OBJECTIVETo investigate the clinical value of high-field-strength intraoperative magnetic resonance imaging (iMRI) combined with optic radiation neuro-navigation for the resection of temporal lobe low-grade gliomas.

METHODSFrom April 2009 to September 2013, 65 patients with temporal lobe low-grade gliomas (WHO grade II) involving optic radiation were operated with iMRI and functional neuro-navigation. Diffusion tensor imaging (DTI) based fiber tracking was used to delineate optic radiation. The reconstructed optic radiations were integrated into a navigation system, in order to achieve intraoperative microscopic-based functional neuro-navigation. iMRI was used to update the images for both optic radiations and residual tumors. Volumetric analyses were performed using 3D Slicer for pre- and intra-operative tumor volumes in all cases. All patients were evaluated for visual field deficits preoperatively and postoperatively. The Student t test was used to evaluate the average rate of extent of resection between groups. Spearman rank correlation analysis was used to assess correlations between predictors and epilepsy prognosis.

RESULTSPreoperative tumor volumes were (78±40) cm3. In 29 cases, iMRI scan detected residual tumor that could be further resected, and extent of resection were increased from 76.2% to 92.7% (t=7.314, P<0.01). In 19 cases (29.2%), gross total resection was accomplished, and iMRI contributed directly to 8 of these cases. Postsurgical follow-up period varied from 13 months to 59 months, mean (33±13) months. Tumor progression were observed in 3 patients, newly developed or deteriorated visual field defects occurred in 4 patients (6.2%). For patients with pre-operative seizures, Engel Class I were achieved for 89.7% of them. Spearman rank correlation analysis revealed that seizure outcome (Engel Class) was related to increased excision of ratio (r=-0.452, P=0.004, 95% CI: -0.636--0.261) and larger tumors (r=0.391, P=0.014, 95% CI: 0.178-0.484).

CONCLUSIONSWith iMRI and functional neuro-navigation, the optic radiation can be accurately located, while extent of resection can be evaluated intra-operatively. This technique is safe and helpful for preservation of visual field for the resection of temporal lobe low-grade gliomas involving optic radiation.

Brain Neoplasms ; pathology ; surgery ; Glioma ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neuronavigation ; Temporal Lobe ; surgery

PURPOSE: Although conventional neuro-navigation is a useful tool for image-guided glioma surgery, there are some limitations, such as brain shift. We introduced our methods using an identifiable marker, a "tailed bullet", to overcome the limitation of conventional neuro-navigation. A tailed bullet is an identifiable tumor location marker that determines the extent of a resection and we have introduced our technique and reviewed the clinical results. MATERIALS AND METHODS: We have developed and used "tailed bullets" for brain tumor surgery. They were inserted into the brain parenchyma or the tumor itself to help identify the margin of tumor. We retrospectively reviewed surgically resected glioma cases using "tailed bullet". Total 110 gliomas included in this study and it contains WHO grade 2, 3, and 4 glioma was 14, 36, and 60 cases, respectively. RESULTS: Gross total resection (GTR) was achieved in 71 patients (64.5%), subtotal resection in 36 patients (32.7%), and partial resection in 3 patients (2.7%). The overall survival (OS) duration of grade 3 and 4 gliomas were 20.9 (range, 1.2-82.4) and 13.6 months (range, 1.4-173.4), respectively. Extent of resection (GTR), younger age, and higher initial Karnofsky Performance Status (KPS) score were related to longer OS for grade-4 gliomas. There was no significant adverse event directly related to the use of tailed bullets. CONCLUSION: Considering the limitations of conventional neuro-navigation methods, the tailed bullets could be helpful during glioma resection. We believe this simple method is an easily accessible technique and overcomes the limitation of the brain shift from the conventional neuro-navigation. Further studies are needed to verify the clinical benefits of using tailed bullets.
Adult ; Aged ; Brain/pathology ; Brain Neoplasms/pathology/*surgery ; Female ; Glioma/pathology/*surgery ; Humans ; Karnofsky Performance Status ; Magnetic Resonance Imaging, Interventional ; Male ; Middle Aged ; Neuronavigation/*methods ; Retrospective Studies ; Surgery, Computer-Assisted/*methods ; Survival Rate ; Time Factors ; Treatment Outcome

BACKGROUNDTumor surgery in brain motor functional areas remains challenging. Novel techniques are being developed to gain maximal and safe resection for brain tumor surgery. Herein, we assessed the magnetic resonance diffusion tensor imaging (MR-DTI) and fluorescein sodium dyeing (FLS) guiding technique for surgery of glioma located in brain motor functional areas.

METHODSTotally 83 patients were enrolled according to our inclusion and exclusion criteria (56 patients in experimental group, 27 patients in control group). In the experimental group, the surgical approach was designed by DTI imaging, which showed the relationship between the tumor and motor tract. The range of resection in the operation was determined using the FLS-stained area, which recognized the tumor and its infiltrated tissue. The traditional routine method was used in the control group. Postoperatively, all patients underwent enhanced brain MRI within 72 hours to ascertain the extent of resection. Patients were followed in our outpatient clinic over 6 - 24 months. Neurological deficits and Karnofsky scoring (KPS) were evaluated.

RESULTSThere were no significant differences in balance test indexes of preoperative data (sex, age, lesion location and volume, and neurological deficits before operation) and diagnosis of histopathology between the two groups. There was a trend in the experimental group for greater rates of gross total resection (80.4% vs. 40.7%), and the paralysis rate caused by surgery was lower in experimental (25.0%) vs. control (66.7%) groups (P < 0.05). The 6-month KPS in the low-grade and high-grade gliomas was 91 ± 11 and 73 ± 26, respectively, in the experimental group vs. 82 ± 9 and 43 ± 27, respectively, in the control group (P < 0.05 for both).

CONCLUSIONSMR-DTI and FLS dye guiding for surgery of glioma located in brain motor functional areas can increase the gross total resection rate, decrease the paralysis rate caused by surgery, and improve patient quality of life compared with traditional glioma surgery.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; pathology ; psychology ; surgery ; Diffusion Tensor Imaging ; methods ; Female ; Fluorescein ; Glioma ; pathology ; psychology ; surgery ; Humans ; Male ; Middle Aged ; Motor Cortex ; pathology ; Muscle Strength ; Prognosis

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

Cerebral Cortex ; physiology ; Electric Stimulation Therapy ; Electroencephalography ; Epilepsy ; pathology ; physiopathology ; surgery ; Female ; Glioma ; pathology ; physiopathology ; surgery ; Humans ; Middle Aged

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

The treatment of gliomas is highly individualized. Surgery for gliomas is essentially for histological diagnosis, to alleviate mass effect, and most importantly, to favor longer survival expectancy. During the past two decades, many surgical techniques and adjuvants have been applied to glioma surgery in China, which lead to a rapid development in the field of cerebral glioma surgery. This article broadly and critically reviewed the existing studies on cerebral glioma surgery and to portrait the current status of glioma surgery in China. A literature search was conducted covering major innovative surgical techniques and adjuvants for glioma surgery in China. The following databases were searched: the Pubmed (January 1995 to date); China Knowledge Resource Integrated Database (January 1995 to date) and VIP Database for Chinese Technical Periodicals (January 1995 to date). A selection criterion was established to exclude duplicates and irrelevant studies. The outcome measures were extracted from included studies. A total of 3307 articles were initially searched. After excluded by abstracts and full texts, 69 studies conducted in the mainland of China were included and went through further analysis. The philosophy of surgical strategies for cerebral gliomas in China is undergoing tremendous change. Nowadays Chinese neurosurgeons pay more attention to the postoperative neurofunctional status of the patients. The aim of the glioma surgery is not only the more extensive tumor resection but also the maximal safety of intervention. The well balance of longer overall survival and higher quality of life should be judged with respect to each individual patient.
China ; Glioma ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Neurosurgery

OBJECTIVETo evaluate the efficacy and toxicity of combination therapy with surgery and recombinant adenovirus-p53 injection of recurrent malignant gliomas.

METHODS38 patients with recurrent malignant gliomas were included in this study. Among them, 18 patients of combined treatment group had Ommaya reservoirs placed into the tumor cavities after the resection of the tumors and received regular recombinant adenovirus-p53 injections after the operation. The other 20 patients received surgery alone.

RESULTSThe 6-month and 1-year survival rates after the combination therapy were 66.7% (14/18) and 44.4% (8/18), respectively. The median survival time was 9.7 months. Compared with the surgery-alone group, the combined treatment group achieved significant improvement (P < 0.05). The Karnofsky score was significantly improved at 6 months after the combination therapy compared with that before the treatment (P < 0.05).

CONCLUSIONThe recombinant adenovirus-p53 injection is safe and effective in treatment of recurrent malignant gliomas. The combination therapy of surgery and recombinant adenovirus-p53 injection may improve the life quality and the prognosis in patients with recurrent malignant gliomas.

Adenoviridae ; genetics ; Adult ; Brain Neoplasms ; pathology ; surgery ; therapy ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Genes, p53 ; Genetic Therapy ; Glioma ; pathology ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Recombinant Proteins ; therapeutic use ; Survival Rate ; Tumor Suppressor Protein p53 ; genetics ; therapeutic use

OBJECTIVE: To study the clinical characteristics and operative effect of hippocampus lesions. METHODS: We retrospectively analyzed the clinical characteristics and operative outcome of 44 patients with hippocampus lesions between August 2005 and April 2010. RESULTS: Seizure attack was the initial symptom among 40 of the 44 patients. Pathological examinations revealed 18 gliomas, 9 cavernous malformations, 12 hippocampus sclerosis, 2 focal cortical dysplasia, 1 atypical hyperplasia, 1 injury glial scar, and 1 encephalomalacia. Thirteen patients received anterior medial temporal lobectomy and the other 31 received lesionectomy or selective amygdalohippocampectomy via transsylvian approach. An average of 15.7 month follow-up was accomplished in 37 patients. Postoperative epileptic outcomes were evaluated according to Engel classification: Grade I 73.0%(27/37), Grade II 13.5%(5/37), Grade III 10.8%(4/37) and Grade IV 2.7%(1/37). No perioperative death occurred. One patient experienced hemiplegia but recovered 8 months after the operation. Noticeable postoperative visual field deficit was left in 2 patients. Two patients with glioma died of remote tumor recurrence during follow-up. CONCLUSION Seizure attack is a major complaint of hippocampus lesions. Satisfactory seizure and tumor control may be achieved through anterior medial temporal lobectomy or selective amygdalohippocampectomy with lesionectomy.
Adolescent ; Adult ; Brain Neoplasms ; surgery ; Child ; Child, Preschool ; Epilepsy ; surgery ; Female ; Glioma ; surgery ; Hippocampus ; pathology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sclerosis ; surgery ; Temporal Lobe ; surgery ; Treatment Outcome ; Young Adult

Adult ; Female ; Glioma ; pathology ; surgery ; Humans ; Neoplasms, Multiple Primary ; pathology ; surgery ; Ovarian Neoplasms ; pathology ; surgery ; Peritoneal Neoplasms ; pathology ; surgery ; Teratoma ; pathology ; surgery