Cerebral metastases are the most common intracranial tumors in adults,with an increasing incidence in recent years.Radiomics can quantitatively analyze and process medical images to guide clinical practice.In recent years,CT and MRI-based radiomics has been gradually applied to the precise diagnosis and treatment of cerebral metastases,such as the precise detection and segmentation of tumors,the differential diagnosis with other cerebral tumors,the identification of primary tumors,the evaluation of treatment efficacy,and the prediction of prognosis.This article reviews the advances in radiomics of cerebral metastases.
Brain Neoplasms/diagnostic imaging* ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Supratentorial Neoplasms

Supratentorial extraventricular anaplastic ependymoma (SEAE) in adults is a relatively rare intracranial tumor. Because of the very low prevalence, only a few cases have been reported. According to a recent study, SEAE is associated with a poor prognosis and there is no definite consensus on optimal treatment. We report a case of an adult SEAE patient who had no recurrence until seven years after a gross total resection (GTR) followed by conventional radiotherapy. A 42-year-old male had a persistent mild headache, left facial palsy, dysarthria, and left hemiparesis. Preoperative neuroimaging revealed an anaplastic astrocytoma or supratentorial ependymoma in the right frontal lobe. A GTR was performed, followed by adjuvant radiotherapy. Histologic and immunohistochemical results revealed anaplastic ependymoma. After seven years of initial therapy, a regular follow-up MRI showed a 3-cm-sized partially cystic mass in the same area as the initial tumor. The patient underwent a craniotomy, and a GTR was performed. Histopathologic examination revealed recurrence of the SEAE. External radiotherapy was performed. The patient has been stable without any disease progression or complications for 12 months since the surgery for recurrent SEAE.
Adult ; Astrocytoma ; Consensus ; Craniotomy ; Disease Progression ; Dysarthria ; Ependymoma ; Facial Paralysis ; Follow-Up Studies ; Frontal Lobe ; Headache ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Paresis ; Prevalence ; Prognosis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Supratentorial Neoplasms

We reported a case of supratentorial extra-axial hemangioblastoma diagnosed by magnetic resonance imaging (MRI). As a simple solid mass,this tumor has its unique MRI features due to its tissue structures.
Hemangioblastoma ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Supratentorial Neoplasms ; diagnostic imaging

Ependymoma is the third most common pediatric primary brain tumor. Ependymomas are categorized according to their locations and genetic abnormalities, and these two parameters are important prognostic factors for patient outcome. For supratentorial (ST) ependymomas, RELA fusion-positive ependymomas show a more aggressive behavior than YAP1 fusion-positive ependymomas. Extracranial metastases of intra-axial neuroepithelial tumors are extremely rare. In this paper, we report a case of aggressive anaplastic ependymoma arising in the right frontoparietal lobe, which had genetically 1q25 gain, CDKN2A homozygous deletion, and L1CAM overexpression. The patient was a 10-year-old boy who underwent four times of tumor removal and seven times of gamma knife surgery. Metastatic loci were scalp and temporalis muscle overlying primary operation site, lung, liver, buttock, bone, and mediastinal lymph nodes. He had the malignancy for 10 years and died. This tumor is a representative case of RELA fusion-positive ST ependymoma, showing aggressive behavior.
Brain Neoplasms ; Buttocks ; Child ; Ependymoma* ; Genetics ; Humans ; Liver ; Lung ; Lymph Nodes ; Male ; Neoplasm Metastasis* ; Neoplasms, Neuroepithelial ; Neural Cell Adhesion Molecule L1 ; Scalp ; Supratentorial Neoplasms ; Transcription Factor RelA

OBJECTIVE: The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery. METHODS: Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status. RESULTS: MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection. CONCLUSIONS: MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.
Brain Neoplasms ; Cooperative Behavior ; Edema ; Evoked Potentials, Motor ; Female ; Hemorrhage ; Humans ; Male ; Monitoring, Intraoperative* ; Paresis ; Supratentorial Neoplasms* ; Vascular System Injuries

Two-thirds of ependymomas arise in the infratentorial or intraventricles, whereas one-third are located supratentorially. But supratentorial "cortical" ependymomas are very rare. We report a case of a cortical ependymoma in a 21-month-old boy. The patient presented with simple partial seizures. This tumor was located in the postcentral gyrus and he had gross total excision. Microscopy and immunohistochemistry showed grade II differentiation ependymoma.
Ependymoma* ; Epilepsies, Partial ; Humans ; Immunohistochemistry ; Infant* ; Male ; Microscopy ; Pediatrics ; Supratentorial Neoplasms

BACKGROUNDStudies have shown that abnormal activation of the sonic hedgehog pathway is closely related to tumorigenesis in central nervous system. This study aimed to investigate the role of the sonic hedgehog signaling pathway in the occurrence of brainstem and supratentorial glioma.

METHODSReal-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and immunohistochemistry were used to detect the expression of sonic hedgehog-related components in 5 specimens of normal brain tissue, 10 of grade II brainstem glioma, and 10 of grade II supratentorial glioma. The significance of differences between two groups was determined using the Mann-Whitney U test or the two-sample test according to the results of normality distribution tests.

RESULTSThe mRNA expression levels of sonic hedgehog-related genes were higher in brainstem astrocytomas than in supratentorial astrocytomas and normal brain tissue. The level of protein patched homolog 1 (PTCH1) was significantly higher in brainstem astrocytomas than in supratentorial astrocytomas and normal brain tissue (P < 0.01). Immunohistochemistry semi-quantitative analysis was consistent with the qRT-PCR result that PTCH1 expression was increased significantly in brainstem astrocytomas at the protein level (P < 0.05).

CONCLUSIONSEnhanced PTCH1 expression and activation of the sonic hedgehog pathway are involved in brainstem glioma. This may be related to the difference in malignant biological behavior between brainstem and hemispheric glioma, and could be an ideal therapeutic target in brainstem glioma.

Adolescent ; Adult ; Astrocytoma ; genetics ; metabolism ; Brain Stem Neoplasms ; genetics ; metabolism ; Female ; Glioma ; genetics ; metabolism ; Hedgehog Proteins ; genetics ; metabolism ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Patched Receptors ; Patched-1 Receptor ; Real-Time Polymerase Chain Reaction ; Receptors, Cell Surface ; genetics ; metabolism ; Signal Transduction ; genetics ; physiology ; Supratentorial Neoplasms ; genetics ; metabolism ; Young Adult

OBJECTIVETo observe the effects of electro-acupuncture combined with sevoflurane anesthesia used in neurosurgery patients and the speed of recovery following surgery.

METHODSEighty patients with supratentorial tumor resection were anesthetized with sevoflurane and randomly allocated into the complete anesthesia group (Group A) and the electro-acupuncture combined with sevoflurane group (Group B). Han's acupoint nerve stimulator with 2/100 Hz frequency was used to stimulate the points. Patients in Group B received electroacupuncture at Fengchi (GB20) toward Tianzhu (BL10) and Cuanzhu (BL2) toward Yuyao (EX-HN4) at the same side of the craniotomy before anesthesia induction. The stimulation was lasted from anesthesia induction until the end of operation. Patients in Group A were pasted with the conducting wire at the aforesaid points, but with no acupuncture or electric stimulation. All patients were induced with propofol 2 mg/kg, sufentanyl 0.3 microg/kg, and vecuronium 0.1 mg/kg, and maintained anesthesia with 2% sevoflurane. The bispectral index (BIS) was maintained ranging 40 -50. The sevoflurane was stopped inhaling at the end of the operation. The end-tidal sevoflurane concentration, minimum alveolar concentration (MAC), BIS, and the anesthesia recovery at each time point were recorded in the two groups.

RESULTSThere was no statistical difference in the mean arterial pressure or the heart rate. The end-tidal concentration and MAC of sevoflurane were significantly lower in Group B than in Group A at each time point (P<0.05). The dose of sevoflurane was reduced by 8.34% +/- 1.24% in Group B when compared with that of Group A. The BIS value could be maintained ranging 40 - 50 in both groups, thus guaranteeing the anesthesia depth. The time for the spontaneous respiration recovery, the extubation time, the time for opening eyes, the time for the voluntary movement recovery, and the time for orientation recovery, and the time for leaving the operation room were significantly shorter in Group B than in Group A (P<0.01). The occurrence of dysphoria, nausea and vomiting was less in Group B than in Group A.

CONCLUSIONSElectro-acupuncture combined with sevoflurane used in neurosurgery could save the dose of sevoflurane, significantly shorten the anesthesia recovery time, and improve the quality of the anesthesia recovery. It was a favorable anesthesia method.

Adult ; Anesthesia ; methods ; Electroacupuncture ; Female ; Humans ; Male ; Methyl Ethers ; therapeutic use ; Middle Aged ; Neurosurgery ; methods ; Supratentorial Neoplasms ; surgery

Crossed cerebellar diaschisis has been described mostly in hemispheric stroke and supratentorial tumors with positron-emission tomography (PET) and single photon emission computed tomography (SPECT). Rarely it has been described with brain diffusion-weighted MRI of status epilepticus. We report a patient with status epilepticus, who developed MRI abnormalities in the cerebral cortex and contralateral cerebellum. EEG abnormalities correlated anatomically with the cerebral cortex of image change. An aggressive medication resulted in seizure control, reversal of neurologic deficit, and improvement or resolution of the MRI and EEG abnormalities in 3 weeks. We concluded that both localization and resolution of lesions may be explained by reversible excitotoxic cell damage due to seizure-related excessive synaptic activity.
Brain ; Cerebellum ; Cerebral Cortex ; Electroencephalography ; Humans ; Neurologic Manifestations ; Positron-Emission Tomography ; Seizures ; Status Epilepticus ; Stroke ; Supratentorial Neoplasms ; Tomography, Emission-Computed, Single-Photon

OBJECTIVETo observe the supplementary analgesic effect of electroacupuncture and its influence on the maintenance of anesthesia and the speed of recovery of patients undergoing craniotomy.

METHODSEighty cases of supratentorial tumor resection were randomly divided into group A and group S, 40 cases in each group. All the patients were anesthetized with 2% Sevoflurane. The patients in group A received electroacupuncture at Hegu (LI 4) and Waiguan (TE 5), Jinmen (BL 63) and Taichong (LR 3), Zusanli (ST 36) and Qiuxu (GB 40) from anesthesia beginning to the end of operation, and in group S without electroacupuncture. The end-tidal Sevoflurane concentration, minimum alveolar concentration (MAC), bispectral index (BIS) and the information during anesthesia recovery stage were recorded, respectively.

RESULTSThe end-tidal concentration and MAC of Sevoflurane in group A at all times were significant lower than those in group S (P<0.05, P<0.01) with a Sevoflurane saving of 9.62% on average. The BIS in group A during a few phases were higher than that in group S (all P<0.05). During anesthesia recovery stage, the time of each phase in group A was significantly shorter than that in group S (all P<0.01). No dysphoria and one case with nausea and vomiting were shown in group A, but in group S, 2 patients had dysphoria and 3 patients had nausea and vomiting.

CONCLUSIONElectroacupuncture combined with Sevoflurane anesthesia can decrease the dosage of Sevoflurane, shorten the recovery time of anesthesia and improve the quality of anesthesia recovery of the patients undergoing resection of supratentorial tumor.

Acupuncture Analgesia ; Adolescent ; Adult ; Anesthesia Recovery Period ; Electroacupuncture ; Female ; Humans ; Male ; Methyl Ethers ; administration & dosage ; adverse effects ; Middle Aged ; Supratentorial Neoplasms ; drug therapy ; surgery ; therapy ; Young Adult