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Background: The radiochemotherapy regimen concomitantly employing temozolomide (TMZ) chemotherapy and radiotherapy (RT) 4 weeks after surgery, followed by 6 cycles of TMZ is a common treatment for glioblastoma (GBM). However, its median overall survival (OS) is only 14.6 months. This study was to explore the effectiveness and safety of early TMZ chemotherapy between surgery and chemoradiotherapy plus the standard concomitant radiochemotherapy regimen. Methods: A randomized, parallel group, open-label study of 99 newly diagnosed GBM patients was conducted at 10 independent Chinese neurosurgical departments from June 2008 to June 2012. Patients were treated with concomitant radiochemotherapy regimen plus early postsurgical temozolomide (early TMZ group) or standard concomitant radiochemotherapy regimen (control group). Overall response was assessed based on objective tumor assessments, administration of corticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event (AE), and neurological condition were measured for 24 months of follow-up. The primary efficacy endpoint of this study was overall survival (OS). The secondary endpoint was progression free survival (PFS). Results: The median OS time in the early TMZ group was 17.6 months, compared with 13.2 months in the control group (log-rank test P = 0.021). In addition, the OS rate in the early TMZ group was higher at 6, 12, and 18 months than in the control group, respectively (P < 0.05). The median PFS time was 8.7 months in the early TMZ group and 10.4 months in the control group (log-rank test P = 0.695). AEs occurred in 29 (55.8%) and 31(73.8%) patients respectively in early and control groups, including nausea (15.4% vs. 33.3%), vomiting (7.7% vs. 28.6%), fever (7.7% vs. 11.9%), and headache (3.8% vs. 23.8%). Only 30.8% and 33.3% were drug-related, respectively. Conclusions: Addition of TMZ chemotherapy in the early break of the standard concomitant radiochemotherapy regimen was well tolerated and significantly improved the OS of the GBM patients, compared with standard concomitant radiochemotherapy regimen. However, a larger randomized trial is warranted to verify these results.

Total resection of adamantinomatous craniopharyngioma (ACP) is complex and often leads to postoperative recurrence. This is due to the tendency of the tumor to invade the surrounding brain tissue and the generation of a local inflammatory state between the tumor cells and parenchyma. While there is evidence to suggest that interleukin‑6 (IL‑6) induces craniopharyngioma (CP)‑associated inflammation, particularly in ACP, the role of IL‑6 in the progression of ACP remains unclear. The results of the present study demonstrated that CP inflammation was associated with pathological classification, extent of surgery, degree of calcification and postoperative hypothalamic status scale. Cytokine antibody arrays were conducted to measure the expression of IL‑6 and other inflammatory factors in tumor tissues in response to various levels of inflammatory exposure. IL‑6, IL‑6 receptor (IL‑6R) and glycoprotein 130 expression was detected by immunohistochemistry. In addition, an ELISA was performed to quantify the levels of soluble IL‑6R (sIL‑6R) in the cystic fluid and supernatants of ACP cells and tumor‑associated fibroblasts. These measurements demonstrated that ACP cells produce IL‑6 and its associated proteins. In addition, the results revealed that while the viability of ACP cells was not affected, the migration of ACP cells was promoted by IL‑6 treatment in a concentration‑dependent manner. Conversely, treatment with an IL‑6‑blocking monoclonal antibody significantly decreased the migration of ACP cells. In addition, IL‑6 treatment increased the expression of vimentin and decreased the expression of E‑cadherin in a dose‑dependent manner. The findings of the present study demonstrate that IL‑6 may promote migration in vitro via the classic‑ and trans‑signaling pathways by inducing epithelial‑mesenchymal transition in ACP cell cultures.

To explore the operative strategies for bilateral brain contusion and laceration and evaluate their clinical significance.Based on the clinical manifestations, computed tomography (CT) and intracranial pressure (ICP), different operative strategies were applied to 25 cases of bilateral brain contusion and laceration. The strategies were classified into 6 types according to the principles of decompression and brain protection.All cases received routine treatments at neurosurgical intensive care unit (ICU) ward. And the occurrences of operative complications and 6-month Glasgow outcome scale (GOS) were statistically analyzed.Type 1:4 cases of unilateral decompressive craniectomy without resection of contusion focus; Type 2:8 cases of unilateral decompressive craniectomy with resection of bilateral contusion focus; Type 3:5 cases of bilateral decompressive craniectomy with resection of unilateral brain contusion; Type 4:5 cases of bilateral decompressive craniectomy; Type 5:1 case of bilateral brain contusion resection; Type 6:2 cases of bilateral decompressive craniectomy and brain contusion resection.Postoperative complications such as epilepsy, expanding contusion foci, brain infarction, encephalocele, incisional CSF leakage, intracranial infection, subdural hydroma and hydrocephalus were rare. The 6-month GOS revealed 6 cases of good outcome (n = 6), moderate disability (n = 8), severe disability (n = 3) and vegetative status (n = 5) and death (n = 3).Different operative strategies may be applied for severe brain contusion and laceration according to their clinical manifestations, CT findings and ICP values. And the efficacies are improved by operative strategies based on the principles of ICP control, prevention of secondary injury and brain function preservation.

To assess the immunophenotypic changes associated with epithelial-mesenchymal transition (EMT) in craniopharyngioma, especially at the tumour invasive front, and to correlate the findings with clinicopathological features and patient outcomes.Forty-two craniopharyngiomas were investigated for the presence of EMT markers (vimentin, E-cadherin and β-catenin) by immunohistochemistry and western blot. The relationships between expression of these markers and various clinicopathological indicators and clinical outcomes of the tumours were analysed. There were statistically significant differences in the expression of vimentin and E-cadherin-β-catenin between adamantinomatous and papillary variants. The expression of vimentin and E-cadherin (but not that of β-catenin) in whole tumour sections was associated with tumour recurrence, and with postoperative weight and hypothalamic disturbances; the expression of vimentin and E-cadherin-β-catenin at the tumour invasive front was also associated with tumour recurrence, postoperative weight, and hypothalamic disturbances. The results from western blotting closely matched those of immunohistochemistry.Our study demonstrates, for the first time, the potential prognostic implications of vimentin, E-cadherin and β-catenin expression in craniopharyngiomas. EMT may represent a crucial mechanism in the progression of craniopharyngiomas.

The completeness of meningioma resection depends on the resection of dura mater invaded by the tumor. The pathological changes of the dura around the tumor can be interpreted by evaluating the dural tail sign (DTS) on MRI studies. The goal of this study was to clarify the pathological characteristics of the DTSs, propose a classification based on the histopathological and radiological correlation, and identify the invasive range of tumor cells in different types of DTS.The authors retrospectively reviewed 179 patients with convexity meningiomas who underwent Simpson Grade I resection. All patients underwent an enhanced MRI examination preoperatively. The convexity meningiomas were dichotomized into various subtypes in accordance with the 2007 WHO classification of tumors of the CNS, and the DTS was identified based on the Goldsher criteria. The range of resection of the involved dura was 3 cm from the base of the tumor, which corresponded with the length of DTS on MRI studies. Histopathological examination of dura at 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 cm from the base of the tumor was conducted, and the findings were correlated with the preoperative MRI appearance of the DTS.A total of 154 (86%) of 179 convexity meningiomas were classified into WHO Grade I subtype, including transitional (44 [28.6%] of 154), meningothelial (36 [23.4%] of 154), fibrous (23 [14.9%] of 154), psammomatous (22 [14.3%] of 154), secretory (10 [6.5%] of 154), and angiomatous (19 [12.3%] of 154). The other 25 (14%) were non-Grade I (WHO) tumors, including atypical (12 [48%] of 25), anaplastic (5 [20%] of 25), and papillary (8 [32%] of 25). The DTS was classified into 5 types: smooth (16 [8.9%] of 179), nodular (36 [20.1%] of 179), mixed (57 [31.8%] of 179), symmetrical multipolar (15 [8.4%] of 179), and asymmetrical multipolar (55 [30.7%] of 179). There was a significant difference in distribution of DTS type between Grade I and non-Grade I tumors (p = 0.004), whereas the difference was not significant among Grade I tumors (0.841) or among non-Grade I tumors (p = 0.818). All smooth-type DTSs were encountered in Grade I tumors, and the mixed DTS (52 [33.8%] of 154) was the most common type in these tumors. Nodular-type DTS was more commonly seen in non-Grade I tumors (12 [48%] of 25). Tumor invasion was found in 88.3% (158 of 179) of convexity meningiomas, of which the range of invasion in 82.3% (130 of 158) was within 2 cm and that in 94.9% (150 of 158) was within 2.5 cm. The incidence of invasion and the range invaded by tumor cells varied in different types of DTS, and differences were statistically significant (p0.001).Nodular-type DTS on MRI studies might be associated with non-Grade I tumors. The range of dural resection for convexity meningiomas should be 2.5 cm from the tumor base, and if this extent of resection is not feasible, the type of DTS should be considered. However, for skull base meningiomas, in which mostly Simpson Grade II resection is achieved, the use of this classification should be further validated. The classification of DTS enables the surgeon to predict preoperatively and then to achieve the optimal range of dural resection that might significantly reduce the recurrence rate of meningiomas.

To highlight recent researches which may show promise for histomolecular classification and new treatments for gliomas.All articles cited in this review were mainly searched from PubMed, which were published in English from 1996 to 2010.Original articles and critical reviews selected were relevant to the isocitrate dehydrogenase-1/2 mutation in gliomas and other tumors.Extraordinary high rates of somatic mutations in isocitrate dehydrogenase-1/2 occur in the majority of World Health Organization grade II and grade III gliomas as well as grade IV secondary glioblastomas. Isocitrate dehydrogenase-1/2 mutations are associated with younger age at diagnosis and a better prognosis in patients with mutated tumors. The functional role of isocitrate dehydrogenase-1/2 mutations in the pathogenesis of gliomas is still unclear.Isocitrate dehydrogenase-1/2 mutations define a specific subtype of gliomas and may have great significance in the diagnosis, prognosis, and treatment of patients with these tumors.

A precise understanding of the ambient cistern and its associated arachnoid membranes is helpful for accessing perimesencephalic lesions. However, few studies of the arachnoid membranes related to the ambient cistern have been published, and, additionally, some aspects of the ambient cistern also require further examination. The goal of this study was to reinvestigate and expound on the anatomical features of the cistern and membranes.The ambient cisterns and its associated arachnoid membranes were examined in 20 adult cadaveric brains using an operative microscope.The perimesencephalic membrane is a set of inner arachnoid membranes surrounding the midbrain at the level of the tentorial incisura. It arises from the outer arachnoidal membranes covering the tentorial edge and the dorsum sellae and can be subdivided into anterior and posterior portions. The anterior membrane is actually the mesencephalic leaf of Liliequist membrane, which is divided into medial and lateral parts by the oculomotor nerve. The posterior membrane can be divided into horizontal and ascending parts. The ambient cistern is located above the perimesencephalic membrane and contains the anterior choroidal arteries, the posterior cerebral arteries, the basal vein, and sometimes the segments of the superior cerebellar arteries. It communicates with the carotid cistern, the interpeduncular cistern, the oculomotor cistern, the cerebellopontine and cerebellomesencephalic cistern, and the quadrigeminal cistern.This study updates some information about the ambient cistern and its arachnoid membranes. The perimesencephalic membrane was identified and described in detail. The ambient cistern was verified to be a supratentorial cistern above the perimesencephalic membrane. The borders and contents of this cistern, as well as its relationship with adjacent cisterns, were also redefined.

To evaluate the feasibility for confirming the preservation of the parasymphathetic nerve pathway innervating the bladder during nerve-sparing radical hysterectomy (RH). A total of 20 patients underwent nerve-sparing RH. Intraoperative electrical stimulation (IES) were performed on the root of pelvic splanchnic nerve (PSN) trunk while recording the electromyographic (EMG) activity of the vesical detrusor. The average duration achieving residual urine ≤50 mL and urodynamic study (UDS) was observed. Evoked potentials were recorded when stimulating, in 18 patients who were referred IES-positive. Its duration was 9.89 days. The UDS results indicated that all voided normally. The remaining 2 IES-negative cases with no evoked potentials had longer duration and the micturitions were performed using abdominal pressure. During nerve-sparing RH, IES based on the measurement of EMG activity is a useful tool for confirmation of the preservation of parasymphathetic nerve pathway innervating the bladder and prediction of the postoperative bladder function.

To review the clinical manifestations, imaging, tumor markers, treatment methods, pathology results and clinical curative effects of pineal region tumors and to evaluate the characteristics and intervention strategies for those tumors.The clinicopathological data of 132 patients with pineal region tumor treated in our department between January 2000 and May 2008 were retrospectively studied.A moderate predominance in males was presented. The clinical manifestations of the disease included increased intracranial pressure and ocular movement impairment. There were some features but no regularity and specific appearance on imaging including CT and MRI. 88.6% of patients associated with hydrocephalus. A high serum level of alpha-fetoprotein (AFP) was presented in 14 cases and high HCG in 9 cases. Eighteen cases received direct radiation therapy and 7 had radiotherapy post biopsy. 107 cases were treated surgically and 63 cases received postoperative adjuvant treatment. 114 cases had pathology results including 56 germ cell tumors. The patients were followed up for 12 approximately 132 months. Recurrence developed in 23 cases and 12 cases died. The 5-year survival rate was 89.3%.Pineal region tumors are often associated with hydrocephalus and this makes preoperative diagnosis difficult. Imaging examination may help diagnosis but less specific. Germ cell tumors may diagnosed by some tumor markers. Radiation therapy is the choice of treatment for pure germinomas. Other types of pineal region tumors should receive surgical treatment. Postoperative adjuvant treatment based on pathology can provide a good prognosis in pineal region tumor.

To summary the microsurgical techniques for removal of huge tuberculum sellae meningiomas through the bi-subfrontal anterior longitudinal fission approach.Eleven patients with huge tuberculum sellae meningiomas underwent microsurgical removal of the meningiomas between January, 2005 and November, 2009. The microsurgical techniques were summarized, and the factors affecting the prognosis were analyzed.Among all the patients, 5 had Simpson grade I meningioma removal and the other patients had Simpson grade II removal. No death occurred in these patients. Nine patients showed vision improvement after the surgery, one had no significant improvement, and the other one experienced worsening of vision. Transient postoperative diabetes insipidus occurred in 5 cases.With satisfactory exposure of Dorsum sellae, bottom of the third ventricle and cavernous sinus, the bi-subfrontal anterior longitudinal fission approach is suggested for treatment of tuberculum sellae meningiomas. The key to improve the GTR and reduce the complication lies in the sequence of the operation, namely resection of the tumoral basement before dissection of the potential arachnoidal space and tuberculum.

To analyze the factors contributing to the occurrence of diabetes insipidus after operations for craniopharyngiomas.A total of 121 cases of diabetes insipidus following surgeries for craniopharyngiomas were retrospectively analyzed and the factors associated with postoperative diabetes insipidus were analyzed.The incidence of diabetes insipidus was 27.3% (33/121 cases) before the operation, 89.9% (107/1119) early after the operation and 39.8%(37/93) in later stages after the operation. The occurrence of early postoperative diabetes insipidus showed a significant relation to the classification and calcification of the craniopharyngioma. Patients with supradiaphragmatic and extraventricular tumors had the lowest incidence of postoperative diabetes insipidus. Late postoperative diabetes insipidus was closely correlated to such factors as age, classification of craniopharyngioma, and intraoperative treatment of the pituitary stalk, but not to the scope of tumor resection or tumor calcification. Late diabetes insipidus was more frequent in children and patients with severed pituitary stalk. The incidence of late postoperative diabetes insipidus was significantly higher in patients with supradiaphragmatic and extra-intraventricular tumors than in those with tumors beneath the diaphragma sellae and extraventricular tumors.Postoperative diabetes insipidus following surgeries for craniopharyngiomas is closely related to the tumor classification, calcification and pituitary stalk protection.

To study angiogenesis patterns in the edematous area and the center of human astrocytomas by histological observation, and to reveal histological basis of vasculogenic mimicry.Tissue samples were drawn from the tumor center and the edematous area in 51 patients with human astrocytomas during operation MR and were examined by CD34 endothelial marker periodic acid-Schiff (PAS) dual staining.Vessels or capillaries stained by both PAS and CD34 were found in edematous areas of human astrocytomas. Besides vessels or capillaries stained by both PAS and CD34, vasculogenic mimicries (PAS-positive and CD34-negative tubes containing red blood cells and lined by neoplastic cells), PAS-positive and CD34-negative tubes containing red blood cells and without cells around, PAS-positive and partial CD34-positive vessels or capillaries, and PAS-positive and CD34-negtive vessels or capillaries were detected in the center of tumor of 4 human glioblastomas.Vasculogenic mimicries in the center of some high-grade astrocytomas may be caused by blood capillary dysplasia, while angiogenesis patterns are vessels or capillaries in the edematus area and the center of most human astrocytomas.

To explore the surgical approaches, microsurgical techniques and therapeutic effect of modified cistern magna reconstruction for treating of syringomyelia with Chiari malformations.The clinical data of 35 patients with syringomyelia complicated by Chiari malformations were retrospectively reviewed, and the patients' chief complaints, presenting symptoms, neurological and radiographic findings, surgical approaches, outcomes, and complications were analyzed.The radiographs revealed type I Chiari in 18 and type II Chiari malformations in these patients. Surgical treatment resulted in symptomatic improvements in 29 patients, and 6 patients showed no obvious changes in the symptoms after the surgery; 3 patients received subarachnoid shunting for syringomyelia. During the follow-up for a mean of 2 years, 32 patients showed obvious clinical improvement, and magnetic resonance imaging demonstrated complete spontaneous resolution of syringobulbia in 25 patients.Modified cistern magna reconstruction relieves brainstem compression and restores the pulsatile flow of the cerebrospinal fluid at the cervicomedullary junction. Cerebellar tonsil reduction is performed chiefly by electric coagulation and cauterization combined with subpial resection, and the integrity of the pia mater should be maintained as much as possible to avoid potential adhesion and recurrence. The median foramens and Luschka of the fourth ventricle have to be opened to recover normal CSF circulation. Arachnoidal suspension and placement of a patulous dural graft are also important. Modified reconstruction of the cistern magna can be a good option for treatment of syringomyelia complicated by Chiari malformations.

To study the findings in radionuclide cisternography in patients with obstructive hydrocephalus following third ventriculostomy.Lumbar radionuclide cisternography was performed in 15 patients with obstructive hydro- cephalus before and after third ventriculostomy.The postoperative cisternography identified radiopharmaceutical reflux into the lateral cerebral ventricles with delayed clearance for 24 h, similar to the findings by cisternography of communicating hydrocephalus.The cause of ventricular radiopharmaceutical reflux is not yet understood, possibly in association with the reversal of normal cerebrospinal fluid flow though the fenestration on the third ventrical floor.

To investigate the growth of craniopharyngioma involving the third ventricular floor with regard to the hypothalamus by detecting expressions of leukocyte common antigen (CD45) and intercellular adhesion molecule (ICAM-1) in the tumor tissue.The expressions of CD45 and ICAM-1 proteins in 30 craniopharyngioma samples with third ventricular floor involvement were detected by SP immunohistochemistry.The inflammations labeled by CD45 were identified commonly in the craniopharyngioma tissues involving the third ventricular floor. The expression of ICAM-1 was mainly in the inner tumor cells and interstitial cells, but not detected in the basilar tumor cells growing toward the third ventricular floor. Adamantinomatous craniopharyngiomas showed markedly higher CD45 and ICAM-1 expressions than squamous papillary tumors (P0.05).Inflammatory adhesion largely characterizes the growth of the craniopharyngioma tissues involving the third ventricular floor toward the hypothalamus without the tendency of invasion. The difference in the inflammation between the two types of craniopharyngioma may affect the prognosis of the patients.

To evaluate the risk factors and study the methods of prevention and treatment for the ruptures of aneurysms in keyhole minimally invasive approaches.From 1999 to 2005, 115 cases of intracranial aneurysms were divided into 2 classes according to the risk factors of aneurysm rupture. Forty-three cases of lower risk underwent microsurgical procedures as keyhole approaches, including pterional approach in 20 cases, supraorbital approach in 18 cases, interhemispheric approach in 5 cases. Seventy-two cases, rest of microsurgical procedures, were performed as conventional craniotomy, including pterional approach in 31 cases, supraorbital approach in 11 cases, interhemispheric approach in 7 cases, pterional-supraorbital in 10 cases, pterional-interhemispheric in 6 cases, supraorbital-interhemispheric in 4 cases, pterional-supraorbital-interhemispheric in 3 cases.Six aneurysms leaked and 3 ruptured (rupture rate 7.0%) treated with keyhole approaches during operations. No one died by keyhole approaches. Eighteen aneurysms leaked and 9 ruptured (rupture rate 12.5%) treated with conventional approaches during operations. Two patients died by conventional approaches.Keyhole approaches as a time-saving, trauma-reducing procedure could improve the postoperative outcomes, but these approaches still exist probability of aneurysm rupture. It is possible that keyhole-bone flap becomes a limitation to deal with huge or ruptured aneurysms. And it is important to make a specially preventive strategy for aneurysm rupture.

To investigate the feasibility of pterion keyhole approach with minimal invasion for treatment of the anterior circulation aneurysm.Aneurysm clipping through the pterion keyhole approach was performed in patients with anterior circulation aneurysms, including 9 with posterior communication artery aneurysms, 3 with middle cerebral artery aneurysms and 6 with anterior communication artery aneurysms, who were in stages I to III according to Hunt-Hess scale.All the aneurysms were clipped successfully. One patient with a left posterior communication artery aneurysm developed transient sensory aphasia and motor aphasia after surgery due to intraoperative aneurysm rupture. No facial paralysis occurred due to damage of the facial nerve.The pterion keyhole approach is a very useful surgical approach for treatment of anterior circulation aneurysms on the basis of cautious determination of indications and careful operation planning.

To discuss the diagnosis, surgical indication, endoscopic fenestration procedures, and prognosis of symptomatic septum pellucidum cyst.Ten patients with symptomatic septum pellucidum cyst showing clinical symptoms of elevated intracranial pressure and epilepsy with the maximal cyst width ranging from 12 to 35 mm underwent endoscopic cystoventriculostomy.During the follow-up period, 8 patients were symptom-free, one had significant improvement of the symptoms, but one failed to respond to the treatment.Endoscopic cystoventriculostomy is effective in the treatment of symptomatic septum pellucidum cyst, but care must be taken to avoid collateral injury in the operation.

To review our experience in the treatment of hydrocephalus caused by aqueduct obstruction with neuroendoscopic third ventriculostomy.Of the 12 patients with hydrocephalus, 10 had primary aqueduct obstruction with the other 2 suffering the obstruction secondary to tectal tumors. In all the cases the neuroendoscope was advanced into the third ventricle via the frontal horn and foramen of Monro, followed by third ventriculostomy to achieve free communication between the third ventricle and interpeduncular cistern.All the procedures were successful and smooth, with only occasional mild intra- and post-operative complications. Nine of the 12 patients were followed up 3 months after the operation, and 7 were found with good therapeutic effect while 2 failed to respond favorably.Neuroendoscopic third ventriculostomy is effective for hydrocephalus due to aqueduct obstruction, and may yield satisfactory short-term results. Different techniques of fenestration should be used to suit the individual-specific conditions of the third ventricle floor. In the follow-up of the patients, evaluation of the intracranial pressure and the patients' symptoms constitutes the main basis for assessment of the clinical results.

To study the clinical features of posttraumatic epilepsy and evaluate the surgical procedures for anti-epileptic treatment and their therapeutic effects.Neurological and scalp EEGs were performed in 35 patients with posttraumatic epilepsy, who also underwent CT, MRI examination, single photon emission computerized tomography (SPECT) and positron emission tomography (PET) prior to intracranial surgery, with intraoperative monitoring of the cortical EEG.With the cortical EEG monitoring, 16 patients underwent surgical resection of the epileptogenic foci identified by intraoperative EEG, 7 had multiple subpial transection and 12 received stereotactic radiosurgery for the epileptogenic foci localized by PET. In most of the cases, the epileptogenic foci were located around the lesions of encephalomalacia. During the follow-up of 32 patients varying from 1 to 4 years, 18 patients became seizure free, 10 had obvious reduction in the frequency of seizure while 4 failed to respond favorably to the treatment.Seizures of posttraumatic epilepsy may aggravate the brain dysfunction due to primary trauma, and surgical treatment often yields good effect and lessens the toxic and adverse effect of antiepileptic drugs. Stereotactic radiosurgery guided by PET is safe and effective in the treatment of patients with posttraumatic epilepsy.

To investigate the effectiveness of treatment of recurrent malignant brain gliomas by surgical excision combined with biodegradable polymers of interstitial chemotherapy.In 30 patients with recurrent malignant brain gliomas, the tumor was surgically removed and Vp-16 biodegradable polymers were implanted during operation in the tumor bed at a dose of 100 - 150 mg. The patients were followed up for 3 - 24 months, and the results were compared with 46 cases with the recurrent malignant brain gliomas who received operation only.At 3, 6, 12, 24 months after treatment, the recurrent rate was 16.7%, 30%, 50% and 83.3%, respectively; the mortality rate was 6.67%, 20%, 40% and 70%, respectively. All the patients had no apparent side-effects of chemotherapy.Surgical treatment combined with interstitial chemotherapy with biodegradable Vp-16 polymers improves the treatment result of recurrent malignant brain gliomas compared to surgery alone.

To explore the clinical feature and surgical treatment of recurrent craniopharyngiomas.The imaging features, intraoperative course, and postoperative outcomes of 83 patients with craniopharyngiomas were retrospectively analyzed.Of the 81 patients that survived, 19 experienced recurrence of the craniopharyngioma 6 to 62 months after the completion of the initial treatment, with recurrence rates of patients with total, subtotal and partial removal being 5.3%, 52.9%, and 100% respectively. Five of the 24 patients aged 6 years or older, who had an incomplete surgical removal, received radiation therapy, and only 1 of them experienced tumor recurrence (20%) whereas as many as 15 of the 19 patients (78.9%) did who did not received it.Surgery resection should be the primary therapeutic option for patients with recurrent craniopharyngioma and radiation therapy should also be considered but only as adjuvant therapy.

We reviewed the clinical data of 32 cases of cerebral infarction after traumatic brain injury, aiming to explore the pathogenesis and assess the prognosis of the condition so as to find effective prevention and treatment measures. According to Glasgow Outcome Scale (GOS) scores, 12 patients were classified as having good recovery, 5 moderate neurological deficit, 4 severe neurological deficit, and 3 in vegetative state. Death occurred in 8 cases. These results indicate the mortality and morbidity of this condition are relatively high, and early diagnosis and treatment may improve prognosis, which should await further investigation.

To investigate proliferating cell nuclear antigen labeling indices (PCNA-LI) in craniopharyngiomas in association with tumor recurrence.Immunohistochemistry was employed to examine the expression of PCNA in 43 craniopharyngioma samples of different pathological types, and the relationship between PCNA-LI and tumor recurrence was evaluated.PCNA-LI was much higher in adamantinous tumors than in squamous papillary tumors that did not give rise to postoperative recurrence. Although PCNA-LI was higher in the recurrent lesions than in the primary tumor in adamantinoma group, the difference was not statistically significant.Craniopharyngioma cells with different pathological features may possess varied proliferating potentials, and active proliferation is the main factor for postoperative recurrence of adamantinoma.

To explore the application and characteristics of electromagnetic navigation in neurosurgical operation.Neurosurgical operations with the assistance of electromagnetic navigation were performed in 12 patients with intracranial tumors.Total removal of the tumor was achieved in 8 cases, subtotal removal in 3 and removal of the majority of the tumor in 1 case. The error in the navigation averaged 1.9+/-0.9 mm and the time consumed by preoperative preparation was 19+/-2 min with the exception in 1 case.In comparison with optic navigation, electromagnetic navigation offers better convenience and absence of signal blockage, and with a head frame, automatic registration can be achieved.

Two cases of fibrous dysplasia of the skull complicated with meningioma that are seldom seen were reported.

To localize the epileptic foci with positron emission tomography (PET), and study the principles of target definition and method to determine the optimal range of exposure in radiosurgery for intractable epilepsy.This study included 176 patients with intractable epilepsy, who received linear accelerator radiosurgery after (18)F-FDG PET for epileptic foci localization. The patients were divided according to different peripheral doses used in the treatment into Group A in which radiation dose of 9 to 11 Gy was used, Group B with 11 to 13 Gy and Group C with exposure to over 13 Gy. Follow-up study was conducted in all the patients for a period ranging from 3 to 16 months, during which the frequency of seizure after treatment was recorded to evaluate the therapeutic effect.The seizure frequency significantly decreased after radiosurgical treatment in all the groups, but between the groups, the decrement evinced no significant difference. According to Wieser's classification of the effect after operation, 46.9% cases belonged to grade I to II and 41.5% to grade III to IV. Obvious complications were not observed, nor did disability or mortality occurred in these cases.Stereotactic radiosurgery with low radiation dose under the guidance of PET provides a safe, effective and minimally invasive surgical approach for patients with intractable epilepsy, and peripheral radiation doses of 9 to 11 Gy for the epileptic foci localized by PET is sufficient to ensure good clinical outcome.

To explore the radiological characteristics of craniopharyngiomas and particularly, to discuss the radiological manifestations of the pituitary stalk and their significance in safe resection of craniopharyngiomas.Retrospective analyses of the data obtained in preoperative radiological evaluation and intraoperative observation were conducted in 63 cases of craniopharyngiomas that were surgically removed.In 6 cases (9.5%) the pituitary stalk was identified in preoperative radiological examination, and in 17 cases (27%) the position and course of pituitary stalk could be presumed according to the displacement of the third ventricle floor, which were confirmed in all cases during the operation. While in the other 33 (52.5%) cases, the pituitary stalk was only located during the operation. Massive calcification in the central position of the tumor stood in the way of achieving complete tumor removal, and the irregular peripheral enhancement in the superoposterior part of the tumor indicated tumor invasion of the hypothalamus.Preoperative identification of the pituitary stalk and tumor calcification, together with a clear understanding of the position of the posterior part of the tumor in association with the hypothalamus is crucial to safe and complete surgical removal of craniopharyngiomas.