Enhancing the Extent of Resection in Glioma Surgery Through the Integration of Intraoperative Contrast-Enhanced Ultrasound and Fluorescein Sodium.

OBJECTIVE: Due to the infiltrative nature and high local recurrence of gliomas, particularly high-grade gliomas, gross total resection (GTR) of a tumor is the first critical step in treatment. This study aimed to determine whether the integration of intraoperative contrast-enhanced ultrasound (CEUS) and fluorescein sodium can improve the identification of tumor boundaries and residuals, and increasethe extent of resection (EOR) to better protect neurological function. METHODS: We retrospectively analysed clinical data from 87 glioma surgeries and categorised the patients into 3 groups: CEUS plus fluorescein sodium, fluorescein sodium alone and microsurgery alone. RESULTS: In terms of EOR, GTR was achieved in 22 (91.7%) patients in the CEUS plus fluorescein sodium group, which was significantly higher than that in other groups. In the subgroup analysis of tumors with lobulated or satellite lesions and WHO grade III or IV gliomas, CEUS plus fluorescein sodium group showed the highest GTR (86.7% and 88.9% respectively) among the groups. Logistic regression analysis of factors that may affect the GTR of tumors showed that the functional areas involvement and the presence of lobulated or satellite lesions were risk factors, whereas CEUS plus fluorescein sodium group was a protective factor. However, CEUS plus fluorescein sodium group had the longest surgery time. CONCLUSIONS: Intraoperative CEUS with fluorescein sodium is a real-time, straightforward, safe, and effective approach to perform surgical resection of gliomas. This approach assists surgeons in identifying tumor boundaries, residual tumors, and normal brain parenchyma, which increases the EOR.

Expression and clinical significance of doublecortin (DCX) in pituitary adenoma.

PURPOSE: To date, no studies have investigated the expression of Doublecortin (DCX) in pituitary adenomas or evaluated the clinical value of DCX in the diagnosis of pituitary adenomas. This study aims to determine the expression levels of DCX in pituitary adenomas and to investigate its role in the staging of this condition. METHODS: Forty-six patients with pituitary adenomas were recruited. The expression of DCX in tumor sections from pituitary adenomas was determined using immunohistochemistry and quantitative real-time polymerase chain reaction. Tumors were classified as either invasive or non-invasive on the basis of clinical stage and using the Knosp grading system. Differences in the expression of DCX and its association with clinical characteristics were investigated. The potential of the measurement of DCX levels for distinguishing between invasive and non-invasive tumors was estimated using receiver operating characteristic (ROC) analysis. RESULTS: Expression of DCX were correlated with Knosp grade. No significant association was observed between DCX level and the clinical stage of the tumors. The expression of DCX was higher in tumors with Knosp 3 and lowest in Knosp 1, at both the mRNA and protein levels. Using DCX as a biomarker for the prediction of tumor invasiveness in pituitary adenoma patients, the area under the ROC curve was 0.829 (95% confidence interval, 0.6-28.1), which is higher than that obtained using Knosp grade. CONCLUSIONS: The expression of DCX is related to the Knosp grade of pituitary adenoma. DCX levels can be used as a biomarker for tumor invasiveness prediction in pituitary adenoma patients.

Prediction of minimally conscious state with somatosensory evoked potentials in long-term unconscious patients after traumatic brain injury.

BACKGROUND: To evaluate the predictive power of somatosensory evoked potentials (SEPs) for minimally conscious state (MCS) in long-term unconscious patients after traumatic brain injury (TBI). METHODS: SEPs were recorded in 58 patients with duration of unconsciousness >30 days after TBI. SEPs were classified into three grades. Predictors including age, sex, Glasgow Coma Scale (GCS), and cause of injury were also analyzed, respectively. The outcome was divided into two groups including unconscious group and MCS group. The outcome was assessed at 12 months after TBI. RESULTS: In 58 patients, 22 of 58 were minimally conscious, 3 of 58 dead, and 33 of 57 were still in vegetative state at 12 months after TBI. SEPs grade (p = 0.001) and GCS (p = 0.010) were significantly associated with the outcome. The area under the receiver operator characteristic curve of SEPs was 0.891 ± 0.048 (p < 0.001; 95% confidence interval, 0.798-0.984) for predicting outcome, and of GCS score was only 0.746 ± 0.066 (p = 0.002; 95% confidence interval, 0.616-0.876). The accuracy of the whole model for predicting unconscious and MCS was 91.7% and 86.4%, respectively. The overall correct prediction was as high as 89.7% (p < 0.001). CONCLUSIONS: SEPs are excellent in predicting the outcome of long-term unconscious patients after TBI. SEPs should be considered more often and more routinely used after TBI.

[Benign fibrous histiocytoma involving the skull: a case report and literature review].

OBJECTIVE: Benign fibrous histiocytomas (BFH) represent a rare group of tumors with a common origin from the tissue histiocytes, often causing pain and space-occupying effect. BFH of bone causes diagnostic difficulties due to its atypical clinical symptoms, radiographic features and cytological characteristics, which can be easily confused with other benign lesions such as non-ossifying fibroma (NOF), giant cell tumor (GCT), and fibrous dysplasia. The lesions are prone to relapse, and the patients often show poor response to radiotherapy and chemotherapy, therefore radical lesion resection should be the therapeutic target of this disease. This paper reported a case of BFH involving the skull and reviewed the associated literatures.