Epidemiological Profile of 96 Intracranial Tumors Treated in a Single Reference Center

Objectives The present study aims to categorize the prevalence of intracranial tumors surgically treated at the neurosurgery service of Hospital Universitário Evangélico Mackenzie (HUEM) between 2016 and 2018. Material and Methods This survey included patients surgically treated due to primary or metastatic intracranial neoplasia between 2016 and 2018 at a referral center in the city of Curitiba. These patients were analyzed for epidemiological, histopathological, and topographic data, and they underwent an assessment of the outcome at the time of hospital discharge. Results Atotal of 96patientsmet the inclusion criteria. Themost prevalent tumorwas the glioma, with 39.6% of the sample, with glioblastoma being themost prevalent histological type. Brainmetastases andmeningiomas represented, respectively, 21.9%and 18.8%of the total. There was a predominance of supratentorial and intra-axial tumors in our sample. Conclusion Glioma was the most commonly found tumor, directly associated with high morbidity and mortality. The development of new and more effective drugs with action directed at themolecular level of intracranial tumorsmay be the path to a longer survival and improvement in the quality of life of these patients.

Caracterización clínica, epidemiológica y anatomopatológica de los tumores cerebrales supratentoriales y su morbilidad posanestésica / Clinical, Epidemiological and Anatomopathological Characterization of Supratentorial Brain Tumor and its Post-Anesthetic Morbidity

Introducción: Los tumores cerebrales no son frecuentes, pero tienen efectos devastadores. Objetivo: Caracterizar según criterios clínicos y anatomopatológicos a los pacientes con tumor cerebral supratentorial. Métodos: Se realizó un estudio observacional y descriptivo de casos clínicos en el período de enero 2017 - enero 2019, en el Hospital Provincial Saturnino Lora de Santiago de Cuba. El universo estuvo constituido por la totalidad de los 117 pacientes a los que se les realizó una tomografía computarizada de cráneo y con diagnóstico histológico postoperatorio de neoplasia primaria del sistema nervioso central (supratentorial) y metástasis cerebral, a los que se les realizó neurocirugía transcraneal. Resultados: Predominó el sexo masculino y las edades entre 40 a 59 años, clínicamente la mayoría de los casos presentó cefalea como signo de hipertensión endocraneana 76,1 por ciento. El 87,2 por ciento presentó la tumoración en los hemisferios cerebrales. El glioblastoma multiforme fue el tipo histológico prevaleciente con 45,3 por ciento. La hipopotasemia fue la complicación post anestésica más frecuente (21,4 por ciento). Conclusiones: Los tumores cerebrales supratentoriales en la edad adulta constituyen un problema de salud, principalmente en los hombres después de los 45 años de edad; la cefalea, las convulsiones y los vómitos son los síntomas cardinales. Durante la excéresis de los tumores supratentoriales los pacientes presentaron diversas complicaciones anestésicas(AU)

Introduction: Brain tumors are not frequent, but they have devastating effects. Objective: To characterize patients with supratentorial brain tumor, according to clinical and pathological criteria. Methods: An observational and descriptive study of clinical cases was carried out, in the period from January 2017 to January 2019, at Saturnino Lora Provincial Hospital in Santiago de Cuba. The universe consisted of the 117 patients who underwent computed tomography of the skull and with a postoperative histological diagnosis of primary neoplasia of the central nervous system (supratentorial) and brain metastases, who underwent transcranial neurosurgery. Results: The male sex predominated, together with the ages 40-59 years old. Clinically, most of the cases (76.1 percent) presented headache as a sign of intracranial hypertension. 87.2 percent presented the tumor in the cerebral hemispheres. Glioblastoma multiforme was the prevalent histological type, accounting for 45.3 percent. Hypokalemia was the most frequent post-anesthetic complication, accounting for 21.4 percent. Conclusions: Supratentorial brain tumors in adulthood constitute a health concern, mainly in men after 45 years of age; headache, seizures and vomiting are the cardinal symptoms. During excision of supratentorial tumors, the patients presented various anesthetic complications(AU)

Advances in Radiomics of Cerebral Metastases / 中国医学科学院学报

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.

A Rare Case of Medulloblastoma with Supratentorial Metastasis Two Years after Treatment

One of the most invasive malignant tumors of the cerebellum is medulloblastoma, which is also the most common malignant tumor of the brain in children. Patients with a recurrent disease following initial treatment have the most unfavorable prognosis. The most common metastasis locations are the spine, the posterior fossa, the bones, and the supratentorium. Late medulloblastoma metastasis in the supratentorial intraventricular region is uncommon. We report here a case with supratentorial seeding.

A Case of Recurrent Supratentorial Extraventricular Anaplastic Ependymoma in Adult

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.

Magnetic Resonance Imaging Features of the Supratentorial Extra-axial Hemangioblastoma:A Case Report / 中国医学科学院学报

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.

Maintenance of balance between airway pressure and intracranial pressure in a patient with tracheal stenosis undergoing craniotomy: a case report / Manutenção do equilíbrio entre a pressão das vias aéreas e a pressão intracraniana em paciente com estenose traqueal submetido à craniotomia: relato de caso

Abstract Background and objectives: Tracheal stenosis is a rare but a life-threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure. Case report: We described a patient undergoing craniotomy with tracheal stenosis. Conclusion: Detailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain of a good balance between cerebral dynamics and airway dynamics were the pearls of this case.

Resumo Justificativa e objetivos: Estenose traqueal é uma doença rara, mas de risco, e a anestesia em paciente com estenose traqueal é um desafio para os anestesiologistas. Manter os parâmetros hemodinâmicos estáveis e a ventilação são questões importantes em neuroanestesia. Qualquer aumento da pressão de pico das vias aéreas e da ETCO2 resultará em aumento da pressão intracraniana, o que deve ser evitado durante craniotomias. A estenose traqueal pode ser uma razão para o aumento da pressão das vias aéreas. Relato de caso: Descrevemos o caso de um paciente submetido à craniotomia com estenose traqueal. Conclusão: A preparação detalhada para a intubação, estabilizar a dinâmica das vias aéreas e tomar a decisão certa para a cirurgia foram pontos importantes. Manter um bom equilíbrio entre a dinâmica cerebral e a dinâmica das vias aéreas foi a pérola deste caso.

Aggressive Supratentorial Ependymoma, RELA Fusion-Positive with Extracranial Metastasis: A Case Report

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.

Intraoperative Monitoring of Motor-Evoked Potentials for Supratentorial Tumor Surgery

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%) 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.

Vascular endothelial growth factor and KIT expression in relation with microvascular density and tumor grade in supratentorial astrocytic tumors

PURPOSE: To evaluate the relationship between microvascular density and the expression of vascular endothelial growth factor (VEGF) and KIT as possible markers of angiogenic stimulus in astrocytic tumors and correlate it with histopathological grading. METHODS: We enrolled 99 surgical specimens of supratentorial astrocytic tumors for analysis of VEGF and KIT and subsequent correlation with MVD and grading. RESULTS: KIT and VEGF expression correlated with microvascular density (p<0.005) and both VEGF and microvascular density correlated with grading (p<0.005). KIT had no significant relationship with grading (p=0.657). CONCLUSION: KIT and VEGF constitute important pathways in the angiogenesis of astrocytomas and therefore are promising prognostic tools and options for therapeutic intervention.

Metastatic brain tumors: a retrospective review in east Azarbyjan [Tabriz]

A set of one hundred and twenty nine patients with known primary malignancy and suspected brain metastasis was reviewed in present study. The patients were selected among patients presented to the MRI section of Imam Khomeini Hospital or a private MRI center in Tabriz [Iran]. Primary tumor site, clinical manifestations, number and site of lesions were identified in this patient population. The primary tumor site was breast in 55 patients [42.6%], followed by lung [40.3%], kidney [7.7%], colorectal [4.6%], lymphoma [3.1%] and melanoma [1.5%]. Most patients were presented with features of increased intracranial pressure [headaches and vomiting], seizures and focal neurologic signs. Single brain metastasis occurred in 16.3% of patients, while multiple lesions accounted for 83.7% of patients. Ninety seven patients had supratentorial metastases [75.2%]. Twenty cases [15.5%] had metastases in both compartments. Infratentorial lesions were observed only in twelve patients [9.3%]

Crossed Cerebellar Diaschisis in Complex Partial Status Epilepticus

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.

The application of electro-acupuncture combined with sevoflurane anesthesia in neurosurgery / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of electro-acupuncture combined with sevoflurane anesthesia used in neurosurgery patients and the speed of recovery following surgery.</p><p><b>METHODS</b>Eighty 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.</p><p><b>RESULTS</b>There 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.</p><p><b>CONCLUSIONS</b>Electro-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.</p>

Expression and significance of sonic hedgehog signaling pathway-related components in brainstem and supratentorial astrocytomas / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Studies 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.</p><p><b>METHODS</b>Real-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.</p><p><b>RESULTS</b>The 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).</p><p><b>CONCLUSIONS</b>Enhanced 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.</p>

Crossed Cerebellar Diaschisis in Complex Partial Status Epilepticus / 대한간질학회지

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.

Supratentorial Cortical Ependymoma in a 21-Month-Old Boy

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.

Intraoperative localization of intracranial cavernomas by real time 3D ultrasonography: first experiences

The aim of this preliminary study was the test the feasibility of intraoperative real time 3D ultrasonography [US] in the prediction of brain cavernomas localization. During a time period of May to August 2009, 7 consecutive patients with intracranial cavernomas [3 supratentorial, 4 brainstem], were operated with the support of intraoperative true real time 3D US [iU 22, Philips, USA]. The ultrasound images were achieved in 2 simultaneous orthogonal planes to find the exact site to corticotomy. Intraoperative true real time 3D US anatomically provided detailed information and good delineation of landmarks in 5 patients [all patients with supratentorial cavernomas and 2 patients with brainstem cavernomas] with a fair delineation in 2 patients with deep-seated brainstem cavernomas. Our primary experience regarding this new technology suggests that intraoperative true real time 3D US is useful to localize cerebral cavernomas and less useful in localization of deep-seated brainstem cavernomas