A machine learning-based integrated clinical model for predicting prognosis in atypical meningioma patients.

PURPOSE: Atypical meningioma (AM) recurs in up to half of patients after surgical resection and may require adjuvant therapy to improve patient prognosis. Various clinicopathological features have been shown to have prognostic implications in AM, but an integrated prediction model is lacking. Thus, in this study, we aimed to develop and validate an integrated prognostic model for AM. METHODS: A retrospective cohort of 528 adult AM patients surgically treated at our institution were randomly assigned to a training or validation group in a 7:3 ratio. Sixteen baseline demographic, clinical, and pathological parameters, progression-free survival (PFS), and overall survival (OS) were analysed. Sixty-five combinations of machine learning (ML) algorithms were used for model training and validation to predict tumour recurrence and patient mortality. RESULTS: The random survival forest (RSF) model was the best model for predicting recurrence and death. Primary or secondary tumour, Ki-67 index, extent of resection, tumour size, brain involvement, tumour necrosis, and age contributed significantly to the model. The C-index value of the RSF recurrence prediction model reached 0.8080. The AUCs for 1-, 3-, and 5-year PFS were 0.83, 0.82, and 0.86, respectively. The C-index value of the RSF death prediction model reached 0.8890. The AUCs for 3-year and 5-year OS were 0.88 and 0.89, respectively. CONCLUSION: A high-performing integrated RSF predictive model for AM recurrence and patient mortality was proposed that may guide therapeutic decision-making and long-term monitoring.

Unusual presentation of epilepsy of germinoma located in the frontal-lobe: case report and literature review.

Germinoma is rare in peripheral lobar locations in the brain, with only 10 cases of primary frontal lobe germinoma having been reported in the previous literature. Epilepsy is a rare manifestation of germinomas. We describe an unusual case of a primary frontal germinoma in a 21-year-old man who presented with epilepsy. A presumptive diagnosis of abscess or cystic glioma was made, and then, we performed microsurgery under magnetic resonance imaging (MRI) neuronavigation guidance. Postoperative histopathologic examination identified the tumour as a rare germinoma. Subsequently, adjuvant radiotherapy and chemotherapy programmes were adopted in the present case, and there were no recurrence and postoperative seizure symptoms observed in the follow-up 6 months after operation.

Comparing survival outcomes of gross total resection and subtotal resection with radiotherapy for craniopharyngioma: a meta-analysis.

BACKGROUND: Recent studies suggest that subtotal resection (STR) followed by radiation therapy (RT) is an appealing alternative to gross total resection (GTR) for craniopharyngioma, but it remains controversial. We conducted a meta-analysis to determine whether GTR is superior to STR with RT for craniopharyngioma. MATERIALS AND METHODS: A systematic search was performed for articles published until October 2017 in the PubMed, Embase, and Cochrane Central databases. The endpoints of interest are overall survival and progression-free survival. Pooled hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using a fixed or random-effects model. The data were analyzed using Review Manager 5.3 software. RESULTS: A total of 744 patients (seven cohort studies) were enrolled for analyses. There were no significant differences between the GTR and STR with RT groups when the authors compared the pooled HRs at the end of the follow-up period. Overall survival (pooled HR = 0.76, 95% CI: 0.46-1.25, P = 0.28) and progression-free survival (pooled HR = 1.52, 95% CI: 0.42-5.44, P = 0.52) were similar between the two groups. CONCLUSIONS: The current meta-analysis suggests that GTR and STR with RT have the similar survival outcomes for craniopharyngioma.

Efficacy of Surgical Treatment on the Recurrent Stroke Prevention for Adult Patients With Hemorrhagic Moyamoya Disease.

OBJECTIVE: It remains controversial about the optimal treatment of adult hemorrhagic moyamoya disease (MMD). In this study, the authors performed a meta-analysis to determine whether surgical treatment of adult hemorrhagic MMD is superior to conservative treatment. METHODS: A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for articles published until May 2017. Randomized-controlled trials and cohort studies about the efficacy of surgical treatment and conservative treatment in patients with hemorrhagic MMD at 16 years of age or older were selected. Recurrent stroke incidence including hemorrhagic and ischemic events at the end of the follow-up period was calculated between the 2 groups with a 95% confidence interval (CI). RESULTS: A total of 3 articles (including 146 patients) were included in the meta-analysis. There were significant differences between the 2 groups when the authors compared the overall recurrent stroke rate at the end of the follow-up period. Surgical treatment significantly reduced the risk of stroke (risk ratio, 0.43; 95% CI, 0.24-0.76; P = 0.004). CONCLUSIONS: The current meta-analysis suggests that surgical treatment is better for conservative treatment in adult hemorrhagic MMD with recurrent stroke rate. Future studies are required to confirm this conclusion.

Clinical Analysis of the Effects of Cranial Suture Reconstruction and Frontal Frame Band Transfer in the Operation of Premature Closure of Coronal Suture in Infants.

AIM: To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants. MATERIAL AND METHODS: A total of 31 infants with premature closure of coronal suture were randomly divided into two groups; experimental group (n=16) and control group (n=15). In the experimental group, the skull model was reconstructed by an imaging examination and three-dimensional (3D) printing technique before the operation, and the fronto-orbital band was anteriorly displaced during the operation to guide the surgical treatment of craniosynostosis. In the control group, the skull model was reconstructed by an imaging examination and 3D printing technique before the operation, and the fronto-orbital band was not anteriorly displaced during the operation by the same operator. The surgical effects of the two groups were compared. RESULTS: During the 12-month follow up after the operation, the cephalic index of short head deformity in the experimental group was 80.7 ± 1.1, while that in the control group was 89.3 ± 4.5. There was a significant difference between the two groups. CONCLUSION: Fronto-orbital band anterior displacement may guide the operation of craniosynostosis and significantly improve the effectiveness of surgical treatment of children with premature closure of coronal suture, which is worth popularizing in the clinical management of cases.

Precision Control in Vat Photopolymerization Based on Pure Copper Paste: Process Parameters and Optimization Strategies.

Vat photopolymerization (VPP) presents new opportunities for metals to achieve the design freedom of components. However, the material properties of copper powder and the inherent defects of the technology seriously hinder its application in high-precision metal additive manufacturing. Precision control is the key to obtaining minimal precision metal parts when copper is prepared by reduction photopolymerization. This paper employed variance analysis (ANOVA) and root mean square deviation (RMSD) to determine the significant parameters affecting dimensional accuracy and their optimal regions. The results show that printing accuracy is improved by optimizing exposure time, intensity, layer thickness, and sweeper moving speed. When the exposure time is 21 s, and the exposure intensity is 220 mW/cm2, a hole with a height of 1 mm and a diameter of 200 µm can be printed with a minimum size deviation of 51 µm. In addition, RMSD and ANOVA provide an effective method for realizing high-precision stereolithography 3D printing metal copper, expanding the material adaptation in the 3D printing metals field. The study highlights the potential of VPP as a method for preparing metals in future studies.

Clinical Analysis of the Effects of Cranial Suture Reconstruction and Frontal Frame Retraction in the Operation of Premature Closure of the Sagittal Suture in Infants.

AIM: To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture. MATERIAL AND METHODS: Infants with premature closure of the sagittal suture were included in this study. All infants underwent preoperative skull model reconstruction using imaging techniques and 3D printing. The infants were then allocated to either the experiment group, where the frontal frame retraction was used to guide the surgical treatment of cranial stenosis, or the control group, where traditional cranial suture reconstruction was performed. All interventions were performed by the same operator. The surgical effects of the two groups were compared. RESULTS: Overall, 28 infants were enrolled in this study, with 15 infants in the experimental group and 13 in the control group. In the one-year post-operative follow-up visit, the cephalic index of scaphoid malformation was 78.3 ± 1.4 in the experimental group and 69.0 ± 4.2 in the control group. The difference between the two groups was statistically significant. CONCLUSION: Frontal frame retraction surgery can guide the surgical procedure for cranial stenosis, significantly improve the treatment outcome in children with premature closure of the sagittal suture, and improve the form of the head aesthetically in children, and the effect is better than traditional operation; therefore, the technique is worth popularizing in the clinic.

Development and Validation of Predicting Nomograms for Craniopharyngioma: A Retrospective, Multiple-Center, Cohort Study.

Craniopharyngiomas (CPs) are benign tumors arising from the sellar region. However, little is known about their clinical features and long-term recurrence due to low morbidity and the lack of large cohort studies. Thus, we aimed to develop nomograms to accurately predict the extent of resection and tumor recurrence using clinical parameters. A total of 545 patients diagnosed with CP between 2009 and 2019 were examined: 381 in the development cohort and 164 in the validation cohort. Least absolute shrinkage and selection operator (LASSO) and Cox regression analyses were performed to establish two nomograms. Receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and Kaplan-Meier (KM) curves were used to evaluate their predictive performance and discriminative power, respectively, in the two cohorts. In addition, the EORTC QLQ-BN20 questionnaire was used to assess neuropsychological status in the follow-up. In the development cohort, the area under the curve (AUC) and C-index were 0.760 and 0.758, respectively, for predicting the extent of resection and 0.78 and 0.75, respectively, for predicting 3-year progression-free survival (PFS) and 5-year PFS. Additionally, the model had a predictive accuracy of 0.785. Both nomograms showed acceptable discrimination in the two cohorts. Moreover, DCA demonstrated excellent clinical benefits from the two nomograms. Finally, participants were classified into two distinct risk groups according to the risk score, and an online calculator was created for convenient clinical use. During long term follow-up, hypothyroidism (77.61%) and hypocortisolism (76.70%) were the most common endocrine dysfunction after surgery and significant deficits were observed concerning visual disorder, motor dysfunction and seizures in the recurrent groups. In particular, better quality of life was associated with gross total resection (GTR), postoperative radiation, anterior interhemispheric (AI) approach and transsphenoidal approach. To our knowledge, these are the first nomograms based on a very large cohort of patients with CP that show potential benefits for guiding treatment decisions and long-term surveillance. The current study demonstrated the online calculator serve as the practical tool for individual strategies based on the patient's baseline characteristics to achieve a better prognosis.

Clinicopathological Features and Microsurgical Management of Lesions Located in the Cavernous Sinus: Analysis of 66 Cases.

AIM: To investigate the clinicopathological features and related factors affecting microsurgical resection of lesions in the cavernous sinus. MATERIAL AND METHODS: Clinical data of 66 patients undergoing microsurgery for lesions located in the cavernous sinus from January 2011 to December 2017 were retrospectively reviewed. RESULTS: Histopathological examination revealed benign lesions in 60 (90.9%) patients, the most common histopathological types were meningiomas, schwannomas, and cavernous hemangiomas. Only six (9.1%) patients had malignant lesions. The gross total resection rate was 33%, subtotal resection rate was 21%, substantial partial resection rate was 26%, and partial resection rate was 20%. Factors influencing the extent of lesion resection included the presence of cavernous sinus syndrome prior to surgery, the size of the lesion, the site of origin, and the surrounding of the internal carotid artery, all of which detrimentally influenced total excision (p < 0.05). CONCLUSION: Most lesions involving the cavernous sinus are histopathologically benign. Preoperative cavernous sinus syndrome, the size of the lesion, the site of origin, and the surrounding of the internal carotid artery all detrimentally influence the extent of lesion resection.

Clinical analysis of syringomyelia resulting from spinal hemangioblastoma in a single series of 38 consecutive patients.

OBJECTIVE: Syringomyelia was predominantly caused by Chiari malformation or intramedullary ependymoma. The goal of this study was to identify factors related to clinical outcomes and spinal hemangioblastoma (SH)-induced syringomyelia formation in a single series of patients. PATIENT AND METHODS: Thirty-eight patients with SH were treated with microsurgery from January 2013 to December 2018. Clinical features and related factors were retrospectively analyzed in SH patients with and without syringomyelia. RESULTS: Out of the total number of SH patients, 21 presented with remarkable syringomyelia, resulting in an incidence of 55.26% (21/38).Gross total resection was achieved in 36 cases (94.73%), and subtotal resection was obtained in 2 patients (5.27%). Neurological symptoms improved in 34 patients, remained stable in 2 patients and were aggravated in 2 cases during follow-up. In addition, there was a notable difference between the location of tumors and syringomyelia (P < 0.05). Syringomyelia occurred more frequently in the cervical segment than in any other spinal segment. Moreover, there was an association between symptom duration and clinical prognosis (P < 0.05). Ordinal regression analysis showed that the prognosis of middle duration groups (6-12 months) was better than early groups (0-6 months, p < 0.05, OR 20.21, 95%CI 2.34-336.97) and late groups (>12 months, p < 0.05, OR 11.54, 95%CI 1.30-102.21). Syringomyelia collapse or reduction occurred between two weeks and 15 months after surgery. An improvement of spinal function grade after surgery was more significant in syringomyelia reduction groups (p < 0.05). CONCLUSIONS: The prevalence of syringomyelia due to SH is considerably high, and the initial clinical presentation of syringomyelia resulting from SH should be emphasized. Satisfactory outcomes were achieved by effective surgery in affected patients.

A novel neuroimaging assessment of predictive risk factors associated with intraoperative massive hemorrhage in intracranial solid hemangioblastoma.

BACKGROUND: A solid hemangioblastoma (SH) is a benign and highly vascularized tumor. Microsurgical treatment of SH is still challenging due to excessive intraoperative bleeding. METHODS: Sixty-six consecutive patients with SH were retrospectively analyzed. The volume of intraoperative blood loss (IBL) and the features detected by magnetic resonance imaging (MRI) were evaluated by a neurosurgeon and multiple neuroradiologists. RESULTS: Four striking MRI features-peritumoral edema, the flow-void effect, large draining veins, and a visible feeding artery-were related to excessive IBL. Regarding the weighted values of these risk factors, the flow-void effect was the factor most significantly correlated with IBL (P<0.01, R=0.418). The feeding artery also contributed substantially to excessive IBL (P<0.05, R=0.412). The next most influential factor was the presence of large draining veins (P<0.05, R=0.350), followed by peritumoral edema (P<0.05, R=0.308). The four major risk factors-the flow-void effect, feeding arteries, large draining veins, and peritumoral edema-were assigned point values of 3, 3, 2, and 1, respectively, for a maximum total score of 9 points. A higher total score indicates that a higher volume of bleeding is more likely to occur during surgery. CONCLUSIONS: This study reports the potential neuroimaging-based risk factors leading to abundant IBL in SH by neuroimaging assessment. The study proposes a novel scoring system to predict IBL, potentially decreasing the risk involved in the surgical treatment of SH.

Clinical study on microsurgical treatment for craniopharyngioma in a single consecutive institutional series of 335 patients.

OBJECTIVES: The optimal management of craniopharyngioma is still controversial. The aim of this study is to explore microsurgical outcomes of craniopharyngioma in 335 cases. PATIENTS AND METHODS: Clinical data of 335 consecutive patients with craniopharyngioma between March 2011 and March 2017 were retrospectively analyzed. RESULTS: Gross total resection (GTR) was achieved in 265 cases (79.1%), subtotal resection (STR) was obtained in 70 cases (20.9%). The GTR rate was 81.93% in pediatric group and 78.17% in adult group respectively, no significant difference regarding the GTR rate was found in adult group compared with in pediatric group (p > 0.05). However, there was a noticeable difference in the elevated hypothalamic obesity in children group compared with in adult group after operation (p < 0.05). Multivariate analysis indicated that the tumor recurrence and surgical times played a negative role in the resection extent, the odds ratio and 95% confidence interval of the tumor recurrence and surgical times is [0.306 (0.155-0.603), (p < 0.01)] and [2.135 (1.101-4.142), (p < 0.05)] respectively. There was significant difference on panhypopituitarism between GTR and STR group (p < 0.05). However, No significant difference regarding the postoperative visual dysfunction and indepent quality of life respectively between GTR and STR group was found (p > 0.05). Additionally, there were no statistically significant differences for recurrence-free curves between GTR and STR plus adjuvant radiotherapy (p > 0.05). CONCLUSIONS: Present findings demonstrated that tumor recurrence and surgical times contribute to negative total resection for craniopharyngioma. Postoperative precise adjuvant radiotherapy was considered in selected cases if pursuit of GTR was rather dangerous under disadvantageous removal factors.