ABSTRACT
OBJECTIVE: Clear cell meningioma (CCM) is a rare histologic subtype of meningioma that is classified as World Health Organization grade II tumor. We conducted the present study to characterize clinical features of intracranial CCM and investigate the prognostic factors associated with surgical recurrence-free survival of the patients. METHODS: PubMed and Embase were searched for case reports and series relevant to CCM. For each included study, relevant data were extracted, including patients' characteristics, pathology findings, therapeutic modality, and outcome. RESULTS: A total of 146 intracranial CCMs patients were included, comprising 73 females and 73 males. The median age of the patients at surgery was 32 years. Most tumors (58.2%) were located in the skull base region. Ninety-nine (67.8%) patients underwent gross total resection (GTR), and 47 (32.2%) patients underwent subtotal resection (STR). Seventy-four (50.7%) patients had tumor recurrence during the follow-up. Recurrence-free survival rates at 1 and 5 years after resection were 86% and 37%, respectively. Multivariate analysis showed that STR (hazard ratio [HR], 4.13; P < 0.001) and male gender (HR, 1.69; P = 0.030) were associated with increased recurrence while postoperative radiotherapy (HR, 0.51; P = 0.040) was related to decreased recurrence. CONCLUSIONS: The results suggest that intracranial CCM has its own unique clinical features compared with the other 2 types of grade II meningiomas. Patients with subtotally resected tumors, males, or those who did not receive postoperative radiotherapy are at greater risk of recurrence. GTR should be the primary goal in the surgical management of intracranial CCMs. Our data also highlight the value of radiotherapy in intracranial CCM patients.
Subject(s)
Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/therapy , Meningioma/diagnosis , Neoplasm Recurrence, Local/diagnosis , Adult , Child , Combined Modality Therapy , Disease-Free Survival , Humans , Meningeal Neoplasms/mortality , Meningeal Neoplasms/pathology , Meningioma/mortality , Meningioma/pathology , Meningioma/therapy , Multivariate Analysis , Neoplasm Grading , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Prognosis , Proportional Hazards Models , Radiotherapy, Adjuvant , Risk FactorsABSTRACT
The translocator protein 18kDa (TSPO) is closely related to regulation of immune/inflammatory response. However, the putative role and signaling mechanisms of TSPO in regulation of neuroinflammation remain unclear. GV287 lentiviral vectors mediating TSPO over-expression were injected into bilateral hippocampal CA1 areas to test whether TSPO over-expression was neuroprotective in lipopolysaccharide (LPS)-induced mice model. Finasteride, a blocker of allopregnanolone production, was used to test whether the protective effects were related to steroideogenesis. The results demonstrated that TSPO over-expression increased progesterone and allopregnanolone synthesis. TSPO over-expression in CA1 area improved LPS-induced cognitive deficiency in mice and this cognitive improvement was reversed by finasteride administration. These data suggest that up-regulation of TSPO level during neuroinflammation may be an adaptive response mechanism, a way to provide more neurosteroids. We confer that TSPO could be an attractive drug target for controlling neuroinflammation in the future.
Subject(s)
CA1 Region, Hippocampal/metabolism , Cognitive Dysfunction/metabolism , Encephalitis/metabolism , Receptors, GABA/metabolism , Animals , CA1 Region, Hippocampal/drug effects , Cognitive Dysfunction/complications , Encephalitis/chemically induced , Encephalitis/complications , Finasteride/administration & dosage , Genetic Vectors/administration & dosage , Lentivirus/physiology , Lipopolysaccharides , Male , Maze Learning/drug effects , Mice , Mice, Inbred C57BL , Pregnanolone/metabolism , Progesterone/metabolism , Up-Regulation/drug effectsABSTRACT
OBJECTIVE: To assess postoperative effects of microelectrode-guided posteroventral pallidotomy (PVP) for Parkinson's disease. METHODS: Intraoperative microelectrode recordings and microstimulation were used to explore the globus pallidus to performance of posteroventral pallidotomy in 48 patients with Parkinson's disease (47 unilateral and 1 bilateral). Assessment was made at baseline preoperatively and at 6 months intervals postoperatively, with unified Parkinson's disease rating scale (UPDRS). RESULTS: All patients were significantly improved on the limbs contralateral to the lesion side 6 - 34 months after operation (mean 24 months). The improvement was seen in the 'on' or 'off' state: UPDRS scores with patients on levodopa were improved by an average of 28.7%, while off medication scores showed reductions (47.6%) at 24 months. There were no deaths and no visual complications, but there were 4 patients (8.3%) of a delayed contralateral limbs dystonia after pallidotomy. CONCLUSIONS: The techniques of microelectrode recording and microstimulation indicate the location of the internal capsule and optic tract, which allow easy identification of these structure and facilitate PVP target in conjunction with radiofrequency microelectrode stimulation.
