesions 27-30 Gy/3 F and 30-40 Gy/5 F [9.52% (2/21) vs. 20.83% (5/24), χ2=0.40, P=0.527]. There was no significant difference in the incidence of radiation brain injury between the BED 10<60 Gy and ≥60 Gy [28.57% (2/7) vs. 13.16% (5/38), χ2=0.22, P=0.641]. There was no significant difference in the incidence of radiation brain injury between the lesions in the same lobe and the single or multiple lesions in different lobes [28.57% (4/14) vs. 9.68% (3/31), χ2=1.38, P=0.240) . Conclusion:FSRT based on linear accelerator is effective for small volume brain metastases. Brain metastases with the diameter <2 cm or volume <4 cm 3 are associated with a lower incidence of radiation brain injury than that of lesions with the diameter of 2-3 cm or volume of 4-6 cm 3.
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Objective Both flee triiodothyronine (FT3) level and Glasgow Coma scale (GCS) scores have been separately described as prognostic predictors for mortality in hypertensive intracerebral hemorrhage (HICH).This study is conducted to investigate the relationship and prognostic impact of low-T3 syndrome and GCS in HICH patients.Methods Two hundred and thirty patients with HICH,admitted to our hospital from January 2015 to January 2016,were chosen and performed thyroid hormone levels examination (FT3,FT4 and thyroid stimulating hormone [TSH] 3).According to the thyroid hormone results,these patients were divided into low T3 group I (FT3＜3.1 pmol/L,normal TSH level) and normal thyroid function group (normal FT3,FT4 and TSH levels).According to best cut-off levels defined by receiver operating characteristic (ROC) curve,these patients were divided into low GCS scores group (GCS＜7.5) and high GCS scores group (GCS＞7.5),and low T3 group Ⅱ (FT3＜2.85 pmol/L) and high T3 group (FT3＞2.85 pmol/L).Telephone follow-up was performed every 6 months,and using death or re-bleeding during follow-up period as end point of the event,prognostic values of FT3 level and GCS scores defined by ROC curve in mortality and re-bleeding rote were recorded;survival rate of these patients were analyzed by Kaplan-Meier curves and compared between each two groups;multivariate Cox regression was used to analyze the relations of FT3 level and GCS scores with mortality and re-bleeding rate.Results As compared with normal thyroid function group,low T3 group Ⅰ had significantly higher re-bleeding rate,percentage of patients with blood loss＞30 mL,and rate of breaking into the ventricles,and statistically lower GCS scores at admission and FT3 level (P＜0.05);the mean age in patients of low T3 group Ⅰ was significantly elder than that in patients of normal thyroid function group (P＜0.05).ROC results indicated that the sensitivity and specificity of GCS scores in predicting mortality and re-bleeding rate were 63％ and 73％,and those of FT3 level were 45％ and 73％.Kaplan-Meier curves showed that both low GCS group and low T3 group Ⅱ had significantly increased mortality and re-bleeding rate as compared with high GCS group and high T3 group (P＜0.05).Unified prediction results indicated that patients from low T3 and low GCS group had significantly higher mortality and re-bleeding rate as compared with patients from low T3 and high GCS group,high T3 and low GCS group,and high T3 and high GCS group (P＜0.05).Conclusion Low T3 syndrome is common in patients with HICH;FT3 level and GCS scores appear to be important predictors for mortality and recurrence in patients with HICH.
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Objective To explore the management of gliomas in pregnant women.Methods We retrospectively analyzed the clinical data in 11 pregnant women with gliomas treated at Xuanwu Hospital of Capital Medical University between January 1989 and December 2012.Results All the patients were first diagnosed with gliomas during pregnancy,including two cases during early pregnancy,four cases during midpregnancy,and five cases during late pregnancy.The main clinical manifestations were dizziness,headache,nausea and vomiting due to intracranial hypertension,accompanied by epilepsy and blurred vision,hearing and speech disorder and other neurological dysfunctions.Among the 11 patients,one received no obstetric treatment,five underwent cesarean section,three had metaphase induced labor,one had induced abortion,and one had spontaneous abortion.Five neonates appeared normal without malformation:four survived,and one with severe asphyxia died.Ten patients underwent neurosurgery,four of them were diagnosed with low-grade gliomas and six were diagnosed with high-grade glioma by pathology.Seven patients received craniotomy after termination of pregnancy,two underwent craniotomy before termination of pregnancy,and one received emergency craniotomy immediately after admission without obstetric treatment because of her critical conditions.Of the ten patients treated with craniotomy,one died after a coma for 50 days,one was lost to follow-up,six received radiotherapy plus chemotherapy,one received chemotherapy alone,and one received neither radiotherapy nor chemotherapy.Among the 11 patients,one patient who underwent cesarean section without craniotomy was lost to follow-up,one patient with low-grade glioma died 50 days after operation,one treated with craniotomy was lost to follow-up,and eight were followed up for four months to three years,among which four survived and four with high-grade glioma died within one year after operation.Conclusion The overall prognosis of glioma patients during pregnancy is poor.It is important to take into account the tumor status of the pregnant women,gestational age,fetal maturity and patient's desire for tocolysis,and weigh the pros and cons,and timely terminate pregnancy and perform neurosurgery.
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Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects.Methods The clinical,imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up.Results Of 74 tunors,67 were resected with Simpson Ⅱ grade,7 with Simpson Ⅲ,none of them with Simpson Ⅰ.Superior sagittal sinus and the vein of central suleus and feeders of cortex were reserved well.Severe brain injury was not occurred in 66 cases with tumors debulking(Simpson Ⅱ 61 cases,Simpson Ⅲ 5 cases),the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively.Tumors of 8 cases were "turned over" and resected by piecemeal (Simpson Ⅱ 6 cases,Simpson Ⅲ 2 cases),weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery.Followed-up ranged from 6 months to 4 years and 2 months,4 cases were lost to follow-up.Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month.Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ 6 months later,no recurrence and death.Conclusion The measures,including piecemeal tumor reseeted mierosugically,good protection of the vein of central sulcus,excellent management of superior sagittal sinus,and avoiding damage to functional cerebral cortex during operations,are best ways for raising the tumor resection rate and nearo-function reserved.