A Case of Refractory Cancer-related Neuropathic-pain Caused by Intracranial Invasion of Left Nasal Cavity Carcinoma Successfully Treated with Goreisan

Introduction: Intracranial tumors cause various neurological symptoms and neuropathic pain, which are often refractory to opioids. In some of these cases, the combination of Kampo medicines can be effective. Case: The case was a 44-year-old patient who underwent surgery for a suspected papilloma. After resection, pathological examination revealed squamous cell carcinoma, positive for margins, and then, the left intraorbital metastasis was observed. Due to the intracranial invasion of the tumor, he had pain in the second and third branches of the trigeminal nerve in the left face and paresthesia in the second branch of the trigeminal nerve bilaterally (Numerical Rating Scale: NRS 10/10). Hydromorphone was introduced, and the pain was relieved, but the paresthesia remained (NRS 8/10). Both paresthesia and pain worsened during the course of chemotherapy, but MRI showed no tumor progression, thus, the cause of symptom aggravation was diagnosed edema of the tissue around the tumor. Therefore, Goreisan was started, and both paresthesia and pain were relieved. Discussion: Goreisan has been shown to be effective in cerebral edema due to its water-regulating effect by inhibiting aquaporin. In the present case, the reduction of edema in peritumoral tissues by Goreisan may have contributed to the symptomatic relief.

Infantile (congenital) anaplastic intracranial solitary fibrous tumor/hemangiopericytoma—A case report with brief literature review

Solitary fibrous tumor/hemangiopericytoma (SFT/HPC) is a rare primary central nervous system (CNS) tumor, included in the World Health Organization (WHO) 2016 classification. Very few cases have been described in the literature so far, especially the infantile type. It is a mesenchymal tumor of the fibroblastic type, characterized by the fusion of NAB 2 and STAT 6 genes. A 10-month-old boy presented to our neurosurgery department with complaints of increasing head circumference since 1 month of age. The magnetic resonance imaging (MRI) showed a space-occupying lesion measuring 8.2 cm × 7 cm × 6.9 cm in the fronto-temporo-parietal region with a clinical diagnosis of glioma/atypical teratoid rhabdoid tumor (ATRT). The microscopy revealed a spindle cell tumor arranged in a patternless pattern with variable cellularity, increased mitosis, and areas of coagulative necrosis. The immunohistochemistry showed vimentin, CD 34, STAT6, CD99 positivity whereas Glial fibrillary acidic protein, Epithelial membrane antigen, and S-100 negativity. Hence, a diagnosis of anaplastic SFT/HPC (grade-III) was rendered. The patient improved after gross total resection (GTR). The primary intracranial congenital SFT/HPC are extremely rare, often a clinico-radiologically misdiagnosed entity. Thus, the immunohistochemistry/molecular study in addition to histology is mandatory for accurate diagnosis.

Preoperative interventional embolization for intracranial hypervascular tumors / 中华神经医学杂志

Objective:To investigate the therapeutic value of interventional embolization on feeding artery in intracranial hypervascular tumors.Methods:Forty-five patients with intracranial hypervascular tumors, admitted to and accepted interventional embolization of the feeding artery before craniotomy in Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from March 2019 to August 2022, were chosen; a retrospective analysis was performed on the clinical data of these patients. The imaging characteristics, pathological types, preoperative embolization indications, embolization effects and embolism-related complications were summarized to evaluate the safety and effecacy of preoperative interventional embolization.Results:Among the 45 patients, 21 patients had hemangioblastomas, 15 had meningiomas, 5 had hemangiopericytomas, and 4 had glomus jugular tumors. The technical success rate of interventional embolization was 97.8% (44/45); in this frustrated case, the middle meningeal artery was too circuitous for microcatheter to pass. Among the successful ones, 41 patients used liquid embolism agent onyx and 3 patients applied liquid embolism agent NBCA. Seven, 26 and the rest 11 patients achieved complete embolization, sub-total embolization and partial embolization, respectively. Four patients had embolism-related complications, including 2 with rupture of middle meningeal arteries, 1 with Marathon catheter failed to be pulled out, and 1 with functional glomus jugular tumor having pheochromocytoma crisis; these 4 patients were treated timely without serious complications.Conclusion:For intracranial hypervascular tumors, preoperative interventional embolization is safe and effective; it is necessary to master embolization indications and select appropriate embolization methods and materials.

Clinical distribution of primary intracranial tumors and risk factors for postoperative complications / 中国神经精神疾病杂志

Objective To examine the clinical distribution of primary intracranial tumors and analyze the risk factors for postoperative complications.Methods From January 2018 to December 2022,the clinical data of 961 patients with primary intracranial tumor in the Department of Neurosurgery of Tiantan Hospital in Beijing were collected and analyzed retrospectively.To examine the clinical distribution of patients with primary intracranial tumor and present the incidence of postoperative complications.To compare the basic data of patients with and without postoperative complications,and analyze the risk factors leading to postoperative complications.Results There were 363 cases of glioma,231 cases of meningioma,158 cases of sellar tumors,142 cases of neurilemmoma and 67 cases of other types of tumors.There were 679 cases of supratentorial tumors and 282 cases of infratentorial tumors.Postoperative complications occurred in 279 patients,and the incidence of postoperative complications was 29.03％.The incidences of intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis and central nervous system infection were 9.37％,5.41％,4.99％,4.47％and 4.27％,respectively.After surgery,D-dimer(D-D),fibrin degradation products(FPD),prothrombin time(PT)in patients with primary intracranial tumors were significantly higher than those in patients without primary intracranial tumors(P<0.05).Activation of partial thromboplastin time(APTT),and thrombin time(TT)levels were significantly higher than those before surgery(P<0.05).Fibrinogen(FIB)was significantly lower than that before surgery(P<0.05).There were significant differences in tumor location,intraoperative blood loss,operation time,anesthesia recovery time and postoperative coagulation function between patients with and without postoperative complications(P<0.05).Conclusions The common types of primary intracranial tumors include gliomas,meningiomas,sellar tumors and neurilemmoma,etc.Surgical treatment has a high risk of postoperative complications.Common postoperative complications include intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis,and central nervous system infection.Tumor location,operation duration,intraoperative blood loss,anesthesia recovery time and postoperative coagulation dysfunction are all risk factors for postoperative complications.

Psicosis depresiva como forma de presentación de un tumor cerebral / Depressive Psychosis as an Onset Symptom of a Brain Tumor

Introducción: Los tumores cerebrales a veces tienen una presentación clínica compleja y atípica en sus inicios, en dependencia de su localización, lo que puede confundirse con trastornos de la esfera psiquiátrica. Objetivo: Describir un caso clínico interpretado como una psicosis por su sintomatología cuyo diagnóstico resultó un glioblastoma multiforme de alta malignidad. Caso clínico: Mujer de 35 años que comienza desde hace varios meses con trastornos de la conducta, síntomas depresivos, irritabilidad y conflictos en el hogar. Se instala un cuadro de depresión profunda que no mejora con tratamiento farmacológico impuesto por psiquiatría y se decide tratamiento electroconvulsivo, después del cual cae en estado de coma con elementos de hipertensión intracraneal y focalización neurológica. La tomografía de urgencia evidencia un tumor intracraneal, con áreas de necrosis, infiltración y desplazamiento de estructuras adyacentes y signos de hipertensión intracraneal. Al realizar intervención microquirúrgica fallece. La necropsia reveló glioblastoma multiforme de alta malignidad con focos de necrosis y de hemorragias. Conclusiones: La depresión y manifestaciones de trastornos mentales pueden tener causa orgánica, un hecho que debe considerarse en el contexto clínico. La historia clínica bien obtenida, la evaluación psicopatológica y las técnicas de imágenes en la actualidad son herramientas fundamentales en la precisión diagnóstica(AU)

Introduction: Brain tumors sometimes have a complex and atypical clinical presentation at the beginning, depending on their location, which can be mistaken for psychiatric disorders. Objective: To describe a clinical case interpreted as a psychosis for its symptoms and whose diagnosis was a highly malignant glioblastoma multiforme. Clinical case: This is the case of a 35-year-old woman who, several months ago, started to present behavioral disorders, depressive symptoms, irritability, and conflicts at home. Clinical signs of deep depression onset, which does not improve with pharmacological treatment prescribed by the psychiatry specialist; electroconvulsive treatment is decided, after which she falls into a coma with elements of intracranial hypertension and a neurological focus. The emergency tomography shows an intracranial tumor, with necrotic areas, infiltration, and displacement of adjacent structures, as well as signs of intracranial hypertension. When microsurgical intervention is performed, she died. The necropsy revealed highly malignant glioblastoma multiforme with necrosis focuses and hemorrhage. Conclusions: Depression and manifestations of mental disorders may have an organic cause, a fact that must be considered in the clinical setting. A well-obtained clinical history, psychopathological evaluation, and imaging techniques are currently essential tools for an accurate diagnosis(AU)

Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10­20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.

Pineal gland tumor resection via supracerebellar infratentorial approach under neuroendoscope: a clinical analysis of four cases / 中华神经医学杂志

Objective:To investigate the clinical effacies of endoscopic midline and paramedian supracerebellar infratentorial (SCIT) approaches during resection of pineal tumors.Methods:The clinical data of 4 patients with pineal tumors resected via SCIT approach under neuroendoscope in our hospital from December 2017 to March 2019 were analyzed retrospectively. All patients underwent MR imaging plain and enhanced scans before operation. The tumors were resected via SCIT approach under general anesthesia in lateral subduction position (three were via paramedian SCIT approach and one was via midline SCIT approach). The patients were followed up for 3-12 months and the brain MR imaging was reexamined.Results:The tumors were completely resected in 4 patients. Two patients were confirmed to have mixed germ cell tumors, one was confirmed to have seminoma, and the other one was confirmed to have mature teratoma by postoperative pathology. One achieved good recovery after surgery. Two were treated with whole brain and spinal cord radiotherapy, the original lesion in one patient recurred 4 months after resection and systemic chemotherapy was given, and so far, no recurrence was noted; and the other one achieved good recovery. One did not receive chemoradiotherapy due to economic reasons and relapsed 4 months after surgery.Conclusion:It is safe and effective to resect the tumors in pineal region via midline and paramedian SCIT approaches with neuroendoscopy; the best approach should be selected according to the blood supply, size and location of the lesions.

Effects of different anesthesia methods on cognitive function in elderly patients with intracranial tumors at different time points / 实用肿瘤学杂志

Objective The objective of this study was to observed the effect of target control intravenous (TCI) anesthesia and intravenous inhalational anesthesia in the postoperative cognitive function in elderly patients with intracranial tumor at different time points.Methods Seventy patients were divided into the experimental and control groups according to the different methods of intraoperative anesthesia.The experimental group was selected to treat with propofol combined with remifentanil TCI anesthesia,and the control group was treated with intravenous anesthetics combined with inhalation isoflurance.Recovery time of respiration,time of opening eyes,extuation time,orientation recovery time,OAAS score before and after operation,and cognitive function (MMSE)were observed in two groups.Results They were no differences in the recovery time of respiration,time of opening eyes and extubation time in two groups (P ＞ 0.05).The orientation recovery time in the experimental group was 20.4 ± 5.8 min and 23.2 ± 4.3 min in the control group.They had significantly different between experimental and control groups (P ＜ 0.05).The time of extubation,leaving the operating room and after 1 h of extubation,OAAS point for the experimental group was 3.3 ± 0.5,4.2 ± 0.4,4.6 ± 0.6 min,respectively,and 2.3 ± 0.2,3.3± 0.4,3.9 ± 0.3 in the control group,respectively.They were significantly different between the experimental and control groups(P ＜ 0.05).Prior to treatment,there was no significant difference in MMSE score between the two groups(P ＞0.05).MMSE score was 25.0 ±0.4 and 27.9 ± 1.1 in the experimental group after treatment for 24 h and 48 h,respectively.MMSE score in the control group was 23.2 ±0.9 and 25.8 ± 1.3 after treatment for 24 and 48 h,respectively.There had a significant different from two groups (P ＜ 0.05).Conclusion For elderly patients with intracranial tumor surgery,TCI anesthesia with propofol and remifentanil is stable and awake,and the effect on postoperative cognitive function is relatively small.

Comparison of remifentanil combined with sevoflurane or propofol in anesthesia for patients with intracranial tumors / 中国生化药物杂志

Objective To study the application of remifentanil combined with sevoflurane or propofol in the anesthesia of patients with intracranial tumors.Methods From January 2015 to December 2015,60 patients with intracranial tumor surgery in our hospital were selected as the research object in this study.They were randomly divided into A group and B group,each group had a total of 30 cases.Patients in group A were treated with remifentanil combined with sevoflurane anesthesia,and B group was treated with remifentanil and propofol anesthesia.Comparative analysis of A group and B group of patients with clinical indicators.Results During the operation,two groups of patients with end tidal carbon dioxide partial pressure and pulse oxygen saturation score.Two groups of patients in the immediate intubation heart rate and blood pressure were significantly lower than before anesthesia,A group reduced the degree of greater,with statistical difference(P<0.05).In group A,30 min and 1H were significantly higher than those in group B after anesthesia,and the difference was statistically significant(P<0.05).The anesthesia time of A group was(187.3±22.7)min,and the extubation time was(22.1±8.2)min.The anesthesia time of B group was(181.4±19.1)min,and the extubation time was(10.2±5.3)min.As a result,B group of patients with anesthesia time and extubation time were significantly less than the A group,and with statistical difference(P<0.05).Conclusion Remifentanil Combined with propofol and sevoflurane anesthesia in patients with intracranial tumors compared to two kinds of methods can effectively stabilize the patient's life signs,but remifentanil and propofol recovery time is fast,contribute to the balance of cerebral oxygen supply and consumption in a certain extent,with the further promotion and application of clinical significance.

Correlative factors of hypopituitarism in patients with non-sellar intracranial tumors / 中华神经医学杂志

Objective To analyze the correlative factors of hypopituitarism in patients with intracranial non-sellar tumors.Methods Eighty-three patients with intracranial non-sellar tumors,admitted to our hospital from May 2014 to April 2015,were included in our study;their clinical data were retrospectively analyzed.The status of pituitary function was assessed according to the level of preoperative serum hormone.Univariate and multivariate Logistic regression analyses were employed to analyze the correlations of preoperative hypopituitarism with age,gender,hypertension,epilepsy history,course of disease,mass effect of tumor,tumor location,intracranial pressure (ICP),and composition of cerebrospinal fluid.Results Before surgery,30 showed hypopituitarism,accounting for 36.14％:23 had deficiency in one pituitary axe and 7 had multi-axial deficiency.Univariate analysis showed that high ICP (ICP＞200 mmH2O),acute or sub-acute course (≤ 3 months) and presence of mass effect by non-sellar brain tumor were the risk factors of hypopituitarism (P＜0.05).Multivariate Logistic regression analysis revealed that intracranial mass effect in patients with non-sellar brain tumor was an independent risk factor (OR=3.197,95％CI=1.085-9.423,P=0.035).Conclusion Hypopituitarism has high morbidity in patients with non-sellar brain tumor;intracranial mass effect is an independent risk factor for hypopituitarism.

New neuronavigation in microsurgery for intracranial tumors / 中华神经医学杂志

Objective To explore the application of new neuronavigation in microsurgery for intracranial tumors. Methods Thirty-six patients with intracranial tumors, admitted to our hospital from November 2016 to April 2017, were treated with brain LAB KICK neuronavigational system-assisted micro-neurosurgery. Preoperative MRI or CT thin-layer scanning were performed, and the images were input to the Brain LAB Vector Vision neural system for three-dimensional reconstruction. The tumors and the important structures were marked. Intraoperative guidance in the neuronavigation system was performed to find the important nerves, vascular and bone signs and other structures. The clinical data and therapeutic effect of these patients were retrospectively analyzed. Results All the 36 patients were successfully guided by neuronavigation to reach the tumor sites, with the registration error of 0.10-0.25 mm. Total resection was achieved in 31 patients, subtotal resection in 3, and most resection in 2. Symptoms improved significantly in 34 patients after the surgery. No surgical complications caused by neuronavigation errors were found, and no asymptomatic deterioration or death were noted. Conclusion Brain LAB neuronavigation system in neurosurgery is accurate and safe, enjoying high total resection rate and minimized operation complications.

Application of ExacTrac X-ray image guidance system to frameless stereotactic radiosurgery of intracranial tumor / 医疗卫生装备

Objective To study the setup accuracy and other factors during frameless stereotactic radiosurgery (SRS) of intracraial tumor using ExacTrac X-ray image guide system.Methods Totally 119 intracranial tumor patients from August 2014 to February 2016 underwent auto setup with infrared marker.Bilateral oblique cross field images were obtained with ExacTrac X-ray system,and went through comparison,registration and correction with the digitally reconstructed ones of the planning system.Then the translation accuracy errors at LAT,LNG and VRT directions and corresponding rotational accuracy errors were acquired,and the errors experienced extended analysis.Results The translation errors at LAT,LNG and VRT directions acquired with ExacTrac X-ray image guidance system and 6DOF couch were (0.16±0.13) mm,(0.17±0.14) mm and (0.15±0.11) mm respectively,the corresponding rotational errors were (0.21±0.15),(0.18±0.15),(0.18±0.14)° respectively,and the vector error was (0.32±0.16) mm.All of 3 translation and 3 rotational errors were in the SRS error range.Conclusion ExacTrac X-ray image guidance system combined with 6 degrees-of-freedom couch increases the treatment accuracy during frameless SRS,and thus is worthy promoting practically.

Application of surgery combined with intra-operative I125 particles implantation in treatment of intracranial tumor / 局解手术学杂志

Objective To discuss the efficacy of surgery combined with intra-operative I125 particles implantation in treatment of intracranial tumor.Methods The data of 25 cases diagnosed with intracranial tumors in general hospital of Shenyang Military Region from January 2015 to November 2016 were retrospectively analyzed.All patients received the combination of surgery and I125 particles intra-operative implantation.The therapeutic effect was observed and evaluated.Results All the patients were followed up for 6 to 18 months and there was no signs of recurrence or adverse reactions in the short term.Conclusion The combination of surgery and I125 particles intra-operative implantation could avoid the pain of postoperative radiotherapy and inhibit the short-term recurrence of multiple intracranial tumors.

Adult Intracranial Gliofibroma : A Case Report and Review of the Literature

Gliofibroma is an extremely rare biphasic tumor with an astrocytic and benign mesenchymal component, which commonly occurs within the first two decades of life. The exact biological behavior of the tumor is not fully understood. Therefore, it is not listed as a distinct entity in the current World Health Organization classification of central nervous system tumors. Here, we describe a rare case of gliofibroma, which was located on the medial temporal lobe in a 61-year-old woman. Preoperatively, we misdiagnosed it as a meningioma because it was a well-demarcated and well-enhanced extra-axial mass with calcification and bony destruction. On the histopathological and immunohistochemical examination, the tumor consisted of a mixture of glial tissue and mesenchymal tissue and it was finally diagnosed as a gliofibroma. To our knowledge, this case of intracranial gliofibroma is in the oldest patient ever reported.

Value of magnetic resonance imaging-guided minimally invasive treatment in glioma and its metastatic tumor / 中国肿瘤临床

Minimally invasive treatment has received increasing attention in the field of tumor therapy. Imaging-guided ablation (phys-ical or chemical) and 125I particle implantation have recently become first-line therapies for malignant tumors. A comparison with com-puted tomography, ultrasound, or digital subtraction angiography (DSA) illustrates that magnetic resonance imaging (MRI) shows ex-treme superiority in both intracranial tumor diagnosis and interventional therapy. Nevertheless, MRI also has a deficiency. This study aims to discuss the value of an MRI-guided minimally invasive treatment in glioma and its metastatic tumor.

Risk factors for postoperative healthcare-associated infection in neurosur-gical patients undergoing intracranial tumor removal / 中国感染控制杂志

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)and its risk factors in neurosurgical patients undergoing removal of intracranial tumor,so as to provide theoretical basis for formulating intervention measures.Methods Prospective survey was adopted to monitor the occurrence of postoperative HAI in patients who admitted to the department of neurosurgery of a hospital and underwent selective removal of intracranial tumor between April 2013 and December 2014 ,risk factors for HAI were analyzed with univariate and multivariate logistic regression analysis.Results A total of 1 218 patients were surveyed,163 patents developed 193 times of postoperative HAI,inci-dence of postoperative HAI was 13.38%,case incidence of HAI was 15.85%.The main HAI site was intracranial site(n=125,64.77%),the next was lower respiratory tract (n=55,28.49%).Multivariate logistic regression analysis showed that operation grade and subtentorial operation were independent risk factors for postoperative HAI in neurosurgical patients undergoing removal of intracranial tumor,OR and 95%CI were 4.352(1.878-10.080)and 1.812(1.280-2.564)respec-tively.Conclusion Risk of postoperative HAI in neurosurgical patients undergoing high grade operation and subtentorial removal of intracranial tumor is high,effective prevention and control measures should be taken to prevent the occurrence of HAI.

MR imaging features of intracranial tumors in infants: a report of 12 cases / 中华神经医学杂志

Objective To explore the MR imaging characteristics of brain tumors in infants to improve the diagnosis and early treatment.Methods Twelve infants with brain tumors (less than 1 year old),performed surgery in our hospital from April 2008 to August 2014 and proved by pathology,were collected in our study; the clinical data and MR imaging features were reviewed retrospectively.Results Among the 12 infants,4 (33％) had tumors located at the lateral ventricle,3 (25％) at the cerebral hemisphere,one (8.3％) at the pineal region,one (8.3％) at the suprasellar region,one (8.3％) at the cerebral convexity,one (8.3％) at the cerebellar hemisphere and one (8.3％) at the fourth ventricle.These tumors included immature teratoma (n=3),choroid plexus tumor (n=3),atypical teratoid/rhabdoid tumor (n=2),medulloblastoma (n=1),anaplastic ependymoma (n=1),pilomyxoidastrocytomas (n=1) and infantile fibrosarcoma (n=1).Diversity of MR imaging features was found in different types of brain tumors; tumors as immature teratoma,atypical teratoid/rhabdoid tumor and infantile fibrosarcoma showed mainly mixed signal intensity on T1-weighted images and T2-weighted images,and these tumors displayed heterogeneously enhancement at MR imaging; choroid plexus tumors and medulloblastoma showed isointenseon T1-weighted images and T2-weighted images mostly,and both had obvious enhancement; anaplastic ependymoma showed isointensity signal on T1-weighted images,slightly hyperintenseon T2-weighted images and heterogeneously enhancement; pilomyxoidastrocytomas were hypointenseon Tl-weighted images,hyperintenseon T2-weighted images and homogeneous enhancement.Conclusions Immature teratomas,choroid plexus tumors and embryonal tumors are common in infants.Supratentorial tumors are mostly found.Typical features are showed in some brian tumors,but part of atypical tumors remain challenging in diagnosis.To improve diagnostic accuracy,imaging data should be accumulated in the future.

Optic Nerve Glioma with Unilateral Proptosis: An Interesting Case Report.

Optic nerve is most important cranial nerve responsible for visual functioning. Optic nerve involvement leading to blindness can be seen in various diseases, which cause swelling, inflammation, ischemia of the optic nerve. The optic nerve glioma (ONG) comprises 5% of all pediatric intracranial tumor and are a leading cause of unilateral proptosis. ONGs can be associated with neurofibromatosis and are more common than meningiomas. 20-30% of ONGs become symptomatic before the age of 10 years. Visual evoked potential testing is helpful in detecting asymptomatic gliomas. Early detection and prompt management can prevent blindness from gliomas. Treatment of ONG should be tailored to the individual patient. Our patient also showed the presence of unilateral ONG with proptosis. Magnetic resonance imaging was diagnostic. Partial optic atrophy was also present.

Reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation of intracranial tumors / 中华显微外科杂志

Objective To evaluate the reliability and accuracy of three-dimensional digital fusion anatomy in the preoperative evaluation and therapeutic strategy choice of intracranial tumors.Methods MRI scan,including regular MRI,MRA,MRV and DTI,were performed in 87 case.Then tumor themselves as well as tumor-associated structures were reconstructed and fused through iPlan 2.6 software.Based on the reconstructed images,therapeutic strategy were established,preoperative and intraoperative imags were compared.Results The digital reconstruction were successfully finished in all cases.Meanwhile,digital images,originally radiological images and actual images matched well.No approach-associated complication were met in our series.Among tumors in the convexity,the relationship of the reflux veins and the tumors were divided into three types:anterior(12 cases),posterior(19 cases) and overriding(3 cases).All of the relationships were seen in the preoperative fusion image,and the veins were all effectively protected during operation.The tumor-associated arteries could be pushed or wraped by the tumors,and the three-dimensional fusion image could provided their virtually aberrant pathway as well as their relationship with tumor.During microsurgical managment of tumors in the deep brain parenchyma,safe approach were found with the help of comprehensive understanding of the tumors and their adjacent structures.Conclusion Three-dimensional digital fusion anatomy can vividly and accurately display full rang of information about the tumor,and facilitate tumor treatment safely.

A Case of Giant Skull Base Chondroma

Intracranial chondroma is a rare benign tumor. Here, we present the case of a 29-year-old female who was afflicted with left eye blindness and ptosis. Brain computerized tomography and magnetic resonance imaging revealed the presence of a giant calcified mass accompanied by a solid mass in the middle and posterior fossa. A differential diagnosis regarding chordoma, chondrosarcoma, and other chondroid tumors based on radiologic information was inconclusive. The lesion was resected completely under a microscope using a combined pterional and subtemporal approach. The pathologic report confirmed the diagnosis of chondroma. No evidence of neurological worsening was observed. The tumor had a calcified mass with mature hyaline cartilage surrounded by a thick fibrous capsule. We dissected the periphery of the tumor mass and removed it via aspiration. It was readily distinguished from normal brain parenchymal tissue. The large calcified mass at the center of the tumor had relatively high vascularity, and a high-speed drill and various rongeurs were used to remove the tumor.