Current researches of the role of dural immunity in neuroinfectious and neuroimmune diseases / 中华神经科杂志

Dura mater, rich in vasculature and immune cells, is the outermost layer of the central nervous system, and thus acts as the first barrier to protect brain. Meningeal lymphatic vessels and immune cells are main components of dural immunity, which respond to a variety of central nervous system diseases. Meanwhile, compared with brain parenchyma, dura mater communicates more with peripheral tissues and is more susceptible to medical interventions. Therefore, dura mater is a promising target to prevent, diagnose and treat intracranial diseases. Here dural immunity is clarified based on meningeal lymphatic vessels and dural immune cells, and current researches inquiring the role of dural immunity in infectious and immune diseases of central nervous system are summarized.

Diagnosis of a case of leptomeningeal metastasis from endometrial carcinoma by next-generation sequencing and cerebrospinal fluid cytology / 中华神经科杂志

Endometrial carcinoma is one of common malignant tumors in female reproductive system, but it is extremely rare in leptomeningeal metastasis. The clinical manifestations and signs of meningeal carcinomatosis are complex and not specific. It is difficult to get a precise diagnosis early, and it has high rate of misdiagnosis and missed diagnosis. Accurate diagnosis and treatment of a case of leptomeningeal metastasis from endometrial carcinoma by next-generation sequencing and cerebrospinal fluid cytology are reported. The patient is an elderly female with a history of endometrial cancer. The main manifestations were fever, headache and dizziness; cerebrospinal fluid cytology showed tumor cells; AKT1 gene and TP53 gene were detected in endometrial carcinoma tissue, plasma and cerebrospinal fluid by next-generation sequencing. After treatment with intrathecal chemotherapy, immunotherapy combined with anti angiogenesis, the patient′s condition still progressed gradually and died finally. The purpose of this case report is to raise clinical awareness of recognition and treatment in early meningeal metastasis of endometrial carcinoma.

Hypertrophic pachymeningitis, IgG4-related disease: case report / Paquimeningite hipertrófica, doença relacionada com a IgG4: relato de caso

ABSTRACT The IgG4-related disease (IgG4-RD) is a systemic disease recently characterized as an inflammatory condition generally related to the increase in serum IgG4 levels, a subclass of immunoglobulins (IgG) which corresponds to less than 6% of the total serum IgG, with singular histopathological features. The involvement of the central nervous system is rare and may be isolated or associated with other organs, mimicking tumors. Commonly, it involves the hypophysis, presenting hypophysitis as the main manifestation, but it can also affect the dura mater, presenting as IgG4-related hypertrophic pachymeningitis (IgG4-RHP). Neurological manifestations occur as a result of mass effect, typically due to vascular or nervous structures compression, resulting in functional deficits according to the anatomical site of the lesion. The main histopathological features are dense lymphoplasmacytic infiltrate, fibrosis arranged, at least focally, in a storiform pattern, and obliterative phlebitis, associated with increased numbers of IgG4+ plasma cells or an increased IgG4/IgG ratio in tissue. In this disease, the serum IgG4 levels are usually increased. The objective of this article is to report the case of a 37-year-old male patient who presented a pulsatile headache associated with diplopia and blurred vision. After radiological, histopathological and immunohistochemical studies, the diagnosis of IgG4-RHP was confirmed, besides presenting a literature review about IgG4-RD and IgG4-RHP.

RESUMEN La enfermedad relacionada con inmunoglobulina G4 (ER-IgG4) es una enfermedad sistémica recientemente caracterizada como condición inflamatoria que se relaciona con el aumento sérico de IgG4, una subclase de inmunoglobulinas (IgG) que incluye menos de 6% del total de IgG séricas, con características histopatológicas propias. El acometimiento del sistema nervioso central (SNC) es raro y puede ser aislado o asociado a otros órganos; es muy confundido con tumores. Es más común en la hipófisis, siendo la hipofisitis su principal manifestación, pero puede acometer también la duramadre, manifestándose como paquimeningitis hipertrófica relacionada con IgG4 (PHR-IgG4). Las presentaciones neurológicas se atribuyen al efecto de masa, tipicamente por compresión de estructuras vasculares o nerviosas, produciendo déficits funcionales según la ubicación anatómica de la lesión. Los hallazgos histológicos más comunes son infiltrado linfoplasmocítico denso, fibrosis (disposta, por lo menos focalmente, en un patrón estoriforme) y flebitis obliterante, además de elevación del número de células plasmáticas IgG4+ o de la proporción IgG4/IgG en el tejido. En esa enfermedad, los niveles séricos de IgG suelen estar elevados. El objetivo de este trabajo es reportar el caso de un paciente masculino con cuadro de cefalea pulsátil asociada a diplopía y visión borrosa. Luego de estudio radiológico, histopatológico y inmunohistoquímico, se obtuvo el diagnóstico de PHR-IgG4. Aún presentamos una revisión de literatura sobre la ER-IgG4 y la PHR-IgG4.

RESUMO A doença relacionada com a imunoglobulina G4 (DRIgG4) é uma enfermidade sistêmica recentemente caracterizada como condição inflamatória que se relaciona com o aumento sérico de IgG4, uma subclasse de imunoglobulinas (IgG) que compreende menos de 6% do total de IgG séricas, com características histopatológicas singulares. O acometimento do sistema nervoso central (SNC) é raro e pode ser isolado ou associado a outros órgãos; é muito confundido com tumores. É mais comum na hipófise, sendo a hipofisite sua principal manifestação, mas pode acometer também a dura-máter, manifestando-se como paquimeningite hipertrófica associada à IgG4 (PH-DRIgG4). As apresentações neurológicas são creditadas ao efeito de massa, tipicamente por compressão de estruturas vasculares ou nervosas, propiciando déficits funcionais de acordo com o sítio anatômico da lesão. Os achados histológicos mais comuns são infiltrado linfoplasmocitário denso, fibrose (em arranjo, pelo menos focalmente, de padrão estoriforme), e flebite obliterativa, além de elevação do número de plasmócitos IgG4+ ou da razão IgG4/IgG no tecido. Nessa doença, os níveis séricos de IgG4 geralmente estão elevados. O objetivo deste artigo é relatar o caso de um paciente do sexo masculino com quadro de cefaleia pulsátil associada à diplopia e turvação visual. Após estudo radiológico, histopatológico e imuno-histoquímico, foi obtido o diagnóstico de PH-DRIgG4. Apresentamos, ainda, uma revisão de literatura sobre DRIgG4 e PH-DRIgG4

Factores de riesgo asociados a la meningitis eosinofílica causada por Angiostrongylus cantonensis (Nematoda: Metastrongylidae) en Chone, Ecuador / Risk factors associated to eosinophilic meningitis caused by Angiostrongylus cantonensis (Nematoda: Metastrongylidae) in Chone, Ecuador

Introducción: El parásito Angiostrongylus cantonensis es el principal causante de meningitis eosinofílica. En el 2008 se reportó el primer caso en Ecuador y un estudio reciente en la Ciudad de Chone, Manabí, Ecuador determinó una alta prevalencia del parásito en el caracol africano (Achatina fulica). Objetivo: Identificar los factores de riesgo asociados a la meningitis eosinofílica causada por A. cantonensis en la ciudad de Chone. Métodos: Se entrevistaron a 500 personas residentes en la ciudad de Chone y se revisaron las historias clínicas del Hospital General de Chone. Resultados: Se observó que la población de Chone, está expuesta a los siguientes factores de riesgos: consumo de caracoles crudos (7,40 por ciento), el frecuente contacto de las personas con el caracol africano en la casa (67 por ciento), como en el trabajo (51,20 por ciento), el contacto que tienen los niños con caracoles, al jugar en el jardín (76,80 por ciento) y la incorrecta limpieza de los alimentos (54,40 por ciento). En el entorno de la población, se evidenció la presencia del caracol africano cerca de las casas en el 35,20 por ciento y las ratas, en el 50,80 por ciento. Además, el 34 por ciento de la muestra de estudio presentó sintomatología relacionada con meningitis eosinofílica. Se encontró que existía asociación entre la presencia de vectores cerca de las casas y la cantidad de síntomas manifestados por las personas. Conclusiones: Se evidenció que la población de Chone, manifiesta hábitos que exponen a la gente de esta localidad a un alto riesgo de contagio de meningitis eosinofílica(AU)

Introduction: The parasite Angiostrongylus cantonensis is the main causative agent of eosinophilic meningitis. The first case in Ecuador was reported in 2008, and a recent study conducted in the city of Chone, Manabí, Ecuador, determined a high prevalence of the parasite in the African snail (Achatina fulica). Objective: Identify the risk factors associated to eosinophilic meningitis caused by A. cantonensis in the city of Chone. Methods: Interviews were conducted with 500 residents from the city of Chone and a review was carried out of the medical records at Chone General Hospital. Results: It was found that the population of Chone is exposed to the following risk factors: eating raw snails (7.40 percent), frequent contact between people and African snails both at home (67 percent) and at work (51.20 percent), contact between children and snails while playing in gardens (76.80 percent) and washing food items incorrectly (54.40 percent). In the areas surrounding people's households the African snail was found in 35.20 percent and rats in 50.80 percent . Additionally, 34 percent of the study sample had symptoms of eosinophilic meningitis. An association was found between the presence of vectors near the houses and the number of symptoms occurring in people. Conclusions: It was evident that the population of Chone has habits which expose them to a high risk for eosinophilic meningitis(AU)

Partial duplication of tentorium cerebelli and complete duplication of falx cerebelli / 대한해부학회지

Variations of the dural folds and the dural venous sinuses are infrequently reported in the existing medical literature. Such variations in the posterior cranial fossa may pose difficulties in various analytical and surgical procedures of this region. We present a rare concurrent variation of the falx cerebelli and tentorium cerebelli that was detected during routine dissection of an adult male cadaver. While removing the brain, a partial duplication of tentorium cerebelli was observed below the left half of the tentorium cerebelli and above the left cerebellar hemisphere. This fold did not have any dural venous sinus in it. Further, a complete duplication of falx cerebelli with a single occipital venous sinus within its attached border was also observed. We present the review of literature and discuss the comparative anatomy of this case.

A comprehensive review of the sinuvertebral nerve with clinical applications / 대한해부학회지

The anatomy and clinical significance of the sinuvertebral nerve is a topic of considerable interest among anatomists and clinicians, particularly its role in discogenic pain. It has required decades of research to appreciate its role, but not until recently could these studies be compiled to establish a more complete description of its clinical significance. The sinuvertebral nerve is a recurrent nerve that originates from the ventral ramus, re-entering the spinal canal via the intervertebral foramina to innervate multiple meningeal and non-meningeal structures. Its complex anatomy and relationship to discogenic pain have warranted great interest among clinical anatomists owing to its sympathetic contribution to the lumbar spine. Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.

Isolated cortical venous thrombosis: analysis of three cases and literature review / 中华神经科杂志

Objective@#Isolated cortical venous thrombosis (ICoVT) has a low incidence and is easily to be misdiagnosed. The clinical characteristics, diagnosis and treatment of three cases of ICoVT were analyzed in order to improve the level of diagnosis and treatment.@*Methods@#The clinical manifestations, examination, imaging and pathological features of three patients with ICoVT admitted to our hospital were retrospectively analyzed.@*Results@#All the three patients had acute onset. The main symptoms were headache, seizures, numbness of one limb and mental disorders. Intracranial pressure was normal. Brain magnetic resonance imaging (MRI) showed abnormal signals located in cortical sulcus and subcortex. Point and linear hypointensity could be seen on T2* or susceptibility weighted imaging (SWI) -weighted image. Digital subtraction angiography was performed in one case, showing occlusion of cortical veins. Protein S decreased in two patients, two patients with hyperhomocysteinemia and one patient with antiphospholipid antibody syndrome. The clinical and imaging manifestations of three patients were spontaneously alleviated. Brain biopsy was performed in two patients, and meningeal biopsy was performed in one patient due to significant meningeal thickening.@*Conclusions@#The clinical manifestations and routine MRI of ICoVT lack specificity and are easy to be misdiagnosed. However, ICoVT patients are often associated with risk factors for thrombophilia. T2* or SWI sequences are sensitive to the diagnosis of ICoVT. Brain biopsy has implications for the diagnosis and it is helpful for differential diagnosis, but the indications should be strictly controlled.

Isolated cortical venous thrombosis: analysis of three cases and literature review / 中华神经科杂志

Objective Isolated cortical venous thrombosis (ICoVT) has a low incidence and is easily to be misdiagnosed. The clinical characteristics, diagnosis and treatment of three cases of ICoVT were analyzed in order to improve the level of diagnosis and treatment. Methods The clinical manifestations, examination, imaging and pathological features of three patients with ICoVT admitted to our hospital were retrospectively analyzed. Results All the three patients had acute onset. The main symptoms were headache, seizures, numbness of one limb and mental disorders. Intracranial pressure was normal. Brain magnetic resonance imaging (MRI) showed abnormal signals located in cortical sulcus and subcortex. Point and linear hypointensity could be seen on T2* or susceptibility weighted imaging (SWI)?weighted image. Digital subtraction angiography was performed in one case, showing occlusion of cortical veins. Protein S decreased in two patients, two patients with hyperhomocysteinemia and one patient with antiphospholipid antibody syndrome. The clinical and imaging manifestations of three patients were spontaneously alleviated. Brain biopsy was performed in two patients, and meningeal biopsy was performed in one patient due to significant meningeal thickening. Conclusions The clinical manifestations and routine MRI of ICoVT lack specificity and are easy to be misdiagnosed. However, ICoVT patients are often associated with risk factors for thrombophilia. T2* or SWI sequences are sensitive to the diagnosis of ICoVT. Brain biopsy has implications for the diagnosis and it is helpful for differential diagnosis, but the indications should be strictly controlled.

Magnetic resonance imaging findings in central nervous system cryptococcosis: comparison between immunocompetent and immunocompromised patients / Achados de ressonância magnética em criptococose do sistema nervoso central: comparação entre pacientes imunocompetentes e imunossuprimidos

Abstract Objective: To assess the magnetic resonance imaging (MRI) patterns associated with central nervous system infection with Cryptococcus sp. in relation to patient immune status. Materials and Methods: This was a retrospective study of MRI data for 19 patients with neurocryptococcosis who underwent the examination between January 2000 and March 2014. The MRI characteristics examined included lesion topography, aspects of diffusion, T1-weighted images, T2-weighted images, and contrast enhancement patterns. Results: In all cases, cryptococcal infection was confirmed by cerebrospinal fluid analysis. Of the 19 patients, 10 were immunocompromised and 9 were immunocompetent. Abnormal imaging patterns occurred alone or in conjunction with other manifestations. The imaging patterns found in immunocompromised patients included the following: leptomeningeal enhancement, in 6; pachymeningeal enhancement, in 3 (due to intracranial hypotension in 2); perivascular space involvement, in 4; granulomas, in 2; hydrocephalus, in 2; miliary nodules, in 1; and plexitis, in 1. In immunocompetent patients, the following imaging patterns were observed: leptomeningeal enhancement, in 5; perivascular space involvement, in 3; granulomas, in 3; cryptococcoma, in 1; ventriculitis, in 1; and hydrocephalus, in 1. In 2 immunocompetent patients, diffusion-weighted imaging showed diffusion restriction in cerebral cryptococcal granuloma. Conclusion: In both groups, the most common imaging finding was leptomeningeal enhancement, followed by dilatation of perivascular spaces with the presence of mucoid material. Rare presentations, such as miliary nodules, plexitis, ventriculitis, and pachymeningeal enhancement, were also observed. None of the imaging patterns common to immunocompetent and immunocompromised patients differed significantly in frequency between them.

Resumo Objetivo: Avaliar os padrões de ressonância magnética (RM) associados à infecção do sistema nervoso central por Cryptococcus sp. em relação ao status imunológico dos pacientes. Materiais e Métodos: Dados de RM de 19 casos de neurocriptococose foram analisados retrospectivamente de janeiro de 2000 a março de 2014. As características de RM examinadas incluíram: sítio da lesão, aspectos em difusão, imagens ponderadas em T1 e T2 e padrões de realce pelo contraste. Resultados: A infecção por Cryptococcus sp. foi confirmada pela análise do liquor em todos os casos. Dos 19 pacientes, 10 eram imunossuprimidos e 9 eram imunocompetentes. Os padrões de imagem anormais ocorreram isoladamente ou em associação com outras manifestações. Os padrões de imagem encontrados nos pacientes imunossuprimidos incluíram: realce leptomeníngeo (n = 6), realce paquimeníngeo (n = 3; 2 devidos a hipotensão intracraniana), envolvimento do espaço perivascular (n = 4), granulomas (n = 2), hidrocefalia (n = 2), nódulos miliares (n = 1) e plexite (n = 1). Em pacientes imunocompetentes, os padrões de imagem incluíram: realce leptomeníngeo (n = 5), envolvimento do espaço perivascular (n = 3), granulomas (n = 3), criptococoma (n = 1), ventriculite (n = 1) e hidrocefalia (n = 1). As sequências ponderadas em difusão mostraram restrição em 2 pacientes imunocompetentes com granulomas intracerebrais por criptococose. Conclusão: O achado mais comum de imagem em ambos os grupos foi realce leptomeníngeo, seguido de dilatação dos espaços perivasculares pela presença do material mucoide. Apresentações raras como nódulos miliares, plexite, ventriculite e realce paquimeníngeo foram também observadas. Nenhum dos padrões de imagem comuns aos pacientes imunocompetentes e imunossuprimidos diferiu significativamente em frequência entre eles.

Excitatory toxicity of glutamate on meningothelial cells of optic nerve sheaths and its oxidative stress mechanism / 中华实验眼科杂志

Background Meningothelial cells (MECs) occupy the predominant cell component of barrier between optic nerve and the cerebral spinal fluid,and any change of cerebral fluid components probably affects the MECs function and further impairs the optic nerve.Objective This study was designed to investigate the influence of glutamate,a potentially excitotoxic amino acid,to the functional changes of MECs and provide a theoretical evidence for clarifying the mechanism of optic nerve disorders.Methods Human MECs strains were cultured in vitro and prepared into cell suspension.The cells were inoculated to 96-well plates with the densities of 1 × 104/we11.The glutamate of 100,200,400,600,800 and 1 000 μmol/L was added into medium for 12,24,36,48 and 72 hours,respectively,and the cultured cells without glutamate were used as normal control group.MTS assay was employed to measure the proliferative rate (absorbency) of the cells.The regularly cultured MECs were divided into 600 μmol/L glutamate-treated group and normal control group and the cells were treated for 12 and 24 hours respectively,and the expression of superoxide dismutase (SOD) mRNA and heat shock protein 90 (HSP90) mRNA in the cells was detected by real-time PCR;the level of total anti-oxidative capacity (T-AOC) of the cells was processed by enzyme linked immunosorbent assay (ELISA),and the reactive oxygen species (ROS) production was determined by DCFH-DA probe.Results Cultured MECs grew well and formed 80％ confluence after 72 hours culture.The proliferative rate of the cells were gradually decreased with the increase of glutamate dose and the lapse of affected time,with significant differences among different concentrations of glutamate and various time points (F tration =52.501,P＜0.001;Ftime =8.505,P＜0.001).The relative expression level of SOD mRNA was significantly reduced in the glutamate-treated group compared with the normal control group in both 24 hours and 48 hours after culture (t =20.278,t =16.724,both at P＜0.001),and the expression of HSP90 mRNA in the cells was significantly lower in the glutamate-treated group than that in the normal control group in 24 hours after culture (t =5.065,P =0.002).No significant difference was found in T-AOC activity between glutamate-treated group and normal control group in 24 hours after culture ([30.835±2.094] nmol/(min · L) vs.[32.873±2.317] nmol/(min · L)) (t=1.599,P =1.414).In 48 hours after culture,T-AOC activity was (29.561 ± 1.831) nmol/(min · L) in the glutamate-treated group,which was significantly lower in comparison with normal control group (33.680±2.039) nmol/(min · L)(t =3.682,P =0.004).Fluorescence staining showed that the intensity of green fluorescence of ROS in MECs in the normal control group was weaker than that in the glutamate-treated group under the immunofluorescense microscope.The ROS level was 48.110± 1.712 and 40.982± 1.853 at 24 hours and 48 hours in the glutamate-treated cells,and which was significantly elevated in comparison with 36.608± 1.009 and 37.153 ± 1.424 in the normal control group (t=14.178,P＜0.001;t=4.012,P=0.002).Conclusions Glutamate inhibits the proliferation of MECs in vitro,and excitatory toxicity of glutamate on MECs probably is associated with oxidative stress response.

Caracterización del realce meníngeo intracraneal / Intracranial Meningeal Enhancement Characterization

Objetivo: Describir las características del realce meníngeo intracraneal (RMI) como hallazgo en resonancia magnética y su comportamiento según las diferentes patologías asociadas descritas en la literatura científica. Materiales y métodos: Estudio descriptivo de corte transversal realizado con información recolectada de 89 estudios, entre enero y diciembre de 2011, en los cuales se encontró realce meníngeo como hallazgo positivo en la lectura original. Cada estudio fue sometido a nueva revisión por un neurorradiólogo para la caracterización morfológica del realce meníngeo. Resultados: Las causas más frecuentes de RMI fueron enfermedad metastásica (21,3 %), etiología infecciosa (21,3 %), antecedente de cirugía intracraneal (20,2 %) y neoplasias primarias (13,5 %). Del total de las infecciones del sistema nervioso central (19 casos) se documentó infección por VIH en 12 pacientes (70,6 %). El paciente con antecedente quirúrgico de mayor antigüedad fue sometido a craneotomía 17 años antes de la toma de la resonancia magnética incluida en el estudio, en la cual persiste el realce aunque no se han definido signos de recidiva por imagen o por clínica hasta 2015. El tipo de realce más frecuente fue el leptomeníngeo (46,1 %), seguido del mixto (43,8 %) y el paquimeníngeo (10,1 %). En el subgrupo de realce leptomeníngeo, las etiologías más frecuentes fueron infecciosa (31,7 %), enfermedad metastásica (19,5 %) y neoplasias primarias (17,1 %), persistiendo esta tendencia en el subgrupo de realce paquimeníngeo. En el subgrupo de realce mixto, la etiología posquirúrgica fue la primera causa (35,9 %), seguida de la enfermedad metastásica (23,1 %) y las infecciones (18 %). En los casos de etiología infecciosa se encontró un predominio del patrón de realce leptomeníngeo, nodular y difuso, sin realce paquimeníngeo, como único tipo de realce. Conclusión: Aunque un patrón de realce meníngeo determinado no es indicativo de una patología específica, el estudio detallado de sus características puede aportar información que permite plantear grupos diagnósticos, particularmente en casos de etiología neoplásica o infecciosa, aporte de relevancia en casos en que el realce meníngeo anormal es la única alteración evidente en una resonancia magnética.

Objective: To describe the characteristics of intracranial meningeal enhancement (IME) as magnetic resonance imaging findings and their behavior under different associated conditions as described in the scientific literature. Materials and methods: Descriptive cross-sectional study with data collected from the images archive between January and December of 2011, obtaining 89 eligible studies in which it was determined, in the original reading, presence of IME as positive finding. Each study was subjected to further review by a neuroradiologist of the institution for morphological characterization of the IME. Results: The most common causes of IME were: metastatic disease (21.3%), infectious etiology (21.3%), history of intracranial surgery (20.2%) and primary neoplasms (13.5%). Of total CNS infections (19 cases), HIV infection was documented in 12 patients (70.6%). The patient with the oldest surgical history underwent craniotomy 17 years before performing the MRI included in the study, with persistance of IME with no signs of recurrence defined by image or clinical manifestations up to 2015. The most frequent IME type was leptomeningeal (LME) (46.1%), followed by mixed (MME) (43.8%) and pachymeningeal (PME) (10.1%) enhancements. In the subgroup of LME, the most common etiologies were: infectious (31.7%), metastatic disease (19.5%) and primary neoplasms (17.1%). This trend persisted in the subgroup of PME. In the subgroup of MME, post-surgical etiology was the leading cause (35.9%), followed by metastatic disease (23.1%) and infections etiologies (18%). Conclusion: Although a particular pattern of meningeal enhancement is not indicative of a specific pathology, detailed study of its features can provide information that allow the proposal of diagnostic groups, particularly in cases of neoplastic or infectious etiology, relevant contribution in cases where the abnormal meningeal enhancement is the only anormality in MRI.

The impact of radiotherapy on clinical outcomes in parameningeal rhabdomyosarcoma

PURPOSE: Radiotherapy (RT) is considered a mainstay of treatment in parameningeal rhabdomyosarcoma (PM-RMS). We aim to determine the treatment outcomes and prognostic factors for PM-RMS patients who treated with RT. In addition, we tried to evaluate the adequate dose and timing of RT. MATERIALS AND METHODS: Twenty-two patients with PM-RMS from 1995 to 2013 were evaluated. Seven patients had intracranial extension (ICE) and 17 patients had skull base bony erosion (SBBE). Five patients showed distant metastases at the time of diagnosis. All patients underwent chemotherapy and RT. The median radiation dose was 50.4 Gy (range, 40.0 to 56.0 Gy). RESULTS: The median follow-up was 28.7 months. Twelve patients (54.5%) experienced failure after treatment; 4 local, 2 regional, and 6 distant failures. The 5-year local control (LC) and overall survival (OS) were 77.7% and 38.5%, respectively. The 5-year OS rate was 50.8% for patients without distant metastases and 0% for patients with metastases (p 22 weeks) of RT was related to a higher rate of local failure (40.0%). CONCLUSION: RT resulted in a higher rate of local control in PM-RMS. However, it was not extended to survival outcome. A more effective treatment for PM-RMS is warranted.

Histological analysis of the repair of dural lesions with silicone mesh in rats subjected to experimental lesions / Análise histológica do reparo de lesões da dura com tela de silicone em ratos submetidos à lesão experimental

ABSTRACT Objective To evaluate inflammatory reaction, fibrosis and neovascularization in dural repairs in Wistar rats using four techniques: simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Methods Thirty Wistar rats were randomized in five groups: the first was the control group, submitted to dural tear only. The others underwent durotomy and simple suture, bovine collagen membrane, silicon mesh and silicon mesh with suture. Animals were euthanized and the spine was submitted to histological evaluation with a score system (ranging from zero to 3) for inflammation, neovascularization and fibrosis. Results Fibrosis was significantly different between simple suture and silicon mesh (p=0.005) and between simple suture and mesh with suture (p=0.015), showing that fibrosis is more intense when a foreign body is used in the repair. Bovine membrane was significantly different from mesh plus suture (p=0.011) regarding vascularization. Inflammation was significantly different between simple suture and bovine collagen membrane. Conclusion Silicon mesh, compared to other commercial products available, is a possible alternative for dural repair. More studies are necessary to confirm these findings.

RESUMO Objetivo : Avaliar reação inflamatória, fibrose e neovascularização da reparação da lesão dural em ratos Wistar, comparando quatro diferentes técnicas: pontos simples, membrana de colágeno bovino, tela de silicone e tela de silicone associada a pontos simples. Métodos : Trinta ratos Wistar foram randomizados em cinco grupos: o primeiro foi um grupo controle, submetido somente à durotomia. Os outros também foram submetidos à durotomia, porém sofreram sutura simples, reparo com membrana de colágeno bovino, tela de silicone e tela de silicone com sutura. Os animais foram sacrificados, e a coluna foi submetida à avaliação histológica com um escore (variando de zero a 3) para inflamação, neovascularização e fibrose. Resultados : A fibrose foi significativamente diferente, comparando-se sutura simples e tela de silicone (p=0,005) e sutura simples e tela com fio de sutura (p=0,015), demonstrando que a fibrose foi mais intensa quando um corpo estranho foi utilizado na reparação. Membrana bovina foi significativamente diferente da tela mais sutura (p=0,011) em relação à vascularização. A inflamação foi significativamente diferente entre os grupos submetidos à sutura simples e ao reparo com membrana de colágeno bovino. Conclusão : A tela de silicone, comparada com produtos similares com disponibilidade comercial, é uma possível alternativa como protetor de dura-máter. Mais estudos são necessários para comprovar esses resultados.

Linfoma leptomeníngeo primario. Reporte de tres casos y revisión de la literatura / Primary leptomeningeal lymphoma. Report of three cases and review of the literature

El linfoma leptomeníngeo primario (LLMP) es una entidad con baja frecuencia de presentación, representa del 1% al 2,4% de los linfomas primarios del sistema nervioso central; las variedades histológica más observadas son el linfoma de la zona marginal tipo MALT, el linfoma B de célula grande difuso y el linfoma linfoblástico de células B. La localización y su extensión determinan las manifestaciones clínicas; en radiología se prefieren las imágenes con medios de contraste, ya que tienden a confundirse con meningiomas como la primera impresión diagnóstica y son la cirugía y los estudios de patología los que confirman el diagnóstico. La quimioterapia es la base del tratamiento en esta entidad, la radioterapia se deja como una opción secundaria. El propósito de este trabajo es presentar tres casos clínicos representativos de LLMP y las variantes por imágenes de radiología, la revisión enfocada de la literatura y el tratamiento de esta infrecuente patología.

Primary Leptomeningeal lymphmoma (PLML) is a low frequency neoplasm representing 1% to 2,4% of primary lymphomas of the central nervous system (CNS). The most frequent histological variety is the extranodal marginal zone lymphoma (MALT lymphoma), but other variants are reported such as diffuse large cell B-cell lymphoma (DLBCL). The location and extent determine the clinical manifestations. In radiology, images with contrast are preferred to difference from meningiomas which are the main differential diagnosis; nevertheless surgery and histology confirm the diagnosis. Chemotherapy is the mainstay of treatment and radiation therapy is a secondary alternative. The purpose of this paper is to present three cases of PML, the radiological variants and to conduct a focused literature review with treatment of this pathology.

A novel methodology to concentrate and quantify malignant cells in CSF from lung cancer patients with leptomeningeal metastasis / 天津医药

Objective To assess the value of tumor marker immunostaining-FISH (TM-iFISH) technology on concen?trating and enumeration of tumor cells in CSF of lung cancer patients with leptomeningeal metastasis(LM). Methods Six cases of non-small cell lung cancer with leptomeningeal metastasis, which were diagnosed by CSF cytology or enhanced MRI scan, were selected. A total of 20 mL of CSF was collected in each case. TM-iFISH technology was employed to concen?trate and quantify circulating tumor cells in 7.5 mL CSF samples in each case while CSF cytology used 10 mL CSF samples in each case;Finally, the rest 2.5 mL CSF in each case was used for biochemistry assay. Results Ten CSF samples from 6 patients with non-small lung cancer with LM were assayed and tumor cells numbers ranging between 3 and 1 823 every 7.5 mL were found in 7 samples. On the other hand, CSF cytology examination only revealed tumor cells in 3 cases. Using CSF biochemical assay, higher than normal of protein level was found in 9 cases. TM-iFISH technology was employed again in 3 cases of patients who received treatment. Tumor cell count in CSF reduced in 2 out of the 3 cases. Conclusion TM-iFISH technology is a new method for detection and enumeration of tumor cells in the CSF in non-small cell lung cancer patients with leptomeningeal metastasis. This technology present diagnosis and curative values in lung cancer patients with leptomen?ingeal metastasis.

Neuronal differentiation of cell subsets with stem cell characteristics in adult rat meningeal tissues / 中国组织工程研究

BACKGROUND:Neural stem cels have the potential to differentiate into neurons and glial cels to replace the injured brain cels, so as to achieve the purpose of repairing nerve injury. OBJECTIVE:To observe the neuronal differentiation ability of cel subsets with stem cel characteristics in the adult rat meningeal tissues. METHODS:Under anesthesia, the meningeal tissues were obtained from adult Sprague-Dawley rats to make cel suspension folowed by inoculation and subculture. Then, the Nestin immunofluorescence staining was performed. The third generation cels were culturedin vitro with complete culture medium containing trichostatin A. After 7 days of induction, western blot assay was used to detect the expression of NF-200 and BM88 proteins in neural cels. RESULTS AND CONCLUSION: At 24 hours of culture, some spherical cels were suspended and some cels adherent. In addition, some spherical cels scattered gradualy formed the clone spheres, and the growth rate decreased with the increasing volume. The positive expression of Nestin was detected by immunocytochemistry staining, and the cel nucleus was stained blue by Hoechst staining. BM88 and NF-200 proteins were al expressed at 7 days of neural induction. These findings indicate that the cel subsets with stem cel characteristics in the adult rat meningeal tissues can differentiate into neurons after in vitro induction.

Safety and validity of a new-type biological dura patch / 中国组织工程研究

BACKGROUND:Dural repair materials in current application mainly include autologous tissue repair material, alograft material, heterogeneous biological material and synthetic material, most of which are imported products with expensive price. OBJECTIVE: To evaluate safety and efficacy of a new biological type dura mater patch made in China based on animal experiments. METHODS:Bilateral dura mater defect models were established in 24 healthy domestic dogs: on the left side of the implant model, a new type biological dura patch was transplanted as experimental group; on the right side, another brand artificial dura patch that was on sale was transplanted as control group. After 1, 3, 6 and 12 months of implantation, we compared degradation, angiogenesis, growth and surrounding tissue reaction of dural substitutes of the experimental group and control group by hematoxylin-eosin staining, detected residual dose of epoxy-cross-linked agent in dogs’ blood and cerebrospinal fluid by fluorescence spectrophotometry. RESULTS AND CONCLUSION: During 1-12 months of implantation, al dogs grew wel and no infection or motor disorder was observed. Pathological examination showed that dura substitutes of the experimental group and control group had good biocompatibility, no or slightly inflammatory response. After 6 months of implantation, the surface of the new biological dural substitute (experimental group) was degraded and became a transit-state biomaterial with surrounding tissue, but the control group materials showed no degradation. After 12 months of implantation, the dura patch in the experimental group degraded nearly 50%, which appeared with neovascularization; while, the dura patch in the control group degraded 30%, and neovascularization was observed in only a smal amount of samples. Epoxy compounds of cross-linked agent were not detected in dogs’ blood and cerebrospinal fluid after 1, 3, 7 and 14 postoperative days. These findings show that this new type of biological dural substitute is a safe and effective dural repair material.

Spinal Meningeal Melanocytoma with Benign Histology Showing Leptomeningeal Spread: Case Report

Meningeal melanocytoma is a rare benign tumor with relatively good prognosis. However, local aggressive behavior of meningeal melanocytoma has been reported, especially in cases of incomplete surgical resection. Malignant transformation was raised as possible cause by prior reports to explain this phenomenon. We present an unusual case of meningeal melanocytoma associated with histologically benign leptomeningeal spread and its subsequent aggressive clinical course, and describe its radiological findings.

Multiple spinal extradural cysts causing progressive paraparesia: case report and review of literature / Cistos espinhais extradurais múltiplos causando paraparesia progressiva: relato de caso e revisão da literatura

Multiple meningeal extradural cysts are extremely rare. The clinical presentation varies from asymptomatic patients to important symptoms due to spinal cord compression. This article reports the case of a girl with multiple meningeal extradural cysts with progressive paraparesis and hypoesthesia on inferior limbs. The MRI showed multiple extradural cysts between C7 and L1. A partial resection was made at the cystis, reflecting a improve at the postoperative follow up of the patient. The management of asymptomatic cases is usually followed up clinical and radiologically. At the management of the symptomatic cases, the resection of the cysts is the most indicated treatment, even for patients with a long-standing history of compression. However the partial removal has as good results as the total one. The authors review the literature and show a subtotal resection of the cysts did not change the evolution of the presentation.

Cistos espinhais extradurais meníngeos múltiplos são extremamente raros. A apresentação clínica varia de pacientes assintomáticos a sintomas importantes devidos à compressão da medula espinhal. Este artigo relata o caso de uma garota com cistos extradurais meníngeos múltiplos com paraparesia progressiva e hipoestesia de membros inferiores. A ressonância magnética mostrou cistos extradurais múltiplos entres C7 e L1. Uma ressecção parcial foi realizada nos cistos, levando à melhora no seguimento pós-operatório da paciente. O tratamento de casos assintomáticos, geralmente, se resume a seguimento clínico e radiológico. Em casos sintomáticos, a ressecção dos cistos é o tratamento mais indicado, mesmo para pacientes com longa história de compressão. Entretanto, a remoção parcial costuma ter bons resultados, semelhante à ressecção total. Os autores revisam a literatura e detalham que uma ressecção parcial dos cistos não mudou o prognóstico da paciente.

Research progress on leptomeningeal metastases of solid carcinoma / 肿瘤研究与临床

Leptomeningeal metastasis (LM),with a high omission rate in diagnosis in approximately 5 ％～8 ％ of all patients, is increasingly recognized as a lethality complication. The diagnosis of LM remains challenges,but commonly can be established by CSF cytology or by definitive neuroimaging. Although a combination of focal radiotherapy,intrathecal chemotherapy,and systemic chemotherapy may be necessary to achieve optimal treatment of patients, but prognosis is unacceptable and therapy remains palliative in most patients.