Cirugía con despertar operatorio para procesos expansivos cerebrales. Reporte de 20 casos

Resumen: Introducción: La cirugía de lesiones expansivas cerebrales con paciente despierto es una técnica que se usa de forma cada vez más frecuente. Esto se debe a que es una técnica costo efectiva para realizar resección de tumores cerebrales de forma amplia y segura. Resultado: Se presentan 20 pacientes operados con dicha técnica. Se trató de 13 hombres y 7 mujeres, rango etario 16 - 67 años, portadores de 17 lesiones tumorales y 3 lesiones vasculares (angiomas cavernosos). Se realizaron 22 cirugías ya que dos pacientes se intervinieron 2 veces. Se logró resección supra-máxima en 3 casos, completa en 9, subtotal en 5 y parcial en 2 pacientes. Un paciente no se pudo operar debido a que presentó un despertar inadecuado y el procedimiento se suspendió. En cuanto a las complicaciones, 18% de los pacientes presentaron crisis intra-operatorias, pero las mismas no impidieron el desarrolló del procedimiento con normalidad luego de yugulada la crisis. Dos pacientes (9% de los procedimientos) presentaron un despertar inadecuado. En un caso la lesión se resecó completamente de todas formas, en el otro se suspendió el procedimiento. 18% de los pacientes presentaron una peoría funcional transitoria y un 4.5% presentó una peoría definitiva (paresia severa). Un solo paciente (4.5%) presentó una infección del colgajo que requirió retiro de la plaqueta ósea y colocación de una placa de acrílico en diferido. Conclusiones: Las cifras presentadas por los autores están en concordancia con las de los centros regionales e internacionales de referencia.

Abstract: Introduction: Expansive brain injury surgery with awake patients is a technique that is being used more and more frequently. This is because it is a cost-effective technique for performing brain tumor resection widely and safely. Outcome: Twenty patients operated with this technique are presented. There were 13 men and 7 women, age range 16 - 67 years, carriers of 17 tumor lesions and 3 vascular lesions (cavernous angiomas). 22 surgeries were performed since two patients underwent surgery twice. Supra-maximal resection was achieved in 3 cases, complete in 9, subtotal in 5, and partial in 2 patients. One patient could not be operated on due to inadequate awakening and the procedure was suspended. Regarding complications, 18% of the patients presented intra-operative seizures, but they did not prevent the normal development of the procedure after the crisis was jugulated. Two patients (9% of the procedures) had inadequate awakening. In one case the lesion was completely resected anyway, in the other the procedure was suspended. 18% of the patients presented a transitory functional deterioration and 4.5% presented a definitive worsening (severe paresis). Only one patient (4.5%) had a flap infection that required removal of the bone plate and placement of a delayed acrylic plate. Conclusions: The figures presented by the authors are in accordance with those of the regional and international reference centers.

Resumo: Introdução: A cirurgia de lesão cerebral extensiva com pacientes acordados é uma técnica cada vez mais utilizada. Isso ocorre porque é uma técnica econômica para realizar a ressecção de tumor cerebral de forma ampla e segura. Resultado: São apresentados 20 pacientes operados com essa técnica. Eram 13 homens e 7 mulheres, com idades entre 16 e 67 anos, portadores de 17 lesões tumorais e 3 lesões vasculares (angiomas cavernosos). Foram realizadas 22 cirurgias, pois dois pacientes foram operados duas vezes. A ressecção supra-máxima foi alcançada em 3 casos, completa em 9, subtotal em 5 e parcial em 2 pacientes. Um paciente não pôde ser operado devido ao despertar inadequado e o procedimento foi suspenso. Em relação às complicações, 18% dos pacientes apresentaram convulsões no intra-operatório, mas não impediram o desenvolvimento normal do procedimento após a jugulação da crise. Dois pacientes (9% dos procedimentos) tiveram despertar inadequado. Em um caso a lesão foi totalmente ressecada de qualquer maneira, no outro o procedimento foi suspenso. 18% dos pacientes apresentaram uma deterioração funcional transitória e 4,5% apresentaram piora definitiva (paresia grave). Apenas um paciente (4,5%) apresentou infecção do retalho que exigiu a retirada da placa óssea e colocação de placa acrílica retardada. Conclusões: Os números apresentados pelos autores estão de acordo com os dos centros de referência regionais e internacionais.

Over-expression of programmed cell death 5 gene enhances chemosensitivity of brain glioma cells to temozolomide / 中国肿瘤生物治疗杂志

@# Objective: To explore the role of tumor suppressor gene programmed cell death 5 gene (PDCD5) in the growth and temozolomide (TMZ) sensitivity of brain glioma cells. Methods:Atotal of 116 patients with cerebral glioma admitted to the Department of Neurosurgery, First Clinical Hospital of Jilin University from January 2009 to December 2014 were enrolled in this study. QPCR, WB and immunohistochemistry method were used to detect the mRNAand protein expressions of PDCD5 in glioma cell lines (U87, U251), U87 cell line with stable PDCD5 expression (U87-PDCD5), glioma cells with si-PDCD5 transfection and primary cerebral glioma tissues, respectively. MTT assay was used to detect the effect of over-expression or knockdown of PDCD5 on the growth and TMZ-sensitivity of glioma cells. The subcutaneous tumor-bearing model of glioma cell line U87 was established in nude mice, and then the experimental mice were randomly divided into control group, TMZ group, PDCD5 group and TMZ+exogenous PDCD5 recombinant expression vector group.After 20 days, the animals were sacrificed by cervical dislocation and the tumor tissue was excised to measure the tumor volume and weigh. The expression of PDCD5 in tumor tissues was detected by qPCR and WB methods, and the effects of PDCD5 combined with TMZ on the growth of gliomas were also analyzed. Results: The relative mRNA and protein expressions of PDCD5 in U87 cells were significantly lower than those in U251 cells (both P<0.05), and the mRNA and protein expressions of PDCD5 in high level glioma tissues were significantly lower than those in low level tissues (all P<0.05). The sensitivity of U87-PDCD5 cells and U251 cells to TMZ was higher than that of U87 cells (all P<0.05). The sensitivity of cells to TMZ in U87-PDCD5-siRNA group and U251siRNA group was significantly lower than that of the control group (both P<0.05). The tumor volume and weigh to fnudemicexenografts were compared,and the results showed control group>TMZ group>PDCD 5group>combined group(allP<0.05);however, the mRNA and protein expressions of PDCD5 in the transplanted tumor tissues of each group showed the opposite trend (all P<0.05). Conclusion: PDCD5 over-expression can enhance the chemosensitivity of braingliomato the chemotherapy drug TMZ, while silencing of PDCD5 expression exertsthe opposite effect.The combination of PDCD5 and TMZ can better inhibit the growth of xenografts in nude mice.

Intracranial multicentric astrocytoma:A case report and literature review / 吉林大学学报(医学版)

Objective:To report the clinical manifestations of 1 case of intracranial multicentric astrocytoma,and to provide a reference for its clinical diagnosis and treatment.Methods:The clinical data of one patient with intracranial multicentric astrocytomas were retrospectively analyzed and the diagnosis and treatment were summarized,and the relevant literatures were reviewed.Results:The patient was male,25 years old,and admitted to hospital due to the sudden convulsions 1 time 18 d ago.The head MRI scanning and enhanced scanning displayed that the left frontal lobe and corpus callosum knee exited the group of patchy mixed abnormal signals,and the left frontal temporal lobe exited the capsule-like mixed signals.Surgical treatment was performed,and the lesions of the left frontal lobe and corpus callosum knee and left frontal temporal lobe were resected.The difference of the two lesions was observed during the operation(the left frontal and corpus callosum knee lesion was cystic and solid mixed tissue,solid organization accounted for majority,and had internal calcification;the left frontal temporal lobe lesion was cystic and solid mixed tissue,and cystic tissue accounted for the majority).The postoperative pathology showed that the left frontal lobe and corpus callosum knee lesion had locally more intensive cells,and more different cells,and it was diagnosed as astrocytoma(WHO Ⅱ-Ⅲ);the left frontal temporal lobe lesion was diagnosed as astrocytoma(WHO Ⅱ).After operation,the patient recovered well,and it was recommended to continue radiotherapy and chemotherapy.Conclusion:For the patients with intracranial multicentric astrocytomas,active surgical treatment is in favor of prolonging the survival of the patients.Postoperative radiotherapy is still controversial,but chemotherapy should be recommended.

Intracranial mulcenic astrocytoma: A case report and literature review / 吉林大学学报(医学版)

Objective: To report the clinical manifestations of 1 case of intracranial multicentric astrocytoma, and to provide a reference for its clinical diagnosis and treatment. Methods: The clinical data of one patient with intracranial multicentric astrocytomas were retrospectively analyzed and the diagnosis and treatment were summarized, and the relevant literatures were reviewed. Results: The patient was male, 25 years old, and admitted to hospital due to the sudden convulsions 1 time 18 d ago. The head MRI scanning and enhanced scanning displayed that the left frontal lobe and corpus callosum knee exited the group of patchy mixed abnormal signals, and the left frontal temporal lobe exited the capsule-like mixed signals. Surgical treatment was performed, and the lesions of the left frontal lobe and corpus callosum knee and left frontal temporal lobe were resected. The difference of the two lesions was observed during the operation (the left frontal and corpus callosum knee lesion was cystic and solid mixed tissue, solid organization accounted for majority, and had internal calcification; the left frontal temporal lobe lesion was cystic and solid mixed tissue, and cystic tissue accounted for the majority). The postoperative pathology showed that the left frontal lobe and corpus callosum knee lesion had locally more intensive cells, and more different cells, and it was diagnosed as astrocytoma (WHO II-III), the left frontal temporal lobe lesion was diagnosed as astrocytoma (WHO II). After operation, the patient recovered well, and it was recommended to continue radiotherapy and chemotherapy. Conclusion: For the patients with intracranial multicentric astrocytomas, active surgical treatment is in favor of prolonging the survival of the patients. Postoperative radiotherapy is still controversial, but chemotherapy should be recommended.

Diagnóstico diferencial entre Glioma y Absceso cerebrales: enseñanzas a partir de un caso / Differential diagnosis between Glioma and Abscess of the brain: teachings from a case

Development of neuroimaging in the last decades has revolutionized the neurological diagnosis, however for they interpretation clinical picture of the patient remains as a relevant aspect. Clinical case: a 30-year-old male patient with recent epileptic seizures, Jaksonian type, secondarily generalized, with no relevant history and normal neurological examination was presented. Initially a Magnetic Resonance of the brain was performed, the case was interpreted as Brain Abscess and treatment with intravenous antimicrobials was instituted for three weeks. A further analysis of the case revolves the diagnosis towards the possibility of a high degree malignant cerebral glioma, which was verified with the accomplishment of a craneotomy and biopsy. Conclusions: focal structural lesions of the brain, such as those caused by neuroepithelial tumors and abscesses, are among the most common causes of Epileptic Syndrome in adulthood. To date, there are no pathognomonic signs in the neuroimagenological differential diagnosis between the two entities. Despite the help of some advanced Magnetic Resonance techniques, the clinical correlation remains as the cornerstone for correct etiological interpretation, as well as pathological examination for the definitive diagnosis of both lesions.

Up-to-date viewpoint of cerebral glioma surgery / 复旦学报（医学版）

Today,the primary goal of cerebral glioma surgery is to achieve maximum safe resection.The cytoreductive surgery ensures the sensitivity to postoperative radiotherapy,chemotherapy (targeted therapy) and immunotherapy and other individualized adjuvant treatment,while limits sacrifice of the quality of life of patients.Comprehensive use of neuronavigation,iMRI intraoperative real-time image guidance,multimodal functional and metabolic image guidance,intraoperative fluorescence technology,awake craniotomy and intraoperative electrophysiological monitoring and other new technologies to achieve accurate positioning of multi-mode brain function,real-time protection and quantitative control of extent of tumor resection,are not only achieving the promising goal of cerebral glioma surgeries,but enhancing the realization of the China Brain Project.

Value of conventional MRI features in solitary cerebral glioma grading / 西安交通大学学报(医学版)

Objective To evaluate the value of conventional MRI in determining high-or low-grade solitary cerebral glioma.Methods We divided 218 patients with solitary cerebral glioma confirmed by surgical pathology into low-grade group (n =134)and high-grade group (n =84).MRI features include the following:in contact with subventricular zone (SVZ ), tumor heterogeneity, tumor boundary, necrosis, hemorrhage, crossing midline, occupying effect,peritumoral edema,volume of enhancement,and enhanced inhomogeneity.The t-test,chi-square test and logistic regression analysis were used to evaluate the differences in age,gender and magnetic resonance imaging between the high-and low-grade glioma groups.MRI findings were then correlated with grade of gliomas. Results There was a significant difference in age between the two groups (P <0.001).There was no significant difference in men and women between the two groups (P =0.864).Seven out of ten MRI findings were identified to be significantly different between high- and low-grade groups.They were SVZ contact (P = 0.011 ),tumor heterogeneity (P <0.001),cystic change and necrosis (P =0.037),degree of edema (P =0.017),occupying effect (P = 0.009 ),tumor boundary (P < 0.001 ),and volume of enhancement (P < 0.001 ).Moreover,the logistic regression analysis indicated that age,cystic change and necrosis,tumor boundary,and volume of enhancement were independently associated with high-grade gliomas. Conclusion Conventional MRI findings are useful in determining high-or low-grade gliomas.Presence of the following MRI features suggests high-grade gliomas:older age,notable cystic changes and necrosis,unclear tumor boundary,and significant enhancement.

Value of conventional MRI features in solitary cerebral glioma grading / 西安交通大学学报(医学版)

Objective To evaluate the value of conventional MRI in determining high-or low-grade solitary cerebral glioma.Methods We divided 218 patients with solitary cerebral glioma confirmed by surgical pathology into low-grade group (n =134)and high-grade group (n =84).MRI features include the following:in contact with subventricular zone (SVZ ), tumor heterogeneity, tumor boundary, necrosis, hemorrhage, crossing midline, occupying effect,peritumoral edema,volume of enhancement,and enhanced inhomogeneity.The t-test,chi-square test and logistic regression analysis were used to evaluate the differences in age,gender and magnetic resonance imaging between the high-and low-grade glioma groups.MRI findings were then correlated with grade of gliomas. Results There was a significant difference in age between the two groups (P <0.001).There was no significant difference in men and women between the two groups (P =0.864).Seven out of ten MRI findings were identified to be significantly different between high- and low-grade groups.They were SVZ contact (P = 0.011 ),tumor heterogeneity (P <0.001),cystic change and necrosis (P =0.037),degree of edema (P =0.017),occupying effect (P = 0.009 ),tumor boundary (P < 0.001 ),and volume of enhancement (P < 0.001 ).Moreover,the logistic regression analysis indicated that age,cystic change and necrosis,tumor boundary,and volume of enhancement were independently associated with high-grade gliomas. Conclusion Conventional MRI findings are useful in determining high-or low-grade gliomas.Presence of the following MRI features suggests high-grade gliomas:older age,notable cystic changes and necrosis,unclear tumor boundary,and significant enhancement.

Influencing factors on the survival time in recurrent glioma after reoperation / 中国生化药物杂志

Objective To investigate the factors influencing the survival time of patients with recurrent glioma after reoperation.Methods 45 cases in our hospital due to recurrence cerebral glioma undergoing reoperation were selected, whose general data were retrospective analyzed, and the surgery conditions, postoperative complications, survival time and its influencing factors were analyzed.Results In 45 cases of recurrent cerebral glioma patients undergoing surgical treatment, 25 cases with total resection, 20 cases with subtotal resection, 3 cases with postoperative brain edema, 3 cases with pulmonary infection; and compared with pre-surgery, the Karnovsky performance status (KPS) score increased significantly (P <0.05); and postoperative survival time was ( 10.62 ±3.25 ) months, multi-factor regression analysis showed that recurrence lesion resection, preoperative KPS score, recurrent interval time and preoperative grading is the independent risk factors related to survival time(P<0.05).Conclusion Surgical treatment of recurrent cerebral glioma is of great significance, and aggressive surgical treatment could improve the quality of life, prolong the survival time and improve the quality of life.

Effects and action mechanism of Fuzheng Xiaoliu Decoction on cerebral glioma orthotopic transplantation model in rats / 中草药

Objective: To observe the inhibitory effect of Fuzheng Xiaoliu Decoction (FXD) on cerebral glioma. Methods: Rat glioma orthotopic transplantation model was established by inoculating C6 glioma cells to brain right caudate nucleus in situ of Wistar rats, and the rats in treatment group were ig administered with FXD for consecutive 14 d. After the last administration, blood was taken to measure whole blood viscosity and plasma viscosity, serum immunoglobulin (IgG, IgA, and IgM), tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), and interferon-γ (IFN-γ) levels; All rats were sacrificed after last administration to collect whole blood; The brain was taken and weighed, brain index was calculated, tumor length and short diameters were measured, and tumor volume and inhibitory rate were calculated; The tumor tissue was taken, vascular endothelial growth factor (VEGF) and prostaglandin E2 (PGE2), insulin-like growth factor-1 (IGF-1) levels were determined. Results: All three doses (1.2, 2.4, and 3.6 g/kg) of FXD could inhibit rat glioma tumor volume. It could reduce the contents of IGF-1, PGE2, VEGF in tumor tissue and serum IgG, elevated the level of serum IgA, IgM, TNF-α, IL-2, and IFN-γ to varying degrees. FXD (3.6 g/kg) can reduce whole blood viscosity at low shear (P < 0.05, 0.01). Conclusion: FXD has significant antitumor effect on C6 glioma, and the mechanism of antitumor effect may be the inhibition of tumor angiogenesis and tumor cell proliferation, enhancing immune response, and reducing blood viscosity.

Effect of Motor Imagery on Patients Accepted Radiotherapy after Operation for Cerebral Glioma / 中国康复理论与实践

@# Objective To observe the effect of motor imagery therapy on patients accepted radiotherapy after operation for cerebral glioma. Methods 34 patients were randomly divided into control group (n=17) and observation group (n=17). Both groups accepted routine physiotherapy during radiotherapy, 45~60 min/d, 5 times a week for 4 weeks, while the observation group underwent motor imagery additionally, 15 min/d for 4 weeks. They were evaluated with Fugl-Meyer Assessment (FMA), Manual Muscle Test (MMT) and modified Barthel Index (MBI) before and after treatment., and with Karnofsky Performance Scale (KPS) 1 year later. Results There was no significantly difference in the scores of FMA, MMT and MBI between 2 groups before treatment (P>0.05). There was no significantly difference in the score of FMA in both groups before and after treatment (P>0.05). The score of MMT improved in the observation group after treatment (P<0.01). The scores of MBI improved in both groups after treatment (P<0.05). And there was no significantly difference in the D-value score of FMA, MMT and MBI between 2 groups (P>0.05). After 1 year follow-up, KPS showed that the number of survival patients and their quality of life were better in the observation group than in the control group (P<0.05). Conclusion Motor imagery therapy can improve the muscle force, activities of daily living and long-term quality of life in patients during radiotherapy after neurosurgery for cerebral glioma.

Application of intraoperative ultrasound in cerebral gliomas surgery / 中国康复理论与实践

@# ObjectiveTo investigate the role of intraoperative ultrasound (IOUS) in the surgical treatment of cerebral gliomas.MethodsThirty patients with primary supratentorial gliomas underwent microsurgery guided by intraoperative real-time ultrasound, IOUS was utilized for localization and delineation of the tumor as well as determination of the extent of resection.ResultsAll of 30 lesions were accurately defined by IOUS due to the distinct echogenicity compared with the normal brain. Solid low grade gliomas tended to be well circumscribed with regular sulcus, while central necrosis was most commonly present with malignant gliomas. Complete tumor extirpation was achieved by IOUS guidance in this group. Two patients exhibited mild neurological deficit following the surgery.ConclusionIOUS may provide valuable real-time information and facilitate effectual surgery with accuracy for the cerebral gliomas.

Study on alteration of IL-6 and cell immunity in patients with cerebral glioma / 西安交通大学学报(医学版)

Objective To study the content of interleukin- 6 (IL-6) and the altering pattern of erythrocyte immunity and T cell subgroup in the blood of outer circulation in the patients with cerebral glioma, and to expl ore their relationship and the clinical significance. Methods Enzyme linked immunosorbent assay (ELISA) was used to determine the content o f IL-6. The immunoabsorption was employed to examine the erythrocytic immune ac tivity and its regulatory function. Streptavidin-Peroxidase (S-P) was used to determine the cell number of CD3 (cluster of differentiation 3), CD4, CD8. Results The content of IL-6 in the group with cerebral glioma i s significantly lower than that in the control group (P0.05). Conclusion The weakening of immune function is obse rved in the patients with cerebral glioma. Testing of the content of IL-6, eryt hrocyte immunity and the activity of T subgroup has important clinical significa nce in the occurrence, development, treatment, outcome and prognosis of the cere bral glioma.

A Clinical Study on 37 Cases of Oligodendroglioma

The authors reviewed 37 consecutive cases of histologically proven oligodendroglioma who were treated at the Seoul National University Hospital, between 1979 and 1986. There was a 1.5 : 1 male to female ratio. The age of patients at the time of diagnosis varied between 6 and 64 years(mean 38 years), with 51% in the fourth and fifth decades. The incidence of oligodendrogliomas represented 5% of all brain tumors and 15.5% of all gliomas. All but one were located supratentorially and 54% of them involved the frontal lobe. The mean duration of symptoms prior to the surgery was 27.2 months, but seizures had a considerably longer duration of 6.4 years. The common symptoms were headache(62%), seizures(38%), and motor weakness(22%). The common neurological findings were papilledema(51%), motor dificit(24%), and change in cognition(19%). Six out of 37 cases(16%) presented as the spontaneous intracranial hemorrhage. Calcifications were detected on plain X-ray films of the skull in 19% of patients and fine vascular stains were found on carotid angiograms in 30% of the cases. Brain CT revealed calcification(57%), cyst formation(43%), low density(35%) and heterogenous contrast enhancement(35%). The important factors affecting the prognosis and the recurrence rate were (1) the extent of surgical excision, (2) postoperative radiation therapy, and (3) the pathologic grading. There was a significant difference in the recurrence rate between patients treated with postoperative irradiation and patients treated with surgery alone.