OBJECTIVE: Neurosurgical technique has recently entered a fantastic era of image guided surgery or neuronavigaton and application of this technology is beginning to have a significant impact on a variety of intracranial procedures. This study purports to investigate the effectiveness of this new technique in its application to the brain tumor surgery. METHODS: We used the BrainLab VectorVision neuronavigation system, which is an intraoperative, imageguided, frameless, and localization system. We operated 220 cases of different brain pathological conditions with its guidance. RESULTS: The mean of target localizing accuracy, mass size, and mass volume were 1.14mm, 3.04x3.78cm, 32.04cc respectively. These cases included 194 microsurgical craniotomies, 21 frameless stereotactic biopsies, 4 endoscopic procedure and 1 catheter placement. The common pathological diagnoses were meningioma in 61 cases, glioma in 59 and metastasis in 45. CONCLUSION: The neuronavigation system has shown to be very effective and user-friendly for routine microsurgical interventions. The application of this technique not only revealed benefits in operative planning, appreciation of anatomy, lesion location, and safety of surgery, but also greatly enhanced surgical confidence. The image guided surgical technology has a great potential to play an important role in contemporary neurosurgery and its various adoptions in practice will be realized in the near future.
Biopsy ; Brain Neoplasms* ; Brain* ; Catheters ; Craniotomy ; Diagnosis ; Glioma ; Meningioma ; Neoplasm Metastasis ; Neuronavigation* ; Neurosurgery ; Surgery, Computer-Assisted

Subependymomas are rare benign tumors located in the ventricular system. Intraparenchymal subependymoma is extremely rare; only 6 cases have been reported, and all were located in the supratentorial region. We describe a case of infratentorial, intraparenchymal subependymoma in a 28-year-old man with intermittent headache. Imaging revealed a well-demarcated cystic and solid cerebellar mass near the fourth ventricle. The mass had a microcystic component and calcification without contrast enhancement. Complete surgical excision was performed, and histopathology confirmed a subependymoma.
Adult ; Calcinosis/diagnosis ; Cerebellar Neoplasms/*diagnosis/surgery ; Fourth Ventricle ; Glioma, Subependymal/*diagnosis/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Rare Diseases/*diagnosis/surgery ; Tomography, X-Ray Computed

OBJECTIVETo study the usefulness of the intraoperative photodynamic diagnosis (PDD) and fluorescence-guided resection of malignant gliomas.

METHODSFifteen consecutive patients with malignant gliomas received doses of hematoporphyrin derivative (HPD, 2 mg/kg body weight) 48 hours before induction of anesthesia. After the tumors recognized by bare eyes they were removed routinely. The fluorescence around 690 nm excited by laser beam (wavelength 632.5 nm) was detected by laser electronic spectrum analyzer and then fluorescing tissue was removed whenever it was considered safel. Tissue samples derived from the walls of tumor cavities after resection and PDD were sent for histological examination. Compared with the result of the histological examination, the sensitivity and specificity of PDD were calculated and recorded. Early postoperative MRI or CT were done to determine the extend of the resection of the tumors. Surgical mortality and morbidity were also recorded.

RESULTSIntraoperatively, in all of 15 cases tumor areas with HPD fluorescence could be recognized by laser electronic spectrum analyzer. On the basis of 106 tissue samples derived from 15 tumors, a sensitivity of 90.6%, a specificity of 96.8% and an accuracy of 94.3% of PDD were achieved. In 2 cases the resection of residual tumor were performed after finding left tumors by PDD. Complete resection of contrast-enhancing tumor was accomplished in 9 patients (60%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 5 of the 6 remaining patients. No perioperative deaths and one case of morbidity were encountered.

CONCLUSIONSIntraoperative photodynamic diagnosis following resection of malignant gliomas can detect residual tumor tissue with high accuracy. Photodynamic diagnosis and fluorescence-guided resection of malignant gliomas have a positive role in improving the radicality of malignant glioma resection.

Adult ; Brain Neoplasms ; diagnosis ; surgery ; Female ; Glioma ; diagnosis ; surgery ; Hematoporphyrin Derivative ; Humans ; Male ; Middle Aged ; Photosensitizing Agents ; Retrospective Studies ; Spectrometry, Fluorescence ; Treatment Outcome

OBJECTIVETo study the clinicalpathologic features of intracranial multiple lesions.

METHODSThe clinical, radiologic and pathologic features of intracranial multiple lesions in 62 cases during the period from 2005 to 2009 in Xuanwu Hospital were retrospectively reviewed.

RESULTSThere were 32 males and 30 females in 62 cases. The mean age of seize onset and duration of disease were 37.4-year-old and 11.6 months, respectively. The lesions could affect cerebral hemisphere, basal ganglia, brain stem, cerebellum and other parts, most lesions were located above the tentorium. Pathological diagnosis as follows: 13 patients with glioma; metastatic tumors in 13 cases; 12 cases of central nervous system infection; immune-mediated inflammatory demyelinating disease in 8 cases; 5 cases of primary lymphoma of central nervous system; primary angiitis of the central nervous system 3 cases; mitochondrial encephalopathy 2 cases; vein thrombosis in 2 cases; Rosai-Dorfman disease in 2 cases; 2 case of radiation encephalopathy. Among them, mitochondrial encephalopathy and vein thrombosis lesions located in the cortex; metastatic tumor and blood-borne infection mainly involving junction of grey and white matter; glioma, radiation encephalopathy and demyelinating disease include white matter lesions; vascular inflammation showed cortical and subcortical white matter lesions.

CONCLUSIONSA variety of tumor and non-neoplastic diseases can be expressed in intracranial multiple lesions, which gliomas, metastatic tumor and central nervous system infections are more common. In order to improve the diagnosis of intracranial multiple lesions, active work in the brian biopsy, study the clinical, imaging and pathological findings must be closely.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; diagnosis ; pathology ; surgery ; Child ; Demyelinating Diseases ; diagnosis ; pathology ; surgery ; Female ; Glioma ; diagnosis ; pathology ; surgery ; Histiocytosis, Sinus ; diagnosis ; pathology ; surgery ; Humans ; Lymphoma, Large B-Cell, Diffuse ; diagnosis ; pathology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasms, Neuroepithelial ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Toxoplasmosis, Cerebral ; diagnosis ; pathology ; surgery ; Tuberculosis, Central Nervous System ; diagnosis ; pathology ; surgery ; Young Adult

Papillary ependymoma is a rare variant of ependymoma and often gives rise to confusion with choroid plexus papilloma because of topographic, light microscopic and ultrastructural similarities. Here, we report two cases of papillary ependymomas regarding their unique clinicopathologic features and differential points from choroid plexus papilloma. Brain MRI revealed a large mass in the left lateral ventricle in one case and a 3cm sized mass in the pineal area and the 3rd ventricle in the other. Microscopically, the tumor was characterized by papillary and tubular structures. Immunohistochemically, the tumor cells in both cases expressed cytokeratins(CK22 and CAM 5.2) but did not express glial fibrillary acidic protein(GFAP), vimentin, epithelial membrane antigen, and S100 protein. This is a very unusual immunohistochemical feature for papillary ependymoma. Ultrastructurally, the tumor showed a mosaic pattern of tumor cells with frequent intercellular microrosettes having a few stubby microvilli, a few cilia and zonulae adherentes. The cytoplasmic processes were markedly reduced compared to conventional ependymoma. The cytoplasm did not contain intermediate filaments. Interestingly, the mitochondria showed abnormal features with a pleomorphic shape and abnormal cristae in both cases. These ultrastructural features enabled differentiation between papillary ependymoma and choroid plexus papilloma in addition to the light microscopic findings.
Adult ; Carcinoma, Papillary/*pathology/surgery ; Case Report ; Diagnosis, Differential ; Ependymoma/*pathology/surgery ; Fatal Outcome ; Female ; Follow-Up Studies ; Glioma/*pathology ; Human ; Magnetic Resonance Imaging ; Middle Age

We describe herein a malignant glioma arising at the site of the resected hemangioblastoma after irradiation in a patient with von Hippel-Lindau disease (VHL). The patient was a 25 year-old male with multiple hemangioblastomas at the cerebellum and spinal cord, multiple pancreatic cysts and a renal cell carcinoma; he was diagnosed as having VHL disease. The largest hemangioblastoma at the right cerebellar hemisphere was completely removed, and he received high-dose irradiation postoperatively. The tumor recurred at the same site 7 years later, which was a malignant glioma with no evidence of hemangioblastoma. The malignant glioma showed molecular genetic profiles of radiation-induced tumors because of its diffuse p53 immunostaining and the loss of p16 immunoreactivity. The genetic study to find the loss of heterozygosity (LOH) of VHL gene revealed that only the cerebellar hemangioblastoma showed allelic losses for the gene. To the best of our knowledge, this report is the first to show a malignant glioma that developed in a patient with VHL disease after radiation therapy at the site of an excised hemangioblastoma. This report also suggests that radiation therapy should be performed very carefully in VHL patients with hemangioblastomas.
Adult ; Cerebellar Neoplasms/complications/*surgery ; Glioma/*diagnosis/*etiology ; Hemangioblastoma/complications/*surgery ; Humans ; Male ; Radiotherapy/*adverse effects ; von Hippel-Lindau Disease/complications/*radiotherapy

A 13-year-old girl with a right intraorbital optic nerve glioma (ONG) was referred to our glaucoma clinic because of uncontrolled intraocular pressure (IOP) in her right eye. The IOP reached as high as 80 mmHg. Several months earlier, she had undergone stereotactic image-guided robotic radiosurgery using the CyberKnife for her ONG; the mass had become smaller after treatment. Her visual acuity was no light perception. Slit lamp examination revealed rubeosis iridis, a swollen pale optic disc, and vitreous hemorrhage. After medical treatment, the IOP decreased to 34 mmHg, and no pain was reported. Although the mass effect of an ONG can cause neovascular glaucoma (NVG), this case shows that stereotactic radiosurgery may also cause NVG, even after reducing the mass of the tumor. Patients who undergo radiosurgery targeting the periocular area should be followed carefully for complications.
Adolescent ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glaucoma, Neovascular/diagnosis/*etiology/physiopathology ; Glioma/diagnosis/*surgery ; Gonioscopy ; Humans ; Intraocular Pressure ; Magnetic Resonance Imaging ; Optic Nerve Neoplasms/diagnosis/*surgery ; Radiosurgery/*adverse effects

OBJECTIVETo study the clinicopathologic features of delayed radiation-induced brain injury after radiotherapy for brain tumor.

METHODSThe clinical, histopathologic and immunohistochemical features of 9 cases with delayed radiation-induced injury were evaluated.

RESULTSThe disease occurred from 6 months to 12 years after radiotherapy and often presented with headache and muscle weakness. Magnetic resonance imaging showed peripheral enhancing lesions with slight mass effect and surrounding edema. Microscopically, the major changes included coagulative necrosis, fibrinoid necrosis of vessels, vascular hyalinization with luminal stenosis and peripheral reactive gliosis. Immunostaining for hypoxia-inducible factors 1α was positive in reactive astrocytes.

CONCLUSIONSDelayed radiation-induced brain injury is a relatively common complication of radiation therapy. The lesion was frequently misdiagnosed as brain tumor. Correct diagnosis relies on clinical, radiologic and pathologic correlation.

Aged ; Brain Neoplasms ; radiotherapy ; Female ; Glioma ; radiotherapy ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; metabolism ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiation Injuries ; diagnosis ; diagnostic imaging ; metabolism ; pathology ; surgery ; Radiotherapy ; adverse effects ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features of pilomyxoid astrocytoma (PmA).

METHODSThe clinical and pathologic features in 3 cases of PmA were analyzed. Immunohistochemical study for glial fibrillary acidic protein (GFAP), CD34 and Ki-67 was performed on paraffin-embedded sections by standard EnVision method.

RESULTSAll the 3 cases occurred in female patients at the age of 10 months, 10 years and 19 years respectively. Two cases were located in the third ventricle, while the remaining case was located at the optic pathway. Histologically, the tumor was composed of bipolar spindle cells setting in a strikingly mucinous background. There was a marked proliferation of vessels within the tumor. In some areas, the tumor cells exhibited an angiocentric growth pattern. The biphasic pattern noted in a classic pilocytic astrocytoma was not found in PmA. Rosenthal fibers and eosinophilic granular bodies were also not identified. Immunohistochemcal study showed that the tumor cells were diffusely positive for GFAP. The Ki-67 labeling index measured less than 1%. CD34 highlighted mainly the vascular networks.

CONCLUSIONSPmA is a distinctive variant of pilocytic astrocytoma with subtle histologic differences. Compared with conventional pilocytic astrocytoma, PmA behaves more aggressively. Some cases tend to occur in older children and adolescents. Immunohistochemical study for GFAP is helpful in differential diagnosis.

Antigens, CD34 ; metabolism ; Astrocytoma ; metabolism ; pathology ; surgery ; Cerebral Ventricle Neoplasms ; metabolism ; pathology ; surgery ; Child ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Immunohistochemistry ; Infant ; Ki-67 Antigen ; metabolism ; Magnetic Resonance Imaging ; Optic Nerve Glioma ; metabolism ; pathology ; surgery ; Third Ventricle ; metabolism ; pathology ; Tomography, X-Ray Computed ; Young Adult