Laser interstitial thermal therapy for recurrent glioblastomas: a systematic review and meta-analysis.

We aim to investigate the efficacy and safety of laser interstitial thermal therapy (LITT) in treating recurrent glioblastomas (rGBMs). A comprehensive search was conducted in four databases to identify studies published between January 2001 and June 2022 that reported prognosis information of rGBM patients treated with LITT as the primary therapy. The primary outcomes of interest were progression-free survival (PFS) and overall survival (OS) at 6 and 12 months after LITT intervention. Adverse events and complications were also evaluated. Eight eligible non-comparative studies comprising 128 patients were included in the analysis. Seven studies involving 120 patients provided data for the analysis of PFS. The pooled PFS rate at 6 months after LITT was 25% (95% CI 15-37%, I2 = 53%), and at 12 months, it was 9% (95% CI 4-15%, I2 = 24%). OS analysis was performed on 54 patients from six studies, with an OS rate of 92% (95% CI 84-100%, I2 = 0%) at 6 months and 42% (95% CI 13-73%, I2 = 67%) at 12 months after LITT. LITT demonstrates a favorable safety profile with low complication rates and promising tumor control and overall survival rates in patients with rGBMs. Tumor volume and performance status are important factors that may influence the effectiveness of LITT in selected patients. Additionally, the combination of LITT with immune-based therapy holds promise. Further well-designed clinical trials are needed to expand the application of LITT in glioma treatment.

Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review.

PURPOSE: Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis. METHODS: We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression. RESULTS: In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008-8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015-12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240-15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335-17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020-9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486-309.595; p = 0.001). CONCLUSION: Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.

Predicting short-term recurrence in pituitary adenomas: Phosphohistone-H3 (Ser 10) proves an effective biomarker.

AIMS: This research sought to assess the effectiveness of the phosphohistone-H3 (PHH3) mitotic index (MI) as a biomarker to predict early recurrence and inform treatment options and follow-up intervals. MATERIALS AND METHODS: Quantitative immunohistochemical analysis was performed to assess H & E, PHH3, and MIB-1/Ki-67 expression in samples of 141 PAs. Next, the correlation between mitotic figures on H & E (mitotic figures), PHH3 MI, Ki-67 labeling index (LI) and clinical variables was analyzed. The difference among primary- and repeated-surgery groups, nonrecurrent and recurrent groups, and tumor subtypes of PHH3 MI and Ki-67 LI were also assessed. Finally, survival analysis was performed to test the predictive capacity of the biomarkers. RESULTS: The results showed that the group with Ki-67 LI > 2.6% was more prone to short-term recurrence (p < 0.05). Ki-67 LI also correlated with tumor size and Knosp grades (p < 0.05); Ki-67 LI was higher in PAs with Knosp grades III and IV. However, PHH3-positive tumor cells were strongly correlated with the mitosis observed by hematoxylin-eosin staining. Significantly, the PHH3 MI showed stronger short-term prognostic capacity than Ki-67 LI. With a cut-off value of 0.5%, PHH3 MI predicted recurrence with a sensitivity and specificity of 61.5 and 92.1%, respectively. Multivariate survival analysis found that only PHH3 MI was found to be an independent prognostic factor with a hazard ratio of 2.884, compared with 1.076 for Ki-67 LI. CONCLUSION: Phosphohistone-H3 is shown to be an effective prognostic biomarker for short-term recurrence of PAs. This suggests that it should be used alongside Ki-67 as a predictor for prognosis.

Non-invasive genotype prediction of chromosome 1p/19q co-deletion by development and validation of an MRI-based radiomics signature in lower-grade gliomas.

PURPOSE: To perform radiomics analysis for non-invasively predicting chromosome 1p/19q co-deletion in World Health Organization grade II and III (lower-grade) gliomas. METHODS: This retrospective study included 277 patients histopathologically diagnosed with lower-grade glioma. Clinical parameters were recorded for each patient. We performed a radiomics analysis by extracting 647 MRI-based features and applied the random forest algorithm to generate a radiomics signature for predicting 1p/19q co-deletion in the training cohort (n = 184). The clinical model consisted of pertinent clinical factors, and was built using a logistic regression algorithm. A combined model, incorporating both the radiomics signature and related clinical factors, was also constructed. The receiver operating characteristics curve was used to evaluate the predictive performance. We further validated the predictability of the three developed models using a time-independent validation cohort (n = 93). RESULTS: The radiomics signature was constructed as an independent predictor for differentiating 1p/19q co-deletion genotypes, which demonstrated superior performance on both the training and validation cohorts with areas under curve (AUCs) of 0.887 and 0.760, respectively. These results outperformed the clinical model (AUCs of 0.580 and 0.627 on training and validation cohorts). The AUCs of the combined model were 0.885 and 0.753 on training and validation cohorts, respectively, which indicated that clinical factors did not present additional improvement for the prediction. CONCLUSION: Our study highlighted that an MRI-based radiomics signature can effectively identify the 1p/19q co-deletion in histopathologically diagnosed lower-grade gliomas, thereby offering the potential to facilitate non-invasive molecular subtype prediction of gliomas.

Scene-based nonuniformity correction for airborne point target detection systems.

Images acquired by airborne infrared search and track (IRST) systems are often characterized by nonuniform noise. In this paper, a scene-based nonuniformity correction method for infrared focal-plane arrays (FPAs) is proposed based on the constant statistics of the received radiation ratios of adjacent pixels. The gain of each pixel is computed recursively based on the ratios between adjacent pixels, which are estimated through a median operation. Then, an elaborate mathematical model describing the error propagation, derived from random noise and the recursive calculation procedure, is established. The proposed method maintains the characteristics of traditional methods in calibrating the whole electro-optics chain, in compensating for temporal drifts, and in not preserving the radiometric accuracy of the system. Moreover, the proposed method is robust since the frame number is the only variant, and is suitable for real-time applications owing to its low computational complexity and simplicity of implementation. The experimental results, on different scenes from a proof-of-concept point target detection system with a long-wave Sofradir FPA, demonstrate the compelling performance of the proposed method.

Point target detection based on multiscale morphological filtering and an energy concentration criterion.

The research on optical imaging characteristics of infrared dim point targets in the presence of nonstationary cloud clutter and random noise is necessary for target detection. We analyze the energy concentration of point targets that are less than 3×3 pixels in size and deduce a simulation model of the point target imaging process. Then we adopt omnidirectional multiscale structural elements to detect all the possible targets distributing in every direction. The adaptive threshold and the energy concentration criterion are employed to eliminate false alarms. Finally, the trajectory of point targets is obtained after the low-order recursive correlation. The results show that the detection probability of the proposed method reaches 99.8% with 0.2% false alarm probability. It demonstrates that the proposed method has a good performance to suppress complex background and random noise. Also, it has the advantage of low complexity and easy implementation in a real-time system.

A comparative analysis of ESM-1 and vascular endothelial cell marker (CD34/CD105) expression on pituitary adenoma invasion.

OBJECTIVE: Pituitary adenomas are benign neoplasms that display invasive behavior-a characteristic traditionally associated with malignancy-through an ill-defined mechanism. The role of angiogenesis-related molecules in this pathological condition remains perplexing. Our purpose is to assess the impact of endocan (endothelial cell specific molecule-1, ESM-1), CD34 and CD105 on pituitary adenoma invasion. METHODS: In this study, immunohistochemical analyses for endocan, CD34 and CD105 were performed on paraffin-embedded samples of 66 pituitary adenomas, five normal pituitaries, and five primary hepatic carcinomas. Knosp tumor grades based on magnetic resonance imaging coronal scanning were used to assess the invasiveness of each sample. The associations between endocan expression, CD34/CD105-positive microvessel densities (MVDs), and Knosp tumor invasion grades were evaluated. RESULTS: These results showed that endocan protein expression in tumor cells (TCs) was higher than that in endothelial cells (ECs) and strongly correlated with Knosp grades (P < 0.001, Spearman's r = 0.616). Moreover, while endocan-positive TCs localized around the blood vessels in adenomas with higher Knosp grades, no significant association was found between CD34/CD105-MVDs and Knosp grades (CD34: P = 0.256, r = 0.142; CD105: P = 0.183, r = 0.166). Normal pituitary seemed to exhibit lower endocan expression and contained more CD34/CD105-MVDs than pituitary adenomas. CONCLUSION: Endocan expresses in both TCs and ECs of pituitary adenoma. Endocan overexpression in TCs more accurately reflects invasiveness compared to that of CD34/CD105-MVDs and that angiogenesis may not be the primary driver of endocan-medicated pituitary adenoma invasion.

Staircase-scene-based nonuniformity correction in aerial point target detection systems.

Focal-plane arrays (FPAs) are often interfered by heavy fixed-pattern noise, which severely degrades the detection rate and increases the false alarms in airborne point target detection systems. Thus, high-precision nonuniformity correction is an essential preprocessing step. In this paper, a new nonuniformity correction method is proposed based on a staircase scene. This correction method can compensate for the nonlinear response of the detector and calibrate the entire optical system with computational efficiency and implementation simplicity. Then, a proof-of-concept point target detection system is established with a long-wave Sofradir FPA. Finally, the local standard deviation of the corrected image and the signal-to-clutter ratio of the Airy disk of a Boeing B738 are measured to evaluate the performance of the proposed nonuniformity correction method. Our experimental results demonstrate that the proposed correction method achieves high-quality corrections.

Microsurgical management of primary jugular foramen meningiomas: a series of 22 cases and review of the literature.

This study summarized clinical manifestations, surgical management, histological grading, and long-term outcome of jugular foramen meningiomas (JFMs). Retrospective study was performed in 22 consecutive patients with primary JFMs from January 2004 to October 2010, enrolling 10 men and 12 women with average age of 39.4 (14-57 years). The most common initial symptom is hearing disorder, followed by lower cranial nerve dysfunctions. The tumor was classified into type I (intracranial) in 1, type II (intracranial) in 15, type IV (intracranial-extracranial) in 6, and none type III (extracranial). Surgical approaches mainly included retrosigmoid in 7, far lateral in 10, and juxtacondylar in 5, with some variations. The gross total resection was achieved in 15 cases and subtotal resection in 7. Fourteen patients (63.6 %) developed new or worse neurological deficits immediately after operation, of whom 11 (78.6 %) got alleviation. Postoperatively, keeping airway patency and prevention from aspiration pneumonia is very important. Nasotracheal intubation is much more tolerated than orotracheal intubation for postoperative patient management. WHO grade 2 was found in four cases (18.2 %) and grade 3 in one. During the average time of follow-up in 83.2 months, only one (grade 3) died of tumor regrowth 20 months after surgery and radiosurgery. Five of 17 patients of grade 1 developed tumor regrowth. Radiosurgery provides a good tumor control for tumor regrowth in grade 1, or postoperative grade 2 tumor. In conclusion, JFMs has a favorable long-term overall survival; however, neurological preservation is still challenging, especially low cranial nerves.

Hotspots and Trends in Meningioma Research Based on Bibliometrics, 2011-2021.

BACKGROUND: Meningiomas, the most prevalent benign intracranial neoplasms, have been studied extensively for many years, but significant problems remain. To date, there is a scarcity of detailed studies elucidating the hotspots and future directions of meningiomas research. METHODS: A comprehensive search and screening strategy was used to collect relevant studies published between 2011 and 2021 in the Web of Science Core Collection database. Thorough and systematic coauthorship and co-occurrence keyword maps were generated, and tables of statistics summarizing countries, organizations, authors, and keywords were created. RESULTS: A total of 1544 articles meeting the screening criteria were collected. The countries producing the most publications between 2011 and 2021 were the United States, Germany, and China, with 586, 244, and 197 records, repectively. The cooperation networks also revolved mainly around these 3 countries, particularly the United States. The most frequently used keyword was "surgery," followed by "recurrence" and "management," with the frequencies of 248, 212, and 163, respectively. The most prominent cluster during the last decade was the #0 methylation cluster, and several keywords, including "survival," "brain invasion," and "magnetic resonance imaging," exhibited significant burst strength. CONCLUSIONS: This study aimed to provide a comprehensive analysis of the research landscape and to identify potential research directions. Our findings disclose productive individuals and institutions. The current research focuses on the molecular pathology of meningiomas, improvements in techniques, and advances in diagnosis by magnetic resonance imaging. In particular, the improvements in molecular pathology might direct future research directions.

Subventricular zone-associated classification in isocitrate dehydrogenase-wildtype glioblastomas: improved prognostic value through integration of FLAIR with contrast-enhanced imaging.

OBJECTIVE: Controversy surrounds the prognostic value of contrast-enhanced T1-weighted (T1CE) imaging-based subventricular zone (SVZ) classification in isocitrate dehydrogenase (IDH)-wildtype glioblastomas (GBMs). In this study, the authors aimed to assess the potential of incorporating FLAIR imaging into T1CE imaging-based classification for improving prognostic accuracy. METHODS: A retrospective analysis was conducted on 281 patients with IDH-wildtype GBM. T1CE imaging-based classification was performed, and T2-weighted/FLAIR imaging was integrated to evaluate its prognostic estimation ability. Based on the relationship between the tumors and SVZ, patients were categorized into SVZ+ and SVZ- cohorts based on T1CE and T2-weighted/FLAIR imaging findings. Kaplan-Meier and Cox proportional hazards regression analyses were used to assess progression-free survival (PFS) and overall survival (OS), respectively. Patients were then categorized into three subgroups based on their combined classifications: group 1 (SVZ+ on T1CE and T2-weighted/FLAIR imaging), group 2 (SVZ- on T1CE but SVZ+ on T2-weighted/FLAIR imaging), and group 3 (SVZ- on T1CE and T2-weighted/FLAIR imaging). Subgroup analysis was used to evaluate differences in clinical and molecular factors as well as in prognoses. RESULTS: The T1CE imaging-based classification failed to stratify OS between SVZ+ and SVZ- cohorts (16.0 vs 20.0 months, p = 0.36). Survival analysis revealed similar prognoses for patients in groups 1 and 2, and patients in group 2 exhibited worse OS compared with those in group 3 (19.0 vs 23.5 months, p = 0.024). Logistic regression identified lower Karnofsky Performance Status (KPS) (p = 0.011), tumor diameter (p = 0.002), and telomerase reverse transcriptase (TERT) promoter mutation (p = 0.003) to be associated with a higher incidence of group 2 GBMs. Additionally, T2-weighted/FLAIR imaging-based classification provided significant prognostic value (17.0 vs 23.5 months p = 0.021) and was found to be an independent prognostic factor in the Cox multivariate analysis (HR 1.79, 95% CI 1.08-2.96; p = 0.024). CONCLUSIONS: This study underscores the limitations of T1CE imaging-based SVZ-associated classification in predicting prognosis for IDH-wildtype GBMs. The authors therefore propose an integrated approach that involves T2-weighted/FLAIR imaging that can provide improved prognostic ability. Notably, the presence of TERT promoter mutation was identified as a critical factor in nonenhancing tumor infiltration into the SVZ. Further validation through extensive cohort studies is recommended to confirm these findings.

Intravenous tranexamic acid for intracerebral meningioma resections: A randomized, parallel-group, non-inferiority trial.

STUDY OBJECTIVES: Tranexamic acid (TXA) is an antifibrinolytic that is widely used to reduce surgical bleeding. However, TXA occasionally causes seizures and the risk might be especially great after neurosurgery. We therefore tested the hypothesis that TXA does not meaningfully increase the risk of postoperative seizures within 7 days after intracranial tumor resections. DESIGN: Randomized, double-blind, placebo-controlled, non-inferiority trial. SETTING: Beijing Tiantan Hospital, Capital Medical University. PATIENTS: 600 patients undergoing supratentorial meningioma resection were included from October 2020 to August 2022. INTERVENTIONS: Patients were randomly assigned to a single dose of 20 mg/kg of TXA after induction (n = 300) or to the same volume of normal saline (n = 300). MEASUREMENT: The primary outcome was postoperative seizures occurring within 7 days after surgery, analyzed in both the intention-to-treat and per-protocol populations. Non-inferiority was defined by an upper limit of the 95% confidence interval for the absolute difference being <5.5%. Secondary outcomes included incidence of non-epileptic complication within 7 days, changes in hemoglobin concentration, estimated intraoperative blood loss. Post hoc analyses included the types and timing of seizures, oozing assessment, and a sensitivity analysis for the primary outcome in patients with pathologic diagnosis of meningioma. MAIN RESULTS: All 600 enrolled patients adhered to the protocol and completed the follow-up for the primary outcome. Postoperative seizures occurred in 11 of 300 (3.7%) of patients randomized to normal saline and 13 of 300 (4.3%) patients assigned to tranexamic acid (mean risk difference, 0.7%; 1-sided 97.5% CI, -∞ to 4.3%; P = 0.001 for noninferiority). No significant differences were observed in any secondary outcome. Post hoc analysis indicated similar amounts of oozing, calculated blood loss, recurrent seizures, and timing of seizures. CONCLUSION: Among patients having supratentorial meningioma resection, a single intraoperative dose of TXA did not significantly reduce bleeding and was non-inferior with respect to postoperative seizures after surgery. REGISTRY INFORMATION: This trial was registered at clinicaltrials.gov (NCT04595786) on October 22, 2020, by Dr.Yuming Peng.

[Clinical analysis of trigemino-cardiac reflex during surgery for patients with skull base tumors].

OBJECTIVE: To investigate the clinical features, risky factors and outcome of the trigemino-cardiac reflex (TCR) during surgery for skull base tumors. METHODS: Two hundred and sixty-two neurosurgical patients with skull base tumors underwent general anesthesia and open surgery from October 2009 to December 2011 in department of neurosurgery of Beijing Tiantan Hospital. The occurrence of TCR and the type of tumor, the surgical approach as well as the postoperative complication relative to TCR was evaluated retrospectively. RESULTS: Seventeen patients occurred TCR events intraoperatively (6.5%). There were 8 men and 9 women with an average age of 40.5 years. Eleven of them (64.7%) underwent schwannoma surgery. Regarding with the surgical procedure, the suboccipital retrosigmoidal approach and the middle fossa transtentorial approach were most commonly associated with TCR in this series (88.2%). The heart rate and blood pressure returned to the patient's normal baseline level after cessation of the surgical manipulation. There was no TCR-relative complication in cardiovascular system. The postoperative course is uneventful in all 17 patients. CONCLUSIONS: TCR may occur during surgery for skull base tumor, especially when performing schwannoma surgery and suboccipital retrosigmoidal or middle fossa transtentorial approach. Accurate recognition and management of TCR during skull base surgery often carry on favorable outcome.

Case report: Clinical and single-cell transcriptome sequencing analysis of a mixed gangliocytoma-adenoma presenting as acromegaly.

Background: Mixed gangliocytoma-adenoma (MGA) is a rare tumor of pituitary gland. It's difficult to distinguish it from pituitary adenoma by clinical manifestations, imaging features or serological testing. Thus, the histopathological examination is still the golden standard for diagnosis. Besides, studies on molecular level are still lacking. Case information: In this case report, we described a 28-year-old male with MGA presenting as acromegaly, who suffered staging operation and post-operation gamma knife radiosurgery, but finally died of secondary hyperglycemic hyperosmolar collapse. A complete data including clinical, histopathological, ultrastructural and single-cell transcriptome level information were collected and analyzed. Conclusion: This case report detailed the only clinical and molecular report of MGA following operation and radiotherapy. Complete clinical data enhanced the understanding of the diagnosis and treatment of this disease. Besides, the single-cell transcriptome sequencing analysis further disclosed the intra-tumoral heterogeneity and provided support for subsequent basic research.

Glioma-related epilepsy in patients with diffuse high-grade glioma after the 2016 WHO update: seizure characteristics, risk factors, and clinical outcomes.

OBJECTIVE: The aim of this study was to investigate the epidemiological characteristics, associated risk factors, and prognostic value of glioma-related epilepsy in patients with diffuse high-grade gliomas (DHGGs) that were diagnosed after the 2016 updated WHO classification was released. METHODS: Data from 449 patients with DHGGs were retrospectively collected. Definitive diagnosis was reaffirmed according to the 2016 WHO classification. Seizure outcome was assessed using the Engel classification at 12 months after surgery. Univariate and multivariate analyses were performed to identify risk factors associated with preoperative and postoperative glioma-related epilepsy. Lastly, the prognostic value of glioma-related epilepsy was evaluated by Kaplan-Meier and Cox analysis. RESULTS: The incidence of glioma-related epilepsy decreased gradually as the malignancy of the tumor increased. Age < 45 years (OR 2.601, p < 0.001), normal neurological function (OR 3.024, p < 0.001), and lower WHO grade (OR 2.028, p = 0.010) were independently associated with preoperative glioma-related epilepsy, while preoperative glioma-related epilepsy (OR 7.554, p < 0.001), temporal lobe involvement (OR 1.954, p = 0.033), non-gross-total resection (OR 2.286, p = 0.012), and lower WHO grade (OR 2.130, p = 0.021) were identified as independent predictors of poor seizure outcome. Furthermore, postoperative glioma-related epilepsy, rather than preoperative glioma-related epilepsy, was demonstrated as an independent prognostic factor for overall survival (OR 0.610, p = 0.010). CONCLUSIONS: The updated WHO classification seems conducive to reveal the distribution of glioma-related epilepsy in DHGG patients. For DHGG patients with high-risk predictors of poor seizure control, timely antiepileptic interventions could be beneficial. Moreover, glioma-related epilepsy (especially postoperative glioma-related epilepsy) is associated with favorable overall survival.

New-Onset Postoperative Seizures in Patients With Diffuse Gliomas: A Risk Assessment Analysis.

Background: Glioma-related epilepsy (GRE) is the most common presenting sign of patients with diffuse glioma. According to clinical experience, new-onset postoperative seizures can be observed even in patients without preoperative GRE. The current study mainly aimed to explore the risk factors of new-onset postoperative seizures in those patients. In addition, the prognostic value of new-onset postoperative seizures was also discussed. Methods: Data of 313 patients without GRE were retrospectively reviewed. Chi-square test or Fisher's exact test were first performed to compare categorical variables between patients with new-onset postoperative seizures and those without. Subsequently, binary logistic regression analysis was conduct to further assess risk factors of new-onset postoperative seizures. Kaplan-Meier and Cox analysis were used to investigate the prognostic value of new-onset postoperative seizures for progression-free survival (PFS) and overall survival (OS). Results: Patients with low-grade tumors (p = 0.006), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.040) or low Ki-67 expression (p = 0.005) showed a higher incidence of new-onset postoperative seizures. IDH1 mutation was identified as the only independent predictor for new-onset postoperative seizures (OR, 2.075; 95% CI, 1.051-4.098; p = 0.035). Additionally, new-onset postoperative seizure occurrence was demonstrated as an independent predicter of prolonged OS (OR, 0.574; 95% CI, 0.335-0.983; p = 0.043), while younger age, gross total resection, low-grade and IDH1 mutation were independently correlated with prolonged OS and PFS. Conclusions: IDH1 mutation is an independent predictor for new-onset postoperative seizures in patients without preoperative GRE. Moreover, new-onset postoperative seizures can independently predict prolonged OS in those patients. The results of the current study can contribute to improving the individualized management of diffuse glioma.

Single-cell transcriptome and genome analyses of pituitary neuroendocrine tumors.

BACKGROUND: Pituitary neuroendocrine tumors (PitNETs) are the second most common intracranial tumor. We lacked a comprehensive understanding of the pathogenesis and heterogeneity of these tumors. METHODS: We performed high-precision single-cell RNA sequencing for 2679 individual cells obtained from 23 surgically resected samples of the major subtypes of PitNETs from 21 patients. We also performed single-cell multi-omics sequencing for 238 cells from 5 patients. RESULTS: Unsupervised clustering analysis distinguished all tumor subtypes, which was in accordance with the classification based on immunohistochemistry and provided additional information. We identified 3 normal endocrine cell types: somatotrophs, lactotrophs, and gonadotrophs. Comparisons of tumor and matched normal cells showed that differentially expressed genes of gonadotroph tumors were predominantly downregulated, while those of somatotroph and lactotroph tumors were mainly upregulated. We identified novel tumor-related genes, such as AMIGO2, ZFP36, BTG1, and DLG5. Tumors expressing multiple hormone genes showed little transcriptomic heterogeneity. Furthermore, single-cell multi-omics analysis demonstrated that the tumor had a relatively uniform pattern of genome with slight heterogeneity in copy number variations. CONCLUSIONS: Our single-cell transcriptome and single-cell multi-omics analyses provide novel insights into the characteristics and heterogeneity of these complex neoplasms for the identification of biomarkers and therapeutic targets.

Comparative efficacy of antiangiogenic treatment for newly diagnosed glioblastoma: A protocol for systematic review and network meta-analysis.

BACKGROUND: Glioblastoma is the most common malignant primary brain tumor which has highly expressed vascular endothelial growth factor. To date, various antiangiogenic drugs have been investigated in clinical trials but with no overall conclusion, especially for newly diagnosed glioblastoma (nGBM). In this study, Bayesian network meta-analysis will be used to conduct a comprehensive analysis of the results of different clinical trials, and assess the efficacy of different antiangiogenic drugs on nGBM. METHODS: In order to find more comprehensive information about the application of antiangiogenic drugs in nGBM patients, we searched the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials for relevant randomized controlled trials. We also reviewed their reference lists to avoid omissions. Cochrane risk of bias tool (V.1.4.3) and Stata (V.15.0) will be used to assess the methodological quality of this review. RESULTS: This study will provide reliable evidence for different antiangiogenic therapies in nGBM patients. CONCLUSION: We will evaluate the relative effectiveness of different antiangiogenic drugs and rank each intervention in nGBM patients through prognosis to provide decision-making reference on which method to choose for clinicians. PROTOCOL REGISTRATION NUMBER: CRD42019146537.

Hemangiopericytomas: Spatial Intracranial Location in a Voxel-Based Mapping Study.

BACKGROUND AND PURPOSE: To investigate the preferred location of intracranial hemangiopericytomas (IHPCs) with voxel-based mapping and 3-dimensional reconstruction from MRI data. METHODS: Gadolinium-enhanced tumors of 258 primary and single IHPCs were segmented semi-automatically, followed by manual checking and editing of boundaries. The lesions were registered to Montreal Neurological Institute standard anatomical space, and heat-map and 3-dimensional rendered frequency images were generated. All tumors were then superimposed on the Anatomical Automatic Labeling (AAL) template to further investigate the difference in the tumor location based on the voxel-wise frequency of occurrence with respect to laterality, sex, age, and pathologic grade. RESULTS: The 3-dimensional rendered images show that the tumors commonly located in the posterior cranial cavity, surrounding the tentorium. The posterior third of the superior sagittal sinus and the confluence of sinuses were commonly affected. According to the analysis of tumor occurrence frequency in the AAL template, IHPCs were mainly observed in the limbic lobe, occipital lobe, and cerebellum. Tumors in younger patients preferentially located in the right occipital region (P = .027), whereas those with higher pathological grade more often located in the left parietal lobe (P = .034). CONCLUSIONS: This is the first voxel-based study to explore the predilection site of IHPCs. Our study suggests that these tumors commonly affect the posterior cranial cavity, adjoining the tentorium and venous sinus. Further research is needed to investigate the possible factors underlying these topographic preferences.

Accurate Preoperative Distinction of Intracranial Hemangiopericytoma From Meningioma Using a Multihabitat and Multisequence-Based Radiomics Diagnostic Technique.

Background: Intracranial hemangiopericytoma (IHPC) and meningioma are both meningeal neoplasms, but they have extremely different malignancy and outcomes. Because of their similar radiological characteristics, they are difficult to distinguish prior to surgery, leading to a high rate of misdiagnosis. Methods: We enrolled 292 patients (IHPC, 155; meningiomas, 137) with complete clinic-radiological and histopathological data, from a 10-year database established at Tiantan hospital. Radiomics analysis of tumor and peritumoral edema was performed on multisequence magnetic resonance images, and a fusion radiomics signature was generated using a machine-learning strategy. By combining clinic-radiological data with the fusion radiomics signature, we developed an integrated diagnostic approach that we named the IHPC and Meningioma Diagnostic Tool (HMDT). Results: The HMDT displayed remarkable diagnostic ability, with areas under the curve (AUCs) of 0.985 and 0.917 in the training and validation cohorts, respectively. The calibration curve showed excellent agreement between the diagnosis predicted by HMDT and the histological outcome, with p-values of 0.801 and 0.622 for the training and the validation cohorts, respectively. Cross-validation showed no statistical difference across three divisions of the cohort, with average AUCs of 0.980 and 0.941 for the training and validation cohorts, respectively. Stratification analysis showed consistent performance of the HMDT in distinguishing IHPC from highly misdiagnosed subgroups of grade I meningioma and angiomatous meningioma (AM) with AUCs of 0.913 and 0.914 in the validation cohorts for the two subgroups. Conclusions: By integrating clinic-radiological information with radiomics signature, the proposed HMDT could assist in preoperative diagnosis to distinguish IHPC from meningioma, providing the basis for strategic decisions regarding surgery.