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1.
Medicine (Baltimore) ; 99(5): e19017, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000446

RESUMEN

O-(2-[F]fluoroethyl)-L-tyrosine positron-emission tomography/computed tomography (F-FET PET/CT) is well known in brain tumor management. Our study aimed to identify the prognostic value of F-FET PET/CT in high-grade gliomas (HGG) according the current 2016 World Health Organization (WHO) classification.Patients with histologically proven WHO 2016 HGG were prospectively included. A dynamic F-FET PET/CT was performed allowing to obtain 2 static PET frames (static frame 1: 20-40 minutes and static frame 2: 2-22 minutes). We analyzed static parameters (standard uptake value [SUV]max, SUVmean, SUVpeak, TBRmax, TBRmean, tumoral lesion glycolysis, and metabolic tumoral volume) for various isocontours (from 10% to 90%). PET parameters, clinical features, and molecular biomarkers were compared with progression-free survival (PFS) and overall survival (OS) in univariate and multivariate analysis.Twenty-nine patients were included (grade III n = 3, grade IV n = 26). Mean PFS and OS were, respectively, 8.8 and 13.9 months. According to univariate analysis, SUVmean, SUVpeak, TBRmax, and TBRmean were significantly correlated with OS. In static 1 analysis, TBRmax seemed to be the best OS prognostic parameter (P = .004). In static 2 analysis, TBRmean was the best parameter (P = .01). In static 1 analysis, only SUVpeak was significant (P = .05) for PFS. Good performance status (PS < 2; P < .0001) and extent of resection (P = .019) identified the subgroup of patients with the best OS. Only TBRmax (P = .026) and extent of resection (P = .025) remained significant parameters in multivariate analysis.Our data suggested that high TBRmax seemed to be the most significant OS independent prognostic factor in patients with newly diagnosed HGG.


Asunto(s)
Glioma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Medios de Contraste , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Pronóstico , Estudios Prospectivos , Radiofármacos , Tasa de Supervivencia , Tirosina/análogos & derivados
2.
World Neurosurg ; 135: e754-e764, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31901497

RESUMEN

OBJECTIVE: To assess the impact of intraoperative magnetic resonance imaging (iMRI), extent of resection (EOR), and other factors on overall survival (OS) and progression-free survival (PFS) for patients with newly diagnosed grade I gliomas. METHODS: A multicenter database was queried to identify patients with grade I gliomas. Retrospective analyses assessed the impact of patient, treatment, and tumor characteristics on OS and PFS. RESULTS: A total of 284 patients underwent treatment for grade I gliomas, including 248 resections (205 with iMRI, 43 without), 23 biopsies, and 13 laser interstitial thermal therapy treatments. Log-rank analyses of Kaplan-Meier plots showed improved 5-year OS (P = 0.0107) and PFS (P = 0.0009) with increasing EOR, and a trend toward improved 5-year OS for patients with lower American Society of Anesthesiologists score (P = 0.0528). Greater EOR was associated with significantly increased 5-year PFS for pilocytic astrocytoma (P < 0.0001), but not for ganglioglioma (P = 0.10) or dysembryoplastic neuroepithelial tumor (P = 0.57). Temporal tumors (P = 0.04) and location of "other" (P = 0.04) were associated with improved PFS, and occipital/parietal tumors (P = 0.02) were associated with decreased PFS compared with all other locations. Additional tumor resection was performed after iMRI in 49.7% of cases using iMRI, which produced gross total resection in 64% of these additional resection cases. CONCLUSIONS: Patients with grade I gliomas have extended OS and PFS, which correlates positively with increasing EOR, especially for patients with pilocytic astrocytoma. iMRI may increase EOR, indicated by the rate of gross total resection after iMRI use but was not independently associated with increased OS or PFS.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Niño , Preescolar , Femenino , Glioma/mortalidad , Glioma/patología , Humanos , Lactante , Cuidados Intraoperatorios , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/métodos , Procedimientos Neuroquirúrgicos/mortalidad , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
3.
World Neurosurg ; 133: 192-195, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31574328

RESUMEN

BACKGROUND: The frontal aslant tract (FAT) is a white matter fiber pathway connecting the superior frontal gyrus to the Broca area. This tract in the dominant hemisphere has been shown to play a role in speech initiation and production, and direct subcortical stimulation can induce stuttering and speech arrest in a patient. However, controversy remains as to whether disruption of this pathway will lead to a permanent language deficit and if it is even necessary to map this tract during tumor resections of the dominant frontal lobe. CASE DESCRIPTION: Here, we report a case of a patient with a lower-grade diffuse glioma invading the dominant FAT that was removed with an asleep craniotomy. In the immediate postoperative state, the patient had a transcortical motor dysphasia and was unable to initiate speech. These immediate language deficits quickly recovered, and the patient was neurologically intact at the time of discharge a few days after surgery. CONCLUSIONS: Given the high likelihood for a complete neurologic recovery including transient aphasia, we propose that awake mapping for the purpose of identifying the dominant FAT is unnecessary during tumor resection and that disruption of this tract is not associated with any long-term language deficits.


Asunto(s)
Afasia/etiología , Craneotomía/efectos adversos , Glioma/cirugía , Sustancia Blanca/cirugía , Afasia/diagnóstico por imagen , Afasia/patología , Femenino , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Imagen por Resonancia Magnética , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Adulto Joven
4.
World Neurosurg ; 133: 196-200, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31606508

RESUMEN

BACKGROUND: Rosette-forming glioneuronal tumors (RGNTs) with multifocal growth throughout the ventricular system are extremely rare, and only 1 case of RGNT with dissemination limited to supratentorial ventricles has previously been reported. Recent evidence based on molecular data suggest that low-grade glioneuronal tumors (GNT) involving the septum pellucidum and the lateral ventricles, with either dysembryoplastic neuroepithelial tumor-like or RGNT-like features, may belong to a neuropathologic entity distinct from cortical dysembryoplastic neuroepithelial tumor and "typical" fourth ventricle RGNT, respectively. Given their rarity, the classification of these neoplasms is still uncertain and their clinicopathological and radiological aspects are only partially known. CASE DESCRIPTION: A 24-year-old male presented a GNT with RGNT-like morphological features centered in the septum pellucidum with multifocal masses occupying the lateral ventricles and the third ventricle with extraventricular infiltration of the frontal lobe. The patient underwent subtotal resection and 4 years follow-up. The clinicopathological and radiological features of the neoplasm are discussed. CONCLUSIONS: Advanced magnetic resonance imaging (magnetic resonance spectroscopy and perfusion-weighted imaging) may provide valuable information in the differential diagnosis between rare GNTs and other more frequent intraventricular neoplasms. In the present case, the enhancing remnant portion of the tumor showed remarkable contrast enhancement variability during the follow-up with slow in situ progression. However, available data suggest that spontaneous contrast enhancement "fluctuations" over time in RGNT may not represent a reliable indicator of tumor behavior.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Tabique Pelúcido/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Craneotomía , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Procedimientos Neuroquirúrgicos , Tabique Pelúcido/diagnóstico por imagen , Tabique Pelúcido/patología , Resultado del Tratamiento , Adulto Joven
5.
World Neurosurg ; 133: 278-282, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31606510

RESUMEN

BACKGROUND: Depression following resection of diffuse low-grade glioma has rarely been described. Location of the tumor and surgical route are potential causes. Lesion network mapping (LNM), leveraging high-quality resting-state functional magnetic resonance imaging data from large samples of healthy adults, has been used to explore the broader network connectivity for given lesions. However, LNM has not been applied to large intra-axial masses or surgical lesions. We used LNM to examine a potential cause of postoperative depression in a patient with a cingulate diffuse low-grade glioma (zones I-III). CASE DESCRIPTION: A 34-year-old woman underwent surgery for medically refractory seizures attributable to diffuse low-grade glioma. Near-total resection was attained via a single-stage, transcortical route through the medial prefrontal cortex. Despite freedom from seizure and lack of tumor growth at 42 months of follow-up, she developed symptoms of major depressive disorder soon after surgery that persisted. To identify functional networks potentially engaged by the surgical corridor and tumor resection cavity, both were segmented separately and used as seeds for normative resting-state functional magnetic resonance imaging connectivity mapping. To study depression specifically, networks associated with the tumor and surgical approach were compared with networks associated with subgenual cingulate deep brain stimulation. LNM results suggested that the surgical corridor, rather than the tumor, had greater overlap with deep brain stimulation-based depression networks (32% vs. 8%). CONCLUSIONS: Early postoperative development of major depressive disorder following resection of a cingulate region tumor, although likely multifactorial, should be considered and patients appropriately counseled preoperatively. Further validation of LNM as a viable methodology for correlating symptoms to lesions could make it a valuable tool in selection of surgical approach and patient counseling.


Asunto(s)
Neoplasias Encefálicas/cirugía , Craneotomía/efectos adversos , Trastorno Depresivo Mayor/etiología , Glioma/cirugía , Giro del Cíngulo/cirugía , Convulsiones/cirugía , Adulto , Neoplasias Encefálicas/complicaciones , Femenino , Glioma/complicaciones , Humanos , Complicaciones Posoperatorias/etiología , Convulsiones/etiología
6.
J Surg Res ; 246: 274-283, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31614325

RESUMEN

BACKGROUND: Fluid therapy influences glycocalyx shedding; however, the effect of this intervention on glycocalyx shedding in patients with glioma remains unclear. In this study, we have investigated glycocalyx shedding and cerebral metabolism during colloid loading in patients with and without glioma. METHODS: Forty patients undergoing general anesthesia were assigned to the glioma brain group (n = 20) or the normal brain group (n = 20); patients in the normal brain group were undergoing partial hepatectomy to treat liver cancer. All patients were subjected to 15 mL/kg hydroxyethyl starch (HES) loading after the induction of anesthesia. Glycocalyx shedding, reflected by syndecan-1 and heparan sulfate levels at the jugular venous bulb, was measured in both groups. We also evaluated cerebral metabolism parameters, including jugular venous oxygen saturation (SjvO2), arterial-jugular venous differences in oxygen (CajvO2), glucose (A-JvGD), lactate (A-JvLD), the cerebral extraction ratio for oxygen (CERO2), and the oxygen-glucose index. RESULTS: Our results showed that patients in the glioma brain group had lower preoperative basal syndecan-1 shedding in plasma than patients in the normal brain group. The hematocrit (Hct)-corrected syndecan-1 level was significantly increased after 15 mL/kg HES fluid administration (19.78 ± 3.83 ng/mL) compared with the Hct-correct baseline syndecan-1 level (15.67 ± 2.35 ng/mL) in patients in the glioma brain group. Similarly, for patients in the normal brain group, Hct-corrected syndecan-1 level was significantly increased after HES loading (34.71 ± 12.83 ng/mL) compared with the baseline syndecan-1 level (26.07 ± 12.52 ng/mL). However, there were no intergroup or intragroup differences in Hct-corrected heparan sulfate levels at any time point. Our study also showed that the SjvO2 was lower and CajvO2 and CERO2 were higher in the glioma brain group at 30 min after HES loading. Intragroup analysis showed that CERO2 and CajvO2 increased after general anesthesia compared with the baseline values in the glioma brain group. In contrast, cerebral metabolism in the normal brain group was unchanged during perioperative period. There were no significant differences in oxygen-glucose index between the two groups throughout the study period. CONCLUSIONS: Preoperative 15 mL/kg HES loading had similar effects on systemic glycocalyx shedding in both the glioma brain and normal brain groups, although patients in the normal brain group had higher levels of plasma syndecan-1. Furthermore, the intraoperative anesthetic management may substantially influence cerebral metabolism in patients with glioma.


Asunto(s)
Encéfalo/metabolismo , Fluidoterapia/efectos adversos , Glicocálix/efectos de los fármacos , Derivados de Hidroxietil Almidón/efectos adversos , Cuidados Preoperatorios/efectos adversos , Adulto , Encéfalo/efectos de los fármacos , Encéfalo/cirugía , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/cirugía , Endotelio Vascular/citología , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/metabolismo , Femenino , Fluidoterapia/métodos , Glioma/metabolismo , Glioma/cirugía , Glicocálix/metabolismo , Heparitina Sulfato/análisis , Heparitina Sulfato/metabolismo , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Cuidados Intraoperatorios/efectos adversos , Cuidados Intraoperatorios/métodos , Venas Yugulares/química , Neoplasias Hepáticas/cirugía , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Sindecano-1/sangre , Sindecano-1/metabolismo
7.
World Neurosurg ; 133: e6-e17, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31284062

RESUMEN

BACKGROUND: Pineal region glioma is a rare systematically reported tumor in the literatures, and little is known about its behavior, development, and best treatment strategies because of its complex anatomical relationship and rarity. OBJECTIVE: We reviewed the outcomes of patients with pineal region gliomas in West China hospital in the past 5 years and searched the literature to add more information. As a result, key factors related to prognosis are identified. METHODS: Twenty-five patients with pineal region gliomas were selected and information was collected about detailed medical history, imaging data, treatment methods, pathologic results, and latest neurosurgical radiologic progress during follow-up. RESULTS: Pilocytic astrocytomas (20%) and glioblastomas (24%) were the most common pathologic subtypes. Twenty-three patients underwent open surgery, 3 Gamma Knife radiosurgery, and 4 whole-brain radiation therapy. Chemotherapy was applied to 3 patients. Low-grade gliomas tended to have a better prognosis than did high-grade. Karnofsky Performance Status at admission (≤60) was intimately associated with prognosis for low-grade gliomas. As for high-grade gliomas, patients whose age at admission was ≤30 years had a better prognosis than did older patients (>30 years). However, whatever the grade, there was no overall survival difference as to gender, gross total resection versus not gross total resection, preoperative maximal tumor diameter (≤4 vs. >4 cm), and time since first symptoms (≤30 vs. >30 days), and radiation therapy versus no radiation therapy. CONCLUSIONS: Open surgery is the first-line strategy for pineal region gliomas with tolerable mortality and disability rate. Radiosurgery and chemotherapy can be applied as adjuvant or alternative methods when surgery is contraindicated.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Glándula Pineal/cirugía , Adolescente , Adulto , Factores de Edad , Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Quimioterapia Adyuvante , Niño , Preescolar , Terapia Combinada , Irradiación Craneana , Craneotomía/métodos , Femenino , Estudios de Seguimiento , Glioma/tratamiento farmacológico , Glioma/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Glándula Pineal/patología , Pronóstico , Radiocirugia/métodos , Radioterapia Ayuvante , Estudios Retrospectivos , Análisis de Supervivencia , Adulto Joven
8.
World Neurosurg ; 133: e197-e204, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31491572

RESUMEN

OBJECTIVE: To evaluate the functional connectivity (FC) and resting-state networks (RSNs) in patients under anesthesia operated for resection of intracerebral lesions. METHODS: We performed intraoperative resting-state functional magnetic resonance imaging (irs-fMRI) in 24 patients under anesthesia before and after lesion resection. Correlation matrices were established for each session (a total 48 of sessions). We analyzed the changes in overall FC and in FC of the healthy and operated hemispheres between the first and second sessions. We tested the correlation between changes in FC and clinical outcomes and the duration, rate, and total dosage of anesthesia. We also performed a group analysis to detect topographic changes in RSNs in patients under anesthesia. A single-subject analysis was performed to detect clinically relevant RSNs in each patient. RESULTS: FC decreased significantly in the second session, as did interhemispheric connectivity. The decrease in the pathological hemisphere was significant and significantly greater than the decrease in the intrahemispheric connectivity of the healthy hemisphere. The change in FC was not correlated with clinical outcome or with the duration, rate, or dosage of anesthesia. Group analysis showed topographic changes in RSNs, especially in high-level networks such as default mode and salience networks. Identification of clinically relevant networks was also possible. CONCLUSIONS: FC and RSNs could be identified under anesthesia and used for extended brain mapping. Further studies are needed to optimize the depth of hypnosis to stabilize FC between sessions.


Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Conectoma/métodos , Glioma/diagnóstico por imagen , Hemangioma Cavernoso/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Neuronavegación/métodos , Radiografía Intervencional/métodos , Cirugía Asistida por Computador , Adolescente , Adulto , Anciano , Neoplasias Encefálicas/cirugía , Preescolar , Femenino , Glioma/cirugía , Hemangioma Cavernoso/cirugía , Humanos , Malformaciones Arteriovenosas Intracraneales/cirugía , Masculino , Persona de Mediana Edad , Adulto Joven
10.
Medicine (Baltimore) ; 98(49): e18271, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31804365

RESUMEN

RATIONALE: Rosette-forming glioneuronal tumor (RGNT) is a rare tumor which has been first reported as the fourth ventricle tumor by Komori et al and is classified as a distinct clinicopathological entity by the WHO Classification of Tumors of the Central Nervous System as in 2007. Although RGNTs were reported to occur in both supratentorial and inflatentorial sites, only 4 case reports of spinal RGNT have been demonstrated. PATIENT CONCERNS: A 37-year-old female presenting with slowly progressing right-sided clumsiness. Cervical magnetic resonance imaging revealed a spinal intramedullary tumor between the C2 and C5 levels. DIAGNOSES: Pathological analysis showed unique biphasic cellular architecture consisting of perivascular pseudorosettes dominantly with few neurocytic rosettes and diffuse astrocytoma component. The tumor cells composed of perivascular pseudorosettes showed positivity for both synaptophysin and glial markers such as GFAP and Olig2. Therefore, the diagnosis of RGNT was made. INTERVENTIONS: Gross total resection of the tumor was achieved. No adjuvant chemotherapy nor radiotherapy was conducted after operation. OUTCOMES: At 2 years after the operation, no recurrence was observed. LESSONS: Although RGNT arising from the spinal cord is extremely rare, we need to consider the tumor as a differential diagnosis for intramedullary spinal cord tumors.


Asunto(s)
Glioma/diagnóstico por imagen , Imagen por Resonancia Magnética , Neoplasias de la Médula Espinal/diagnóstico por imagen , Adulto , Diagnóstico Diferencial , Femenino , Glioma/patología , Glioma/cirugía , Humanos , Neoplasias de la Médula Espinal/patología , Neoplasias de la Médula Espinal/cirugía
11.
Cancer Imaging ; 19(1): 65, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615562

RESUMEN

MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Terapia por Láser/métodos , Imagen por Resonancia Magnética/métodos , Neuronavegación/métodos , Humanos
12.
J Neurooncol ; 145(1): 35-48, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31502042

RESUMEN

BACKGROUND: Chromobox protein homolog 3 (CBX3) is one of the heterochromatin protein 1 (HP1) family members. Among multiple cancers, it is usually overexpressed. However, the mechanism and function of CBX3 in glioma remain incompletely illustrated. METHODS: The expression level of CBX3 as well as its correlation with glioma are detected through TCGA and Oncomine database. The expressions of CBX3 mRNA and protein in glioma tissues and normal brain tissues have been identified by qRT-PCR and Western blot. The prognostic role of CBX3 has been assessed in a retrospective cohort study. Additionally, the correlation between CBX3 expression and the clinicopathological characteristics of glioma patients were also discussed. To better understand the role of CBX3 in glioma, a lentiviral vector expressing CBX3-shRNA and cyclin dependent kinase inhibitor 1A (CDKN1A) siRNA were established and transfected into the glioma U87 cells. Besides, the CBX3 and CDKN1A expression levels in glioma U87 cells after transfected with CBX3-shRNA were gauged by qRT-PCR and Western blot. CCK-8, colony formation and EdU assays have been applied to evaluate the influence of CBX3 on U87 cells proliferation, and flow cytometry has been applied to manage the changes in cell cycle and cell apoptosis after transfection with CBX3-shRNA. Xenograft tumors have been examined in vivo for the carcinogenic effects and prognostic value of CBX3 in glioma tissues. RESULTS: In the present study, CBX3 was demonstrated to be highly expressed in human glioma tissues, and high CBX3 expression predicted the dismal recurrence-free survival (RFS) and poor overall survival (OS) for glioma patients. High CBX3 expression was dependent on the tumor size, Karnofsky performance scale (KPS) score, WHO grade, recurrence and survival status. Moreover, CBX3 expression knockdown could remarkably suppress the proliferation and colony formation ability of U87 cells, which was achieved through blocking cell arrest at G0/G1 phase and inducing apoptosis. Additionally, our findings also suggested that, compared with shRNA-Ctrl transfection, the mRNA and protein expression levels of CDKN1A have been dramatically up-regulated in vitro after transfection with shRNA-CBX3. Consistent with the results of in vitro assays, the outcomes of xenograft assay and immunohistochemistry (IHC) also indicated that, the tumor growth and Ki-67 expression level were restrained in response to CBX3 inhibition, while the CDKN1A expression level in vivo was up-regulated. Down-regulation of CDKN1A expression partially restored the ability of cell proliferation in the U87 cells, which was inhibited by shRNA-CBX3 CONCLUSIONS: In conclusion, results of the current research suggest that a high CBX3 expression level predicts the poor prognosis for glioma patients. CBX3 can stimulate the growth of glioma U87 cells through targeting CDKN1A and CBX3 may become a novel target in the clinical treatment for glioma.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Neoplasias Encefálicas/patología , Proliferación Celular , Proteínas Cromosómicas no Histona/metabolismo , Glioma/patología , Animales , Apoptosis , Biomarcadores de Tumor/genética , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/cirugía , Proteínas Cromosómicas no Histona/genética , Femenino , Estudios de Seguimiento , Regulación Neoplásica de la Expresión Génica , Glioma/metabolismo , Glioma/cirugía , Humanos , Masculino , Ratones , Ratones Endogámicos BALB C , Ratones Desnudos , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Células Tumorales Cultivadas , Ensayos Antitumor por Modelo de Xenoinjerto
13.
J Clin Neurosci ; 70: 242-246, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31477467

RESUMEN

Accurate margin delineation and safe maximal resection of glioma is one of the most challenging problems of neurosurgery, due to its close resemblance to normal brain parenchyma. However, different intraoperative visualization methods have been used for real-time intraoperative investigation of the borders of the resection cavity, each having advantages and limitations. This preliminary study was designed to simulate multi-wavelength photoacoustic imaging for brain tumor margin delineation for maximum safe resection of glioma. Since the photoacoustic signal is directly related to the amount of optical energy absorption by the endogenous tissue chromophores such as hemoglobin; it may be able to illustrate the critical structures such as tumor vessels during surgery. The simulation of the optical and acoustic part was done by using Monte-Carlo and k-wave toolbox, respectively. As our simulation results proved, at different wavelengths and depths, the amount of optical absorption for the blood layer is significantly different from others such as normal and tumoral tissues. Furthermore, experimental validation of our approach confirms that, by using multi-wavelengths proportional to the depth of the tumor margin during surgery, tumor margin can be differented using photoacoustic imaging at various depths. Photoacoustic imaging may be considered as a promising imaging modality which combines the spectral contrast of optical imaging as well as the spatial resolution of ultrasound imaging, and may be able to delineate the vascular-rich glioma margins at different depths of the resection cavity during surgery.


Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Glioma/diagnóstico por imagen , Neuroimagen/métodos , Técnicas Fotoacústicas/métodos , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Glioma/patología , Glioma/cirugía , Humanos , Márgenes de Escisión , Método de Montecarlo
14.
World Neurosurg ; 132: 356-362, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31536810

RESUMEN

The degree of primary resection of malignant brain gliomas (MBGs) has correlated positively with progression-free and overall survival. The indications for surgery and reoperation in MBG relapse remain controversial. Surgery will not be curative and should be followed by adjuvant treatment. We reviewed the reported studies with respect to repeat resection and the various methods of intraoperative radiotherapy for MBGs from the initial experience with high-energy linear accelerators in Japan to modern, integrated brachytherapy solutions using solid and balloon applicators. Because of the findings from our review, we have begun to research into the use of intraoperative balloon brachytherapy for recurrent MBGs.


Asunto(s)
Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Glioma/radioterapia , Glioma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Radioterapia/métodos , Terapia Combinada , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Procedimientos Neuroquirúrgicos/historia , Procedimientos Neuroquirúrgicos/tendencias , Radioterapia/historia , Radioterapia/tendencias , Reoperación
15.
J Clin Neurosci ; 70: 55-60, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31537460

RESUMEN

The first step of glioma treatment is surgery. Extent of resection (EOR) improves patient survival if surgery does not negatively impair a patient's neurological status. However, how surgery affects the patient's quality of life (QOL) has been less studied, especially as regards cognitive aspects. In our study, we retrospectively analyzed our cases with awake surgery. In all patients, surgical excision was stopped when active functions were intraoperatively identified. A neuropsychological assessment was performed both before and after surgery (5 days and 1 month after). Writing, motor speech, comprehension, expression, reading, pragmatics, attention, memory, problem solving and visuoperceptive functions were evaluated and scored with the NOMS scale. We found no differences in the median values of writing and motor speech, while there was a difference in the following variables: comprehension, expression, reading, pragmatics, attention, memory, problem solving and visuoperceptive functions. Moreover, the Dunn test did not show any difference between preoperative evaluation and evaluation performed 30 days after surgery regarding comprehension, expression, reading, pragmatics, attention, problem solving and visuoperceptive functions. However, there was a difference between preoperative and postoperative evaluation for memory. This retrospective study shows that awake surgery could be a reasonable possibility to preserve a patient's QOL achieving an EOR >82% of the Total Tumor Volume (Fluid-attenuated inversion recovery (FLAIR) hyperintense region in low-grade gliomas and enhancing nodules plus FLAIR hyperintense region in high-grade gliomas). In this series memory was the only aspect that had an impairment after surgery without a complete recovery at one month after surgery.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Complicaciones Posoperatorias/prevención & control , Adulto , Cognición , Femenino , Humanos , Masculino , Persona de Mediana Edad , Destreza Motora , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos
16.
Int J Comput Assist Radiol Surg ; 14(10): 1697-1713, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31392670

RESUMEN

PURPOSE: In image-guided surgery for glioma removal, neurosurgeons usually plan the resection on images acquired before surgery and use them for guidance during the subsequent intervention. However, after the surgical procedure has begun, the preplanning images become unreliable due to the brain shift phenomenon, caused by modifications of anatomical structures and imprecisions in the neuronavigation system. To obtain an updated view of the resection cavity, a solution is to collect intraoperative data, which can be additionally acquired at different stages of the procedure in order to provide a better understanding of the resection. A spatial mapping between structures identified in subsequent acquisitions would be beneficial. We propose here a fully automated segmentation-based registration method to register ultrasound (US) volumes acquired at multiple stages of neurosurgery. METHODS: We chose to segment sulci and falx cerebri in US volumes, which remain visible during resection. To automatically segment these elements, first we trained a convolutional neural network on manually annotated structures in volumes acquired before the opening of the dura mater and then we applied it to segment corresponding structures in different surgical phases. Finally, the obtained masks are used to register US volumes acquired at multiple resection stages. RESULTS: Our method reduces the mean target registration error (mTRE) between volumes acquired before the opening of the dura mater and during resection from 3.49 mm (± 1.55 mm) to 1.36 mm (± 0.61 mm). Moreover, the mTRE between volumes acquired before opening the dura mater and at the end of the resection is reduced from 3.54 mm (± 1.75 mm) to 2.05 mm (± 1.12 mm). CONCLUSION: The segmented structures demonstrated to be good candidates to register US volumes acquired at different neurosurgical phases. Therefore, our solution can compensate brain shift in neurosurgical procedures involving intraoperative US data.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Procedimientos Neuroquirúrgicos/métodos , Cirugía Asistida por Computador/métodos , Algoritmos , Neoplasias Encefálicas/diagnóstico por imagen , Glioma/diagnóstico por imagen , Humanos , Imagen Tridimensional/métodos , Imagen por Resonancia Magnética/métodos , Neuronavegación/métodos , Ultrasonografía
17.
World Neurosurg ; 131: e379-e391, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31369883

RESUMEN

BACKGROUND: Pineal region tumors represent challenging surgical lesions with wide ranges of survival reported in different surgical series. In this article, we emphasize the role of complete microsurgical resection (CMR) to obtain a favorable long-term outcome of pineal region tumors. METHODS: We report a retrospective study of pineal region tumors operated on in Helsinki Neurosurgery between 1997 and 2015. Information was obtained from the hospital records, and an evaluation of the Finnish population register was conducted in July 2018 to determine the current status of the patients. RESULTS: A total of 76 pineal region tumors were operated on. The survival was 62% at a mean follow-up of 125 ± 105 months (range, 0-588 months), and the disease-related mortality was limited to 14 patients (18.4%). Up to July 2018, 29 patients had died. Two patients died 1 and 3 months after surgery of delayed thalamic infarctions, 12 patients of disease progression, and 15 had non-disease-related deaths. Only 1 patient was lost in the long-term follow-up. Ten of 14 disease-related deaths occurred during the first 5 years of follow-up: 5 diffuse gliomas, 3 germ cell tumors, 1 grade II-III pineal parenchymal tumor of intermediate differentiation, and 1 meningioma. CMR was linked to better tumor-free survival and long-term survival, with the exception of diffuse gliomas. CONCLUSIONS: CMR, in the setting of a multidisciplinary management of pineal region tumors, correlates with favorable survival and with minimal mortality. Surgically treated grade II-IV gliomas constitute a particular group with high mortality within the first 5 years independently of the microsurgical resection.


Asunto(s)
Neoplasias Encefálicas/cirugía , Glioma/cirugía , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Neoplasias de Células Germinales y Embrionarias/cirugía , Glándula Pineal/cirugía , Pinealoma/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Astrocitoma/mortalidad , Astrocitoma/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Quimioterapia Adyuvante , Niño , Preescolar , Femenino , Finlandia , Glioma/mortalidad , Glioma/patología , Humanos , Lactante , Masculino , Neoplasias Meníngeas/mortalidad , Neoplasias Meníngeas/patología , Meningioma/mortalidad , Meningioma/patología , Microcirugia , Persona de Mediana Edad , Neoplasias de Células Germinales y Embrionarias/mortalidad , Neoplasias de Células Germinales y Embrionarias/patología , Procedimientos Neuroquirúrgicos , Glándula Pineal/patología , Pinealoma/mortalidad , Pinealoma/patología , Radioterapia Ayuvante , Estudios Retrospectivos , Sobrevida , Carga Tumoral , Adulto Joven
18.
J Clin Neurosci ; 68: 45-50, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31371189

RESUMEN

There is limited information on the patterns of care and outcomes of high grade gliomas (HGGs) in young adults, in particular, the impact it has on a person's employment. We retrospectively identified young adult patients (age ≤ 40 years old) with newly diagnosed high grade gliomas treated between January 2013 and June 2018 across four major neuro-oncology centres in Australia. Patient demographics, tumour characteristics and treatment parameters were collected and outcomes determined. A total of 113 patients were identified with a median follow up of 27.0 months (range 1.0-70.2 months). The median age was 31 years, majority were male (65%) and employed (71.6%). IDH mutations were detected in 66 (62%) cases. The median progression-free survival (PFS) was 38.0 months (95% CI 23.3-52.7 months) and median overall survival (OS) was not reached. Patients with IDH wild type anaplastic astrocytoma and glioblastoma had a significantly shorter median PFS (19.3 months vs. NR, p = 0.001) and median OS (43.5 months vs NR, p = 0.007) than those with IDH mutated grade III anaplastic astrocytoma and oligodendroglioma. There was no significant difference in median OS or PFS between patients who underwent gross or subtotal tumour resection. Significantly, after diagnosis only 36 (32%) patients reported being employed. Young patients with IDH wild type astrocytomas and glioblastoma had better outcomes than reported historical controls. Most patients did not continue in employment post diagnosis.


Asunto(s)
Neoplasias Encefálicas , Empleo/estadística & datos numéricos , Glioma , Adolescente , Adulto , Australia , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/cirugía , Femenino , Glioma/mortalidad , Glioma/patología , Glioma/cirugía , Humanos , Masculino , Supervivencia sin Progresión , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
19.
World Neurosurg ; 131: e155-e169, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31376550

RESUMEN

OBJECTIVE: To integrate 3-dimensional (3D) intraoperative ultrasound (iUS) data in spinal navigation. METHODS: In 11 patients with intradural spinal tumors, 3D-iUS was performed before and after tumor resection. Intraoperative computed tomography (iCT) was used for automatic patient registration for spinal navigation; fiducial-based registration was performed in 1 case. The outlines of the vertebra were defined in preoperative image data by automatic mapping; risk and target structures were segmented manually; all these data were rigidly and if necessary non-rigidly registered with iCT. For 3D-iUS acquisition, tracked convex-shaped transducers (contact surface: 29 x 10 mm; scanning frequency: 10-3.8 MHz or 13-5 MHz) were used. RESULTS: Navigated 3D-iUS was successfully implemented in all cases; 3D-iUS datasets were acquired and could be used as 3D image data for further navigation after iUS scanning. The 3D objects defined in preoperative image data, outlining the vertebra, target and risk structures, could be visualized in the 3D-iUS data. Navigated 3D-iUS allowed to reliably evaluate the extent of resection in all cases and updating of navigation, ensuring high navigational accuracy. The target registration error applying iCT-based automatic registration was 0.78 ± 0.23 mm. The effective dose for iCT was 0.11 ± 0.077 mSv for cervical and 1.75 ± 0.72 mSv for thoracic scans. CONCLUSIONS: Using 3D-iUS can be successfully integrated in spinal navigation. Automatic registration applying low-dose iCT and non-linear image registration offers displaying preoperative images in the same orientation as the 3D-iUS scan, as well as visualizing segmented structures in the navigated 3D-iUS data. This greatly facilitates image interpretation. Navigated 3D-iUS provides a possibility for navigation updating and immediate online quality control.


Asunto(s)
Imagen Tridimensional/métodos , Neoplasias Meníngeas/cirugía , Neuronavegación/métodos , Neoplasias de la Médula Espinal/cirugía , Ultrasonografía/métodos , Adolescente , Adulto , Anciano , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Ependimoma/diagnóstico por imagen , Ependimoma/cirugía , Femenino , Glioma/diagnóstico por imagen , Glioma/cirugía , Hemangioblastoma/diagnóstico por imagen , Hemangioblastoma/cirugía , Humanos , Cuidados Intraoperatorios , Neoplasias Pulmonares/patología , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Meningioma/diagnóstico por imagen , Meningioma/cirugía , Persona de Mediana Edad , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/secundario , Adulto Joven
20.
J Neurooncol ; 144(3): 573-582, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31410731

RESUMEN

INTRODUCTION: Patients with diffuse glioma often experience neurocognitive impairment already prior to surgery. Pertinent information on whether damage to a specific brain region due to tumor activity results in neurocognitive impairment or not, is relevant in clinical decision-making, and at the same time renders unique information on brain lesion location and functioning relationships. To examine the impact of tumor location on preoperative neurocognitive functioning (NCF), we performed MRI based lesion-symptom mapping. METHODS: Seventy-two patients (mean age 40 years) with a radiologically suspected glioma were recruited preoperatively. For each of the six cognitive domains tested, we used tumor localization maps and voxel-based lesion-symptom mapping analyses to identify cortical and subcortical regions associated with NCF impairment. RESULTS: Compared to healthy controls, preoperative NCF was significantly impaired in all cognitive domains. Most frequently affected were attention (30% of patients) and working memory (20% of patients). Deficits in attention were significantly associated with regions in the left frontal and parietal cortex, including the precentral and parietal-opercular cortex, and in left-sided subcortical fiber tracts, including the arcuate fasciculus and corticospinal tract. Surprisingly, no regions could be related to working memory capacity. For the other neurocognitive domains, impairments were mainly associated with regions in the left hemisphere. CONCLUSIONS: Prior to treatment, patients with diffuse glioma in the left hemisphere run the highest risk to have NCF deficits. Identification of a left frontoparietal network involved in NCF not only may optimize surgical procedures but may also be integrated in counseling and cognitive rehabilitation for these patients.


Asunto(s)
Mapeo Encefálico/métodos , Neoplasias Encefálicas/patología , Glioma/patología , Trastornos Neurocognitivos/fisiopatología , Neuroimagen/métodos , Adulto , Neoplasias Encefálicas/psicología , Neoplasias Encefálicas/cirugía , Femenino , Estudios de Seguimiento , Glioma/psicología , Glioma/cirugía , Humanos , Masculino , Pruebas Neuropsicológicas , Pronóstico , Estudios Retrospectivos
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