Clinicopathological features and myeloid differentiation factor 88 L265P gene mutation in patients with diffuse large B-cell lymphoma of central nervous system / 中华神经科杂志

Objective:To analyze the clinical features and mutation of myeloid differentiation factor 88 (MYD88) L265P in patients with diffuse large B-cell lymphoma (DLBCL) of central nervous system (CNS).Methods:The clinicopathological materials of 45 cases of DLBCL of CNS were retrospectively collected in Xuanwu Hospital, Capital Medical University from September 2014 to February 2017. The clinicopathological data were retrospectively analyzed, combined with immunohistochemistry, EB virus in situ hybridization, imaging and medical history. The mutation of MYD88 L265P gene was detected by pyrosequencing and its clinical significance was analyzed. Results:The age of the patients ranged from 42 to 82 years [(57.6±8.8) years], including 24 males and 21 females. Totally 93.3% (42/45) of the patients had supratentorial tumours, which were single or multiple. The cerebral hemisphere (31/45, 68.9%) was the most common involved site, and 21 cases (21/45, 46.7%) had multiple lesions. Histologically, DLBCL in the CNS showed diffuse infiltration of tumor tissue, some of which grew around blood vessels in a "sleeve" arrangement. CD 20 and CD 79a were diffusely and strongly positive. Thirty-nine cases (39/45, 86.7%) were non-germinal center B cell (non-GCB) subtype and 6 cases (6/45, 13.3%) were germinal center B cell (GCB) subtype. MYD88 L265P mutation was found in 64.4% (29/45) patients. There was statistically significant difference between non-GCB type (71.8%, 28/39) and GCB type DLBCL (1/6, P=0.017). Compared with the operation/biopsy group without chemotherapy, operation+chemotherapy, biopsy+chemotherapy, operation/biopsy+chemotherapy+stem cell transplantation can improve the survival and prognosis ( HR=0.05, 95% CI 0.01-0.33 , P=0.002; HR=0.04, 95% CI 0.01-0.36 , P=0.004; HR=0.01, 95% CI 0.00-0.17 , P=0.001; respectively). Conclusions:DLBCL of the CNS is aggressive tumor with poor prognosis, the clinical manifestations are complex and diverse, and the diagnosis is challenging. MYD88 L265P is a common and specific gene mutation in primary CNS lymphoma(PCNSL), which is of great significance in the diagnosis and treatment of lymphoma. The MYD88 L265P mutation was more frequently detected in non-GCB than GCB subtype. Chemotherapy can improve the survival rate of PCNSL patients. If chemotherapy achieves complete remission and autologous hematopoietic stem cell transplantation is performed, there may be a chance of long-term survival.

Feasibility of High-Resolution 3-Dimensional Sampling Perfection with Application-Optimized Contrast Using Different Flip Angle Evolution Imaging for the Preoperative Detection of Parasinus Meningioma: A Pilot Study Compared with Contrast-Enhanced Magnetic Resonance Venography.

OBJECTIVES: To prospectively evaluate the diagnostic value of 3.0 Tesla magnetic resonance 3-dimensional sampling perfection with application-optimized contrast using different flip angle evolution (3D-SPACE) in the detection of sinus wall invasion and sinus patency in parasinus meningiomas. METHODS: In this study, 28 patients with suspected meningiomas adjacent to the venous sinus underwent conventional magnetic resonance imaging, contrast-enhanced magnetic resonance venography, and 3D-SPACE scans. We collected patient charts and surgical reports for demographic details, histologic analysis, and neurologic performance preoperatively and postoperatively. Images obtained by each technique were assessed independently by 2 neurosurgeons for characteristics of sinus infiltration, wall invasion, lumen patency, and collateral veins. RESULTS: The blood flow signal inside the lumen and collateral veins were depressed and presented as black, contrasting well with the sinus wall on 3D-SPACE imaging. When the curved-planar reconstruction images were combined, it was intuitive and accurate to detect the extent of sinus wall invasion by meningioma and also to detect lumen patency. An intratumoral "false lumen" was shown to maintain the blood flow inside the sinus at a totally invaded lesion. Moreover, collateral veins enveloped in a meningioma with their confluence points of the venous sinus were easily observed on 3D-SPACE images. CONCLUSION: With an integrative presentation of parasinus meningioma, wall invasion, lumen patency, and collateral veins, high-resolution 3D-SPACE imaging provides a reliable technique to accurately assess venous sinus invasion preoperatively.

Patched Closure of Dural Outlet of External Ventricular Drainage Catheter: Better Way to Prevent Cerebrospinal Fluid Leakage.

Postoperative continuous bloody cerebral spinal fluid drainage with external ventricular drainage catheter could decrease the incidence of inflammation. But the drainage catheter left in place will interrupt the watertight dura matter closure. To prevent the related cerebrospinal fluid leakage and subgaleal pseudomeningocele after the catheter removal, we developed a patched closure method to seal the dural outlet of the drainage catheter with a favorable clinical outcome.

The neurosurgery residency training at Brigham and Women's Hospital of United States: what can we learn / 中华医学教育探索杂志

By taking the neurosurgery residency program of Brigham and Women's Hospital as an example,the neurosurgery residency training system of United States is introduced,which emphasizes on the progressive gaining of the trainee with regard to medical knowledge,surgical skills,decision-making strategy,humanity,professionalism,inter-human communication ability and updated neuroscience research.This training system can shed some light on our own neurosurgery residency program,which only begins to take shape in recent years.

Anatomy of the petrous apex as related to the endoscopic endonasal approach.

The endoscopic endonasal approach (EEA) has been reported to be an efficient approach for treating lesions of the petrous apex. However, there have been only limited anatomic studies for the EEA. Furthermore, most of the relevant distances for EEA cannot be measured easily on a cadaveric skull. Two fresh adult cadaver heads and five formalin-fixed adult cadaver heads were dissected using the EEA to identify groups of landmarks for safe guidance during this approach. The distances between these landmarks were then measured by CT angiography by using three-dimensional software. The EEA to the petrous apex can be divided into five phases. In each phase, a group of landmarks, rather than a single landmark, can be identified easily for guiding the next phase of the approach. There was no significant difference between males and females in any of the distances reported in the present study. The EEA can be performed to manage a petrous apex lesion more safely by referring to multiple landmarks and the distances between them.