Optical biopsy identification and grading of gliomas using label-free visible resonance Raman spectroscopy.

Glioma is one of the most refractory types of brain tumor. Accurate tumor boundary identification and complete resection of the tumor are essential for glioma removal during brain surgery. We present a method based on visible resonance Raman (VRR) spectroscopy to identify glioma margins and grades. A set of diagnostic spectral biomarkers features are presented based on tissue composition changes revealed by VRR. The Raman spectra include molecular vibrational fingerprints of carotenoids, tryptophan, amide I/II/III, proteins, and lipids. These basic in situ spectral biomarkers are used to identify the tissue from the interface between brain cancer and normal tissue and to evaluate glioma grades. The VRR spectra are also analyzed using principal component analysis for dimension reduction and feature detection and support vector machine for classification. The cross-validated sensitivity, specificity, and accuracy are found to be 100%, 96.3%, and 99.6% to distinguish glioma tissues from normal brain tissues, respectively. The area under the receiver operating characteristic curve for the classification is about 1.0. The accuracies to distinguish normal, low grade (grades I and II), and high grade (grades III and IV) gliomas are found to be 96.3%, 53.7%, and 84.1% for the three groups, respectively, along with a total accuracy of 75.1%. A set of criteria for differentiating normal human brain tissues from normal control tissues is proposed and used to identify brain cancer margins, yielding a diagnostic sensitivity of 100% and specificity of 71%. Our study demonstrates the potential of VRR as a label-free optical molecular histopathology method used for in situ boundary line judgment for brain surgery in the margins.

Intracranial Clear Cell Meningiomas: Study on Clinical Features and Predictors of Recurrence.

OBJECTIVE: Clear cell meningioma (CCM) is a rare histologic subtype of meningioma that is classified as World Health Organization grade II tumor. We conducted the present study to characterize clinical features of intracranial CCM and investigate the prognostic factors associated with surgical recurrence-free survival of the patients. METHODS: PubMed and Embase were searched for case reports and series relevant to CCM. For each included study, relevant data were extracted, including patients' characteristics, pathology findings, therapeutic modality, and outcome. RESULTS: A total of 146 intracranial CCMs patients were included, comprising 73 females and 73 males. The median age of the patients at surgery was 32 years. Most tumors (58.2%) were located in the skull base region. Ninety-nine (67.8%) patients underwent gross total resection (GTR), and 47 (32.2%) patients underwent subtotal resection (STR). Seventy-four (50.7%) patients had tumor recurrence during the follow-up. Recurrence-free survival rates at 1 and 5 years after resection were 86% and 37%, respectively. Multivariate analysis showed that STR (hazard ratio [HR], 4.13; P < 0.001) and male gender (HR, 1.69; P = 0.030) were associated with increased recurrence while postoperative radiotherapy (HR, 0.51; P = 0.040) was related to decreased recurrence. CONCLUSIONS: The results suggest that intracranial CCM has its own unique clinical features compared with the other 2 types of grade II meningiomas. Patients with subtotally resected tumors, males, or those who did not receive postoperative radiotherapy are at greater risk of recurrence. GTR should be the primary goal in the surgical management of intracranial CCMs. Our data also highlight the value of radiotherapy in intracranial CCM patients.

Over-expression of TSPO in the hippocampal CA1 area alleviates cognitive dysfunction caused by lipopolysaccharide in mice.

The translocator protein 18kDa (TSPO) is closely related to regulation of immune/inflammatory response. However, the putative role and signaling mechanisms of TSPO in regulation of neuroinflammation remain unclear. GV287 lentiviral vectors mediating TSPO over-expression were injected into bilateral hippocampal CA1 areas to test whether TSPO over-expression was neuroprotective in lipopolysaccharide (LPS)-induced mice model. Finasteride, a blocker of allopregnanolone production, was used to test whether the protective effects were related to steroideogenesis. The results demonstrated that TSPO over-expression increased progesterone and allopregnanolone synthesis. TSPO over-expression in CA1 area improved LPS-induced cognitive deficiency in mice and this cognitive improvement was reversed by finasteride administration. These data suggest that up-regulation of TSPO level during neuroinflammation may be an adaptive response mechanism, a way to provide more neurosteroids. We confer that TSPO could be an attractive drug target for controlling neuroinflammation in the future.

A dorsally located giant posterior fossa neurenteric cyst in a Chinese woman.

Neurenteric cysts (NC) are rare, endodermal-derived intracranial lesions, commonly located anteriorly in the posterior cranial fossa. We describe a rare case of a giant posterior fossa NC (6.5 × 5.9 × 4.3cm) located dorsal to the brain stem in a Chinese woman with a 1 week history of cerebellar symptoms. To our knowledge, this is the largest documented cyst of this type and the third dorsally located NC in the posterior fossa.

Primary intracranial leiomyosarcoma: review of the literature and presentation of a case.

BACKGROUND: Primary intracranial leiomyosarcoma (LMS) is a rare tumor of the central nervous system and therefore has only been reported sporadically. METHODS: The MEDLINE database was searched for relevant case reports and series published in English from 1969 to March 2012. These papers were reviewed to identify clinical and histopathological features, treatment modalities, and prognoses of patients with primary intracranial LMS. RESULTS: We reviewed 37 patients, including our patient, with primary intracranial LMS. Of these cases, 16 (43.2%) involved immunosuppression, 4 (10.8%) involved radiation-induced LMS, 3 (8.1%) cases involved a potential leiomyosarcomatous transformation of a brain lesion, and 7 (18.9%) cases, including the presented case, had no specific medical history. The treatment for these cases included resection (33/37, 89.2%), postoperative radiotherapy (20/37, 54.1%), and chemotherapy (7/37, 18.9%). CONCLUSIONS: The best method for the treatment of LMS could not be determined due to the limited number of cases that have been reported. However, optimized surgical resection, postoperative radiotherapy, and sarcoma-based chemotherapy may improve treatment outcomes.

[Stereotactic microelectrode-guided posteroventral pallidotomy for Parkinson's disease].

OBJECTIVE: To assess postoperative effects of microelectrode-guided posteroventral pallidotomy (PVP) for Parkinson's disease. METHODS: Intraoperative microelectrode recordings and microstimulation were used to explore the globus pallidus to performance of posteroventral pallidotomy in 48 patients with Parkinson's disease (47 unilateral and 1 bilateral). Assessment was made at baseline preoperatively and at 6 months intervals postoperatively, with unified Parkinson's disease rating scale (UPDRS). RESULTS: All patients were significantly improved on the limbs contralateral to the lesion side 6 - 34 months after operation (mean 24 months). The improvement was seen in the 'on' or 'off' state: UPDRS scores with patients on levodopa were improved by an average of 28.7%, while off medication scores showed reductions (47.6%) at 24 months. There were no deaths and no visual complications, but there were 4 patients (8.3%) of a delayed contralateral limbs dystonia after pallidotomy. CONCLUSIONS: The techniques of microelectrode recording and microstimulation indicate the location of the internal capsule and optic tract, which allow easy identification of these structure and facilitate PVP target in conjunction with radiofrequency microelectrode stimulation.