Clivus-involved immunoglobulin G4 related hypertrophic pachymeningitis mimicking meningioma: A case report.

BACKGROUND: Immunoglobulin G4 related disease (IgG4-RD) is a fibroinflammatory disease with markedly elevated serum IgG4 levels and fibrous tissue proliferation, accompanied by numerous plasma cells. IgG4 related hypertrophic pachymeningitis (IgG4-RHP) is relatively rare and indistinguishable from other phymatoid diseases before the operation. The risk of long-term immunosuppression needs to be balanced with disease activity. CASE SUMMARY: A 40-year-old man presented with headache and bilateral abducent paralysis. He was also diagnosed with pulmonary tuberculosis 10 years ago and was on regular treatment for the same. Before the operation and steroid therapy, the patient was suspected of having tubercular meningitis at a local hospital. A clivus lesion was found via brain magnetic resonance imaging (MRI) at this presentation. He was preliminarily diagnosed with meningioma and underwent Gamma Knife Surgery. Transnasal endoscopic resection was performed to treat deterioration of nerve function. Postoperative pathologic examination suggested IgG4-RD. Moreover, the serum IgG4 was elevated at 1.90 g/L (reference range: 0.035-1.500 g/L). After steroid therapy for 2 mo, the lesion size diminished on MRI, and the function of bilateral abducent nerves recovered. CONCLUSION: IgG4-RHP is relatively rare and indistinguishable before the operation. Elevated serum IgG4 levels and imaging examination help in the diagnosis of IgG4-RHP. Surgery is necessary when lesions progress and patients start to develop cranial nerve function deficit.

[Advances in Intraoperative Neurophysiological Monitoring Techniques in Transnasal Endoscopic Skull Base Surgery].

Transnasal endoscopic skull base surgery has been increasing in volume in recent years and its indications are constantly expanding. The potential occurrence of intraoperative and postoperative neurovascular complications deserves special attention from neurosurgeons. Multimodal intraoperative neurophysiological monitoring technology allows neurosurgeons to monitor cerebral perfusion and the functional status of the associated cranial nerves in real time, thereby enabling surgeons to make prompt adjustments in surgical procedures and strategies and reduce the risks of postoperative neurological complications in patients. Based on available literature, we reviewed how appropriate monitoring strategies were optimized for different key components of transnasal endoscopic skull base procedures, intending to provide reference for clinicians.

[The Role of Cancer-associated Fibroblasts in Invasive Behavior of Pituitary Adenoma].

OBJECTIVE: To determine the role of cancer associated fibroblasts (CAFs) in the invasive behavior of pituitary adenoma. METHODS: Pituitary adenoma tissues were divided into invasive group (IPA) and non-invasive group (nIPA) according to pre-operative MRI and observations during surgery. Those tissues were cultured and CAFs were identified through a smooth muscle actin (α-SMA). The migratory and invasive ability of CAFs was tested with transwell migration and invasion assay. The expressions of α-SMA and matrix metalloproteinase (MMP)-9 from CAFs were determined by immunocytochemistry and Western blot. RESULTS: All cultured CAFs expressed α-SMA. No significant difference in migratory ability of CAFs was found between the IPA and nIPA tissues; however, CAFs from the IPA tissues had stronger invasive ability than those from the nIPA tissues (P= 0. 010). Higher levels of MMP-9 expression were found in group IPA as compared with nIPA (P=0. 025). No significant difference in the expression of α-SMA was found between the two groups. CONCLUSION: CAFs may promote invasive behavior by secreting more MMP-9, which may play a part in the invasive behavior of pituitary adenomas.

Management of large medial sphenoid wing meningiomas: a series of 178 cases.

AIM: The aim of this study was to evaluate our treatment and outcome in patients with large medial sphenoid wing meningiomas (SWMs). MATERIAL AND METHODS: Data from 178 patients with large medial SWMs treated was collected and analyzed retrospectively. Most of patients underwent microsurgical resection under electrophysiological monitoring and Doppler probe. Radiation therapy was administered in 64 patients with residual tumor and malignant pathology. RESULTS: Total resection of the tumor was achieved in 118 of 178 cases (66.3%), subtotal in 60 of 178 (33.7%) at the time of initial surgery without serious surgical complications except 2 patients with ptosis. Postoperative vision improved in 84 patients (87.5%), remained unchanged in 8 (8.3%) and deteriorated in 4 (4.2%). The progress free survival (PFS) and Karnofsky performance score (KPS) between patients with gross total resection (GTR) and patients with subtotal resection (STR) followed by radiation therapy (RT) had no significant difference. CONCLUSION: Surgery still remains a principal treatment option for SWMs. Good craniotomy techniques, proper hemostasis and optimal surgery strategy are critical to improve resection rate and elevate prognosis. Likewise, it is expected that STR with adjuvant RT can provide satisfactory results in case of total removal impossible.

[Postoperative management of patients with sellar tumors through monitoring urine volume and urine electrolytes].

OBJECTIVE: To determine the value of urine volume and urine electrolytes in postoperative management of patients with sellar tumors. METHODS: Medical records of 103 patients with sellar tumors in the West China Hospital from January 2009 to December 2009 were retrospectively reviewed. The patients were managed either based on blood electrolytes (Group A, n = 56) or based on urine volume and urine electrolytes (Group B, n = 47). The incidence of balance disturbance of water and electrolytes was compared between the two groups. RESULTS: The levels of blood electrolytes were normal in both groups 3 days after operations despite significant loss of electrolytes through urine. Balance disturbance of water and electrolytes was revealed 4-7 days after operations. Group B had a lower incidence of balance disturbance of water and electrolytes (17.02%, 8/47) compared with Group A (73.21%, 41/56, P < 0.05). No gender difference in the incidence of balance disturbance of water and electrolytes was found. Higher incidence of balance disturbance of water and electrolytes was found in craniopharyngioma (P < 0.05, vs. pituitary adenoma) and in the patients undergoing craniotomy (P < 0.05, vs. transsphenoidal approach) in Group A, but not in Group B. CONCLUSION: Better management of balance disturbance of water and electrolytes can be achieved for patients with sellar tumors through monitoring urine than through blood. It can also simplify the postoperative management of patients with sellar tumors.

[Pituitary functional recovery and hormone replacement therapy of patients with pituitary adenoma surgery].

OBJECTIVE: To study the pituitary functional recovery of patients with pituitary adenoma surgery and to identify appropriate dosages of hormone replacement for those patients. METHODS: Serum hormone levels of 187 patients with pituitary adenoma were detected before and after surgery. RESULTS: The lowest serum hormone levels were detected on the 3rd day after surgery (P < 0.05). The hormone levels were partly recovered on the 30th day (P < 0.05) and continued to rise to a relatively high level on the 90th day and one year after surgery (P < 0.05). Patients with older ages were more likely to suffer from hypopituitarism and had less satisfying recovery (P < 0.05) than their younger counterparts. The dosages of Euthyrox and Prednisone that were needed for hormone replacement therapy reached a relatively stable level on the 90th day after surgery (P < 0.05). CONCLUSION: Most patients with pituitary adenoma experienced hypopituitarism shortly after surgery, especially for the elderly who recovered more slowly. Low dosage of hormone replacement therapy based on their symptoms can help the patients reach a stable level of hormone within three months. As a result, the 90th day after surgery can be regarded as a cut-off time for measuring functional recovery of glandula pituitaria.

[Effects of bromocriptine on the treatment of prolactinomas in male patients and its influences on their sexual function].

OBJECTIVE: To explore the effect of bromocriptine in the treatment of male patients with prolactinoma and its impacts on their sexual function. METHODS: The clinical data of 29 male patients with prolactinomas treated with Bromocriptine were analysed, International Index of Erectile Function-5 (IIEF-5) was used to assess the sexual function of married patients before and after the treatment of Bromocriptine. RESULTS: The main clinical symptoms of male patients with prolactinomas were sexual dysfunction, headache and hypopsia, which were released significantly at 6 months after Bromocriptine therapy, with the decrease of serum prolactin (PRL) level (P < 0.05) and the improvement of basal testosterone (T) level (P < 0.05). The total normalization rate of PRL was 82.8%, and total effective rate of Bromocriptine therapy was 100%. According to the assessment of IIEF-5, all the male patients had their sexual function improved in various degree. CONCLUSION: Bromocriptine can improve the clinical symptoms of male patients with prolactinoma and their sexual function.

[Isolation and preliminary identification of stem-like cells in pituitary adenoma].

OBJECTIVE: To isolate and identify the pituitary adenoma stem-like cells from pituitary adenoma tissue. METHODS: Total RNA was prepared with 42 cases of pituitary adenoma tissue samples frozen in liquid nitrogen, the expression of Nestin was detected by RT-PCR. Tumor spheres were cultured in serum-free conditions and the immunefluorescence were used to detect the expression of stem cell markers such as Nestin, Sox2. RESULTS: The positive rate of Nestin mRNA expression was 88.1% (37/42). The cultured tumor spheres were found positive for Nestin, Sox2 by immunefluorescence detection. CONCLUSION: Stem cell markers are expressed in the pituitary adenoma tissue and the pituitary adenoma stem-like cells can be cultured in serum-free condition.

[Repair and reconstruction of diaphragmatic defect during transcranial pituitary adenoma surgery].

OBJECTIVE: To investigate the application value of titanium-clip and artificial menigeal in the sella diaphragm repair and reconstruction during transcranial pituitary adenoma surgery. METHODS: Thirty eight patients undergoing transcranial pituitary adenoma surgery received sella diaphragmatic defect repair and reconstruction after the removal of tumor, intraoperative diaphragmatic defect was classified as three grades, titanium-clip, artificial menigeal and EC glue were used for the sella diaphragmatic repair and reconstruction. The short-term and long-term complications were compared with those in the control group which contains 74 patients without diaphragmatic reconstruction. RESULTS: As 14 to 46 months' follow-up in the diaphragmatic reconstruction group, there were no leakage of cerebrospinal fluid(CSF), infections, empty sella syndrome (ESS), optic nerve damage, and any other severe complications was found. Only one inter-sella hemorrhage without optic nerve damage was found 3 hours after surgery by CT scan. In the group without diaphragmatic reconstruction, more secondary empty sella, cerebrospinal fluid rhinorrhea and intra-cranial infection were found after the following transsphenoidal surgery (P < 0.05), there was one case underwent the 2nd time transcranial surgery 1 hours later due to severe inter-sella hemorrhage resulting in vision damage and conscious disturbance. There was no significant difference in pituitary function and vision improvement between the two groups as the occurrence of diabetes insipidus (P > 0.05). CONCLUSION: It is important to repair the sellae diaphragm defect during transcranial pituitary adenoma surgery, which could reduce short-term and long-term complication.

[Apoptosis and differentiation induced with TCLA in rat glioblastoma cells in vitro].

OBJECTIVE: To investigate the effect of conjugated trienoic fatty acids on the growth inhibition, apoptosis in rat glioblastoma cells and to elucidate its mechanism of activity. METHODS: Rat glioblastoma cells were tested in vitro cytotoxicity, colony formation inhibition, Brdu incorporation after treatment with TCLA. Its effect of apoptosis induction was detected through Hoechst 33342 staining, cell cycle analysis. The expressions of ADPRTL1, CYP1A1 and PPAR-gamma genes were detected through RT-PCR. RESULTS: After TCLA treatment, the proliferation of C6 cells were inhibited (40 micrommol/L, 72 h, viability 56.71% +/- 0.98%), this action acted as dose-time-dependent relations; colony formation decreased significantly (40 micrommol/L, 0) and BrdU labeling index of cancer cells decreased (63.1% +/- 1.0% vs 95.6 % +/- 1.4%); apoptotic cells increased; By FCM analysis, the apoptotic indices increased, the cells increased in G0/G1 phase, decreased in S phase, which have signigicant difference; RT-RCR showed that TCLA signigicantly increased the level of ADPRTL1, CYP1A1, and PPAR-gamma mRNA expression. CONCLUSION: The findings in this experimental study suggested that TCLA has potent cytotoxicity and induction apoptosis in human and rat glioblastoma cells, its mechanism of activity might be associated with the inhibition of DNA synthesis, cell cycle arrest, up-regulation the expression of apoptosis related genes ADPRTL, CYP1A1, PPAR-gamma.