Search

Abstract Objectives This study aimed to investigate the histological and molecular characteristics of atypical central neurocytomas (CNs) and evaluate their clinical treatment outcomes, with the aim of identifying reliable biomarkers for differentiation and optimal treatment strategies. Methods We conducted a retrospective study including 61 patients diagnosed with CNs. Clinical data, neuroimaging, and pathological findings were analyzed. RNA sequencing was performed on tumor tissues to identify differentially expressed genes. Results Histological atypia and the Ki-67 index showed no significant impact on progression-free survival (PFS) or overall survival (OS). RNA sequencing identified significant genetic alterations in pathways such as neuroactive ligand–receptor interaction, cAMP, MAPK, and Ras signaling. Differently expressed genes included AMOTL1, PIK3R3, TGFBR1, SMO, COL4A6, MGP, SOX4, IGF2, SLIT1, and CKS2. The five-year OS rate (p = 0.015) and PFS rate (p = 2.00 × 10−6) were significantly higher in the complete resection (CR) group compared to the incomplete resection (IR) group. Postoperative radiotherapy did not affect OS or PFS in the CR group. The five-year PFS rate (p = 3.80 × 10−5) was significantly longer in patients in the CR group who did not receive radiotherapy compared to those in the IR group who did receive radiotherapy. The extent of surgical resection and operative approaches were found to be irrelevant to perioperative complications and dysfunctions at the last follow-up. Conclusion CR is crucial for a better prognosis in patients with atypical CNs. Additional radiotherapy after CR offers little benefit. Histological atypia and the Ki-67 index are not effective in distinguishing between atypical and typical CNs. Identified genetic alterations provide insights into the aggressive behavior of atypical CNs, suggesting potential therapeutic targets and underscoring the need for further research to optimize treatment strategies.

BackgroundGlioma patients often experience neurocognitive deficits, particularly mild cognitive impairment (MCI), which affects their perioperative safety. The use of auditory event-related potentials (AERPs) might be a promising method for reflecting perioperative cognitive function in patients, even under unresponsive sedation. In this study, we aimed to investigate the relationships between the AERP under sedation and preoperative cognitive performance in glioma patients.MethodsPatients with primary supratentorial gliomas who were scheduled for elective craniotomy under general anesthesia were included in this prospective observational study. The patients were categorized into MCI and non-MCI groups based on their preoperative Montreal Cognitive Assessment (MoCA) scores. AERP characteristics, including mismatch negativity (MMN), P300, and event-related spectral perturbation (ERSP) in the theta bands, were analyzed under different propofol-induced sedation conditions. Differences in these parameters between groups and their relationships with preoperative cognitive performance were subsequently investigated.ResultsTwenty-nine eligible patients were included in the analysis. Compared to that in the non-MCI group, the average amplitude of the MMN component evoked by the novel stimulus significantly decreased during the recovery period in the MCI group (−3.895 ± 1.961 μV vs. -1.617 ± 1.831 μV, p = 0.003). Theta-ERSPs also differed between the two groups under standard (0.021 ± 0.658 μV2/Hz vs. 0.515 ± 0.622 μV2/Hz, p = 0.048) and novel (0.212 ± 0.584 μV2/Hz vs. 0.823 ± 0.931 μV2/Hz, p = 0.041) stimulation conditions under light sedation. After correcting for age, education level, site of lesion, WHO pathological grade and combined symptomatic epilepsy as confounders, the frontal theta-ERSP induced by standard and novel stimuli under light sedation was inversely related to the preoperative MoCA score (standard stimuli: β = −0.491, p = 0.011; novel stimuli: β = −0.594, p = 0.007), as was the average MMN amplitude induced by novel stimuli during the recovery period (β = −0.356, p = 0.035).ConclusionThe AERP neural response characteristics of glioma patients during propofol sedation were associated with preoperative cognitive performance, which might be a potential neurophysiological indicator for monitoring perioperative cognitive function, especially theta-ERSP.