Malignant tumors of the skull base are rare,present with a variation of histologic stypes, and don't have specific symptoms. Their treatment paradigms differ with histology,location and stage. Many times it is essential to need multidisciplinary cooperation for dealing them. A better understangding of malignant tumors of the skull base will be beneficial for standardized treatment.

ObjectiveTo present the experience of microsurgery for giant sellar region tumor via supraorbital pterional approach. Methods Eighteen patients with giant sellar region tumor were treated microsurgically ,There were 7 pituitary adenomas, 8 craniopharyngiomas, 1 germinoma, 1 meningioma and 1 teratoma.ResultsTumor was totally removed in 12 cases,subtotally removed in 6. The patients were followed up with a period of 4 to 23 months,good recovery was achieved in 12 cases,moderate in 3,severe deficit in 1,1 patient died 16 days after operation. ConclusionSupraorbital pterional approach offers an excellent expposure to sellar region tumor and its surrounding structures. Microsurgical techniques play a great role in tumor removing and preserving hypothalamic function during operation.

OBJECTIVETo analyze the clinical features and treatment of skull base osteosarcoma.

METHODSThe clinical data of 18 patients with skull base osteosarcoma, who were admitted to the CAMS Cancer Hospital from January 2005 to November 2013, were retrospectively analyzed. The patients were followed up by telephone, outpatient review and other means. Fifteen patients were followed up, 4 cases received surgery only, and 11 cases received surgery with adjuvant chemotherapy and/or radiotherapy. Kaplan-Meier survival curve analysis was used to analyze the clinical data and Log rank method was used for verification.

RESULTSNine patients died among the 15 patients who were followed up for 3-103 months (mean 25.0 months): seven patients died of local recurrence, and two patients died of distant metastasis, and six patients were still alive. Four patients received surgery only, with a median survival time of 25.0 months, and 11 patients received comprehensive treatment, with a median survival time of 47.0 months (P = 0.02). Five patients received sub-total resection, with a mean survival time of 47.0 months, and 10 patients received total resection, with a mean survival time of 45.0 months (P = 0.37). The 1- and 2-year recurrence rates were 46.6% and 68.9%, respectively. The overall 1-, 2-, 3- and 5-year survival rates were 82.4%, 61.8%, 36.0% and 36.0%, respectively, with a median survival time of 30.0 months.

CONCLUSIONSTo compare the long bone and head and neck osteosarcoma with skull base osteosarcoma, the skull base osteosarcoma has a lower total resection rate, a higher recurrence rate, and a poorer prognosis. Radical surgery and comprehensive treatment are appropriate for skull base osteosarcoma.

Bone Neoplasms ; diagnosis ; pathology ; therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Humans ; Kaplan-Meier Estimate ; Neoplasm Recurrence, Local ; Osteosarcoma ; diagnosis ; pathology ; therapy ; Retrospective Studies ; Skull Base ; pathology ; Survival Rate

Background and objective Leptomeningeal carcinomatosis is a rare type of metastatic tumors of the central nervous system. In recent years, with the improvement of neoplasms therapies and longer survival of patients by better systemic control, incidence of leptomeningeal metastases has increased every year. However, there is still lack of effective thera-pies. hTe aim of this study is to investigate the effcacy, security and prognosis of intrathecal chemotherapy with methotrexate (MTX) in the treatment of neoplastic meningitis.Methods A total of 27 patients were enrolled. We investigated clinical fea-tures and cerebrospinal lfuid (CSF) examination results retrospectively, and analyzed the adverse reactions as well as prognosis atfer intrathecal chemotherapy.Results All 27 patients were treated by intrathecal MTX, 70.4% had clinical remission, how-ever, there was no signiifcant difference in CSF pressure and CSF biochemical changes. We observed that 55.6% patients were all appropriate, 25.9% appeared lower limb numbness and mild pain, no serious irreversible adverse reactions occurred. Median overall survival was 4 months.Conclusion We suggest that intrathecal administration of MTX is associated with improvement of symptoms of leptomeningeal metastasis patients and no severe adverse events observed.

Atypical and malignant meningiomas are characterized by high invasiveness and local recurrence.Traditional treatments such as surgery,radiotherapy and chemotherapy have limited effects.Recently,with the further study of the pathogenesis of meningioma and the development of molecular biology techniques,some new biomarkers have been found to play important roles in development and malignant progression of meningioma.Several genetic and epigenetic factors have been identified as contributing to the malignant progression of meningioma.Genetic factors include multiple phenotypic changes such as abnormal cell proliferation,increased cell invasiveness,angiogenesis,apoptosis inhibition,and changes in telomerase activity.And the discovery of biomarkers provides references for early diagnosis,molecular targeted therapy and prognosis assessment of high-grade meningiomas.

Objective:To analyze the prognosis-related factors of patients with surgical treatment of lung cancer brain metastases.Methods:From January 2016 to November 2018, the clinical data of the patients with lung cancer brain metastases received surgical treatment in Department of Neurosurgery, Cancer Hospital of Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively collected, and completed data of 83 patients were obtained. The single factor analysis was based on the log-rank method, and the multi-factor analysis was used by the Cox proportional hazard model, and the R software was used to map the influencing factors into the nomogram and verify them.Results:The median overall survival (OS) of 83 patients was 27.0 months. The median OS of patients with surgery alone was 15.7 months, the median OS of patients with surgery combined with radiotherapy, chemotherapy or targeted therapy was 27.7 months, and the difference was statistically significant ( χ2=8.735, P=0.003). The results of single factor analysis showed that gender ( χ2=4.652, P=0.031), smoking history ( χ2=8.239, P=0.004), postoperative targeted treatment ( χ2=13.697, P<0.001), postoperative adjuvant therapy ( χ2=8.735, P=0.003), pathology of metastatic tumor ( χ2=11.799, P=0.001), and lung cancer molecular graded prognostic assessment (Lung-molGPA) sore ( χ2=11.333, P=0.004) affected patients′ OS. The results of multivariate analysis showed that smoking history ( HR=0.311, 95% CI: 0.107-0.901, P=0.031), postoperative targeted therapy ( HR=3.563, 95% CI: 1.286-9.868, P=0.015), pathology of metastatic tumor ( HR=0.364, 95% CI: 0.137-0.965, P=0.042), Lung-molGPA score ( HR=0.595, 95% CI: 0.374-0.946, P=0.028) were independent prognostic factors for OS of patients with lung cancer brain metastases. In order to further evaluate the prognosis of patients, nomogram was drawn using these four independent prognostic factors. The model had high accuracy and could better evaluate the prognosis of patients. Conclusion:Lung cancer brain metastases patients with operative indication can benefit from surgery, and active adjuvant therapy after operation can further prolong the OS of patients. The nomogram constructed by smoking, targeted therapy, pathology of metastatic tumor and Lung-molGPA score can be used to evaluate individual patient outcomes and guide clinical treatment.