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Background: Intracerebral hemorrhage (ICH) is a common stroke type with high morbidity and mortality. There are mainly three surgical methods for treating ICH. Unfortunately, thus far, no specific surgical method has been proven to be the most effective. We carried out this study to investigate whether minimally invasive surgeries with endoscopic surgery or stereotactic aspiration (frameless navigated aspiration) will improve functional outcomes in patients with supratentorial ICH compared with small-bone flap craniotomy. Methods: In this parallel-group multicenter randomized controlled trial conducted at 16 centers, patients with supratentorial hypertensive ICH were randomized to receive endoscopic surgery, stereotactic aspiration, or craniotomy at a 1:1:1 ratio from July 2016 to June 2022. The follow-up duration was 6 months. Patients were randomized to receive endoscopic evacuation, stereotactic aspiration, or small-bone flap craniotomy. The primary outcome was favorable functional outcome, defined as the proportion of patients who achieved a modified Rankin scale (mRS) score of 0–2 at the 6-month follow-up. Results: A total of 733 patients were randomly allocated to three groups: 243 to the endoscopy group, 247 to the aspiration group, and 243 to the craniotomy group. Finally, 721 patients (239 in the endoscopy group, 246 in the aspiration group, and 236 in the craniotomy group) received treatment and were included in the intention-to-treat analysis. Primary efficacy analysis revealed that 73 of 219 (33.3%) in the endoscopy group, 72 of 220 (32.7%) in the aspiration group, and 47 of 212 (22.2%) in the craniotomy group achieved favorable functional outcome at the 6-month follow-up (P =.017). We got similar results in subgroup analysis of deep hemorrhages, while in lobar hemorrhages the prognostic outcome was similar among three groups. Old age, deep hematoma location, large hematoma volume, low preoperative GCS score, craniotomy, and intracranial infection were associated with greater odds of unfavorable outcomes. The mean hospitalization expenses were ¥92,420 in the endoscopy group, ¥77,351 in the aspiration group, and ¥100,947 in the craniotomy group (P =.000). Conclusions: Compared with small bone flap craniotomy, endoscopic surgery and stereotactic aspiration improved the long-term outcome of hypertensive ICH, especially deep hemorrhages. Trial Registration: ClinicalTrials.gov Identifier: NCT02811614. [ABSTRACT FROM AUTHOR]

This document is a retraction notice for an article titled "TNFα Promotes Glioblastoma A172 Cell Mitochondrial Apoptosis via Augmenting Mitochondrial Fission and Repression of MAPK–ERK–YAP Signaling Pathways." The retraction is due to concerns about the duplication of images from other unrelated articles in Figures 1, 2, 3, 4, 5, and 6 of the original article. The authors did not respond to queries or provide an explanation for the duplicated images. The retracted article will remain online but will be digitally watermarked as "Retracted." [Extracted from the article]

Abstract Object Methods Results Conclusions Vertebrobasilar dissecting aneurysms (VBDAs) are known to have a poor natural history with high rates of re-bleeding and mortality. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the male of Chinese Han population to explore the association between HHcy and VBDAs.Eighty-eight male patients with VBDA and Eighty-one male control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of VBDAs was estimated. Interaction and stratified analyses were conducted according to age, BMI, smoking status, drinking status, and chronic disease histories. The two-piecewise linear regression model examined the threshold effect.The multivariate logistic regression analyses revealed a significant association between HHcy and VBDAs (odds ratio (OR) = 2.62; 95% confidence interval (CI), 1.02–6.71) after adjusting for classical vascular risk factors. The relationship was stable in all subgroup analysis. The interactive role was not found in the association between HHcy and VBDAs for the potential risk factor.In summary, our study provides evidence that HHcy can increases the risk of VBDAs in the male Han Chinese population. Further researches with appropriate study designs including sex differences and aneurysm types are needed to verify this association. [ABSTRACT FROM AUTHOR]

Real‐time in vitro detection of glioma cells facilitates precise tumor removal. However, the fluorescent labeling of tumor cells in clinical practice is limited by many factors, including the time consumed, low recognition efficiency, and fluorescence quenching. Here, a general strategy for building perovskite quantum dot (PQD)‐based biological probes utilizing the attraction between positive and negative electric charges is reported. Poly (lactic‐co‐glycolic acid) (PLGA) is chosen for encapsulating PQDs to completely prevent their aggregation, decomposition, or release in water or oxygen. The carboxyl group of PLGA has anchoring coordination with the PQDs, which reduces the surface defects. Moreover, it causes PQD‐based nanocrystals (P‐PNCs) to be surrounded by a positively charged layer in water. Given the specific recognition of chlorotoxin for the channels, rapid imaging of glioma cells is successfully performed in 15 min using P‐PNCs modified with chlorotoxin via charge attraction. The photoluminescence quantum yield of P‐PNC probes reached 87% and remained at 93% after 30 days of dispersion in water, while maintaining a much longer fluorescence lifetime of 15 µs. Therefore, this promising biological probe will be a general nanoplatform for identifying distinct cellular compartments using different biomarker imaging methods. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to present a more precise and objective way to assess the effectiveness of neuroendoscopic application in the treatment of middle cranial fossa arachnoid cysts. Methods: Between March 2009 and December 2012, 28 patients affected by middle cranial fossa arachnoid cysts were initially treated with endoscopic fenestration at the three spaces. The volumes of the cysts on MR images at the time of pre-op and 4 months after surgery were reconstructed by 3D Slicer and quantitatively calculated to compare the volumetric changes. The possible predisposing factors of surgical outcomes were analyzed as well. Results: All the models of the cysts were successfully reconstructed, and the mean volume of the cysts was 135.77 ± 90.43 cm before surgery and 93.08 ± 100.31 cm after surgery at 4 months follow-up ( t = 2.98, P = 0.006). The volumes of those two cases (7.14 %), presenting intracranial hypertension and ventricular dilation after surgery, were dramatically increased, whereas the others were decreased in 20 cases (71.43 %) or remained unchanged in 6 cases (21.43 %). There was significant difference on the age factor among the three result groups ( P = 0.001). Conclusions: The reconstruction of 3D for the assessment of the endoscopic fenestration outcomes is a feasible and precise way for clinical work. The variety of outcomes probably depends on age discrepancy. [ABSTRACT FROM AUTHOR]

Background: Isorhapontigenin (ISO) has been shown to have antioxidant activity. This study aimed to investigate the antioxidant effects of ISO on cerebral ischemia/reperfusion (I/R) injury and its possible molecular mechanisms. Methods: Focal cerebral ischemia‐reperfusion injury (MCAO/R) model and primary cortical neurons were established an oxygen‐glucose deprivation (OGD / R) injury model. After 24 hr of reperfusion, the neurological deficits of the rats were analyzed and HE staining was performed, and the infarct volume was calculated by TTC staining. In addition, the reactive oxygen species (ROS) in rat brain tissue, the content of 4‐Hydroxynonenal (4‐HNE), and 8‐hydroxy2deoxyguanosine (8‐OHdG) were detected. Neuronal cell viability was determined by MTT assay. Western blot analysis was determined for protein expression. Results: ISO treatment significantly improved neurological scores, reduced infarct volume, necrotic neurons, ROS production, 4‐HNE, and 8‐OHdG levels. At the same time, ISO significantly increased the expression of Nrf2 and HO‐1. The neuroprotective effects of ISO can be eliminated by knocking down Nrf2 and HO‐1. In addition, knockdown of the PKCε blocked ISO‐induced nuclear Nfr2, HO‐1 expression. Conclusion: ISO protected against oxidative damage induced by brain I/R, and its neuroprotective mechanism may be related to the PKCε/Nrf2/HO‐1 pathway. [ABSTRACT FROM AUTHOR]

Determining the rupture source is imperative in patient with aneurysmal subarachnoid hemorrhage (SAH). About one third of SAH cases with multiple intracranial aneurysms cannot be certain of the rupture source according to the hemorrhage pattern. This study aims to identify of the rupture source in patients with multiple intracranial aneurysms by fusing SAH data and computed tomography angiography (CTA) data. This retrospective study included 52 aneurysmal SAH patients with multiple intracranial aneurysms. In the 52 patients, 36 had definitive hemorrhage patterns on computed tomography imaging. And the other 16 patients had non-definitive hemorrhage patterns, which were bewildered for us to determine the ruptured aneurysms. Fusion of SAH data and CTA data was performed to demonstrate the spatial relationship between the SAH with each aneurysm by using the 3D Slicer software. For the patients with definitive bleed patterns, all of the suspected ruptured aneurysms were confirmed to be accurate according to the surgical records. Interestingly, the suspected rupture sources were correct in 14 of 16 patients with non-definitive hemorrhage patterns. For all 52 patients with multiple intracranial aneurysms, the ruptured aneurysms were identified in 50 cases (96.2%). In conclusion, fusion of SAH data and CTA data can precisely demonstrate the spatial relationship between the SAH with each aneurysm, which is helpful to determine the ruptured aneurysm in patients with multiple intracranial aneurysms. [ABSTRACT FROM AUTHOR]

Objectives: Spontaneous intracerebral hemorrhage remains a major cause of death and disability throughout the world. We tried to establish accurate long‐term outcome prediction models for hypertensive intracerebral hemorrhage (HICH) using CT radiomics and machine learning. Methods: In a retrospective study of 270 patients with HICH between June 2013 and June 2018, CT images and patients' 6‐month outcome based on the modified Rankin Scale were collected. Hematomas on CT images were selected as volumes of interests (VOIs), and 1,029 radiomics features of the VOIs were extracted. Based on correlations with patients' outcome, radiomics features underwent dimensionality reduction analyses. Then, the support vector machine (SVM), k‐nearest neighbor (KNN), logistic regression (LR), decision tree (DT), random forest (RF), and XGBoost algorithms were applied with the screened features to establish prognostic prediction models of HICH. Accuracies of all models were compared. Results: Eighteen radiomics features were screened as prognosis‐associated radiomics signature of HICH based on the variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) regression models. Patients were randomly allocated into training (n = 215) and validation (n = 55) sets. Accuracies of all 6 machine learning algorithms in the validation set exceeded 80%. The sensitivity, specificity, and accuracy in the validation set were 93.3%, 92.5%, and 92.7% for the RF model and 92.3%, 88.1%, and 89.1% for the XGBoost model, respectively, which were the best two among all models. Conclusions: Taking advantage of radiomics and machine learning, we established accurate prognostic prediction models of HICH. The RF model and XGBoost model returned the best accuracies. [ABSTRACT FROM AUTHOR]

Intracranial aneurysms (IAs) are common lesions in the brain. There is a strong relation between hyperhomocysteinemia (HHcy) and cerebrovascular disease; we perform a retrospective study within the Chinese Han population to explore the association between HHcy and IAs. Two hundred six patients with IAs and 206 control subjects were evaluated for their serum total homocysteine levels. With multiple logistic regression analysis, the association between HHcy and the risk of IAs was estimated. Interaction and stratified analyses were conducted according to age, sex, BMI, smoking status, drinking status, and chronic disease histories. The threshold effect was examined by the two-piecewise linear regression model. The multivariate logistic regression analyses revealed a significant association between HHcy and IAs (odds ratio (OR) = 1.68; 95% confidence interval (CI), 1.02–2.75) after adjusting for classical vascular risk factors. And a 2% higher risk of IAs was observed, which was associated with a 1-μmol/L increase in serum total homocysteine level. The interaction analysis showed that age played an interactive role in the association between HHcy and IAs. In summary, our study provides evidence that HHcy is an independent risk factor for IAs in the Chinese Han population, especially in the elderly subgroup. Taking all the findings into consideration, longitudinal studies and clinical trials of homocysteine-lowering therapy via dietary or medical intervention are needed to assess the causal nature of these relationships. [ABSTRACT FROM AUTHOR]

The suboccipital midline approach is common dealing with posterior fossa tumors but has a high risk of postoperative complications, such as pseudomeningocele, cerebrospinal fluid (CSF) leak, and meningitis. Neurosurgeons used various kinds of method to lower its rate. A retrospective, single-center review of patients diagnosed with posterior fossa tumor underwent a suboccipital midline approach. Compare the rates of pseudomeningocele, CSF leak, and meningitis between 2 groups (artificial dura mater or cervical fascia autograft). We get the cervical fascia autograft from the superficial layer of deep cervical fascia just above the trapezius. Our retrospective review involved 123 patients matching the inclusion criteria between January 2009 and April 2019. The complication rate of pseudomeningocele, CSF leak and meningitis were 8.9%, 4.9%, and 17.9%, respectively. The presence of pseudomeningocele or CSF leak for group "artificial" was 11 of 75 (14.67%) and for group "autograft" it was 3 of 48 (6.25%). The rate of meningitis for group "artificial" (24.0%, 18 of 75) was significantly higher (P = 0.027) than the one for group "autograft" (8.33%, 4 of 48). Multivariate regression analysis suggested that the age was negatively correlated with postoperative pseudomeningocele or CSF leak (P = 0.006), with meningitis (P < 0.001). Using cervical fascia autograft decreased the rate of meningitis (P = 0.021) while showing no statistically significant clinical impact on pseudomeningocele or CSF leak. Applying the cervical fascia autograft to reconstruct the dura during posterior fossa surgery is a simple and effective method to reduce the rate of meningitis as compared with artificial dura mater. [ABSTRACT FROM AUTHOR]

Diffusion tensor imaging is currently the only noninvasive way to map subcortical white matter tractography. Radiologists and neurologists often fail to reconstruct the complex auditory pathways when applying the most commonly used approach, deterministic fiber tracking, as this method is limited in spatial and angular resolution. A different fiber-tracking method involving a probabilistic approach could partly compensate for these limitations. We investigated efficiency and potential usefulness of probabilistic fiber tracking in depicting human auditory pathways in healthy individuals and patients with unilateral vestibular schwannoma (VS). Eight healthy volunteers and 14 patients with unilateral VS underwent diffusion tensor imaging. Probabilistic fiber tracking of the auditory pathways for each subject was carried out using FSL software. Tracking rate, reliability of results, fiber volume, fiber length, and fractional anisotropy values were considered in assessing reliability and sensitivity of this method. Fiber length and fiber volume were analyzed separately for the healthy group and VS group. Good tracking sensitivity and consistency were shown in healthy subjects and patients with VS. For fiber length, the 8 healthy subjects exhibited significant between-sides differences, whereas the 14 patients with VS showed no such difference. For fiber volume, there was a statistically significant difference between groups, as the patients with VS displayed a smaller fiber volume on the nontumor side. Fractional anisotropy values revealed no significant autologous or between-group differences. These results match results of previous anatomic and neurologic studies. The auditory pathway can be depicted well by probabilistic fiber tracking. This method can compensate in part for weaknesses of the widely used deterministic tractography approach in depicting fine and complicated subcortical fibers. [ABSTRACT FROM AUTHOR]

Idiopathic hypertrophic pachymeningitis is a rare inflammatory condition with diffuse thickening of the dura mater, which may cause a compressive effect or vascular compromise. A 40-year-old Chinese man presented with persistent headache for 6 months and a sudden epileptic seizure 2 days ago. Magnetic resonance imaging demonstrated a large (71 × 34 × 27 mm) extra-axial mass at the right frontal convexity with severe edema mimicking meningioma. The lesion and peripheral dura mater showed contrast enhancement. Additionally, the skull near the lesion was eroded. Meningioma was diagnosed, and the patient underwent surgery. During the operation, we found the lesion texture was very tough, and the superior sagittal sinus was occluded. Histopathologic findings revealed a large number of infiltrated lymphocytes with fibrosis and microabscess formation; intracranial idiopathic hypertrophic pachymeningitis was diagnosed. Follow-up magnetic resonance imaging performed 3 months after surgery demonstrated the enhancement was notably alleviated. Idiopathic hypertrophic pachymeningitis should be part of the differential diagnosis of some cases of meningioma. [ABSTRACT FROM AUTHOR]

Background and objective: The present study was designed to explore the roles of mitochondrial fission and MAPK–ERK–YAP signaling pathways and to determine their mutual relationship in TNFα-mediated glioblastoma mitochondrial apoptosis.Materials and methods: Cellular viability was measured via TUNEL staining, MTT assays, and Western blot. Immunofluorescence was performed to observe mitochondrial fission. YAP overexpression assays were conducted to observe the regulatory mechanisms of MAPK–ERK–YAP signaling pathways in mitochondrial fission and glioblastoma mitochondrial apoptosis.Results: The results in our present study indicated that TNFα treatment dose dependently increased the apoptotic rate of glioblastoma cells. Functional studies confirmed that TNFα-induced glioblastoma apoptosis was attributable to increased mitochondrial fission. Excessive mitochondrial fission promoted mitochondrial dysfunction, as evidenced by decreased mitochondrial potential, repressed ATP metabolism, elevated ROS synthesis, and downregulated antioxidant factors. In addition, the fragmented mitochondria liberated cyt-c into the cytoplasm/nucleus where it activated a caspase-9-involved mitochondrial apoptosis pathway. Furthermore, our data identified MAPK–ERK–YAP signaling pathways as the primary molecular mechanisms by which TNFα modulated mitochondrial fission and glioblastoma apoptosis. Reactivation of MAPK–ERK–YAP signaling pathways via overexpression of YAP neutralized the cytotoxicity of TNFα, attenuated mitochondrial fission, and favored glioblastoma cell survival.Conclusion: Overall, our data highlight that TNFα-mediated glioblastoma apoptosis stems from increased mitochondrial fission and inactive MAPK–ERK–YAP signaling pathways, which provide potential targets for new therapies against glioblastoma. [ABSTRACT FROM AUTHOR]

Abstract: Background: With rapid advances in technology, wearable devices as head‐mounted display (HMD) have been adopted for various uses in medical science, ranging from simply aiding in fitness to assisting surgery. We aimed to investigate the feasibility and practicability of a low‐cost multimodal HMD system in neuroendoscopic surgery. Methods: A multimodal HMD system, mainly consisted of a HMD with two built‐in displays, an action camera, and a laptop computer displaying reconstructed medical images, was developed to assist neuroendoscopic surgery. With this intensively integrated system, the neurosurgeon could freely switch between endoscopic image, three‐dimensional (3D) reconstructed virtual endoscopy images, and surrounding environment images. Using a leap motion controller, the neurosurgeon could adjust or rotate the 3D virtual endoscopic images at a distance to better understand the positional relation between lesions and normal tissues at will. Results: A total of 21 consecutive patients with ventricular system diseases underwent neuroendoscopic surgery with the aid of this system. All operations were accomplished successfully, and no system‐related complications occurred. The HMD was comfortable to wear and easy to operate. Screen resolution of the HMD was high enough for the neurosurgeon to operate carefully. With the system, the neurosurgeon might get a better comprehension on lesions by freely switching among images of different modalities. The system had a steep learning curve, which meant a quick increment of skill with it. Compared with commercially available surgical assistant instruments, this system was relatively low‐cost. Conclusions: The multimodal HMD system is feasible, practical, helpful, and relatively cost efficient in neuroendoscopic surgery. [ABSTRACT FROM AUTHOR]

It is always a great challenge to distinguish high-grade glioma (HGG) from primary central nervous system lymphoma (PCNSL). We conducted a meta-analysis to assess the performance of MR perfusion-weighted imaging (PWI) in differentiating HGG from PCNSL. The heterogeneity and threshold effect were evaluated, and the sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC) were calculated. Fourteen studies with a total of 598 participants were included in this meta-analysis. The results indicated that PWI had a high level of accuracy (area under the curve (AUC) = 0.9415) for differentiating HGG from PCNSL by using the best parameter from each study. The dynamic susceptibility-contrast (DSC) technique might be an optimal index for distinguishing HGGs from PCNSLs (AUC = 0.9812). Furthermore, the DSC had the best sensitivity 0.963 (95%CI: 0.924, 0.986), whereas the arterial spin-labeling (ASL) displayed the best specificity 0.896 (95% CI: 0.781, 0.963) among those techniques. However, the variability of the optimal thresholds from the included studies suggests that further evaluation and standardization are needed before the techniques can be extensively clinically used. [ABSTRACT FROM AUTHOR]

Disruption of blood-brain barrier (BBB) follows brain trauma or central nervous system (CNS) stress. However, the mechanisms leading to this process or the underlying neural plasticity are not clearly known. We hypothesized that ATP/P2X7R signaling regulates the integrity of BBB. Activation of P2X7 receptor (P2X7R) by ATP induces the release of interleukin-1β (IL-1β), which in turn enhances the activity of matrix metalloproteinase-9 (MMP-9). Degradation of tight junction proteins (TJPs) such as ZO-1 and occludin occurs, which finally contributes to disruption of BBB. A contact coculture system using human astrocytes and hCMEC/D3, an immortalized human brain endothelial cell line, was used to mimic BBB in vitro. Permeability was used to evaluate changes in the integrity of TJPs. ELISA, Western blot, and immunofluorescent staining procedures were used. Our data demonstrated that exposure to the photoreactive ATP analog, 3′-O-(4-benzoyl)benzoyl adenosine 5′-triphosphate (BzATP), induced a significant decrease in ZO-1 and occludin expression. Meanwhile, the decrease of ZO-1 and occludin was significantly attenuated by P2X7R inhibitors, as well as IL-1R and MMP antagonists. Further, the induction of IL-1β and MMP-9 was closely linked to ATP/P2X7R-associated BBB leakage. In conclusion, our study explored the mechanism of ATP/P2X7R signaling in the disruption of BBB following brain trauma/stress injury, especially focusing on the relationship with IL-1β and MMP-9. [ABSTRACT FROM AUTHOR]

Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for preoperative grading of gliomas. We performed a meta-analysis to evaluate the diagnostic performance of MRS in differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs).Methods: PubMed and Embase databases were systematically searched for relevant studies of glioma grading assessed by MRS through 27 March 2015. Based on the data from eligible studies, pooled sensitivity, specificity, diagnostic odds ratio and areas under summary receiver operating characteristic curve (SROC) of different metabolite ratios were obtained.Results: Thirty articles comprising a total sample size of 1228 patients were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled sensitivity/specificity of Cho/Cr, Cho/NAA and NAA/Cr ratios was 0.75/0.60, 0.80/0.76 and 0.71/0.70, respectively. The area under the curve (AUC) of the SROC was 0.83, 0.87 and 0.78, respectively.Conclusions: MRS demonstrated moderate diagnostic performance in distinguishing HGGs from LGGs using tumoural metabolite ratios including Cho/Cr, Cho/NAA and NAA/Cr. Although there was no significant difference in AUC between Cho/Cr and Cho/NAA groups, Cho/NAA ratio showed higher sensitivity and specificity than Cho/Cr ratio and NAA/Cr ratio. We suggest that MRS should combine other advanced imaging techniques to improve diagnostic accuracy in differentiating HGGs from LGGs.Key Points: • MRS has moderate diagnostic performance in distinguishing HGGs from LGGs. • There is no significant difference in AUC between Cho/Cr and Cho/NAA ratios. • Cho/NAA ratio is superior to NAA/Cr ratio. • Cho/NAA ratio shows higher sensitivity and specificity than Cho/Cr and NAA/Cr ratios. • MRS should combine other advanced imaging techniques to improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background Thalamic gliomas are rare tumors that constitute 1%–5% of all central nervous system tumors. Despite advanced techniques and equipment, surgical resection remains challenging because of the vital structures adjacent to the tumor. Intraoperative magnetic resonance imaging (MRI) might play an active role during brain tumor surgery because it compensates for brain shift or operation-induced hemorrhage, which are challenging issues for neurosurgeons. Methods We reviewed 38 patients treated surgically under intraoperative MRI guidance between January 2008 and July 2015 at our center. Preoperative, intraoperative, and postoperative MRI scans were reviewed. Preoperative and postoperative motor power, morbidity and mortality, resection rate, surgical approach, pathologic results, and patient demographics were also reviewed. Results Mean patient age was 37 years ± 18; 12 patients were included in the low-grade group, and 26 patients were included in the high-grade group. Under intraoperative MRI guidance, the gross total resection rate was increased from 16 (42.1%) to 26 (68.4%), and the near-total or subtotal resection rate was increased from 5 (13.2%) to 9 (23.7%). Hematoma formation was discovered in 3 patients on intraoperative MRI scan; each patient underwent a hemostatic operation immediately. Conclusions With improvements in neurosurgical techniques and equipment, surgical resection is considered feasible in patients with thalamic gliomas. Intraoperative MRI may be helpful in achieving the maximal resection rate with minimal surgical-related morbidity. However, because of severe disease progression, the overall prognosis is unfavorable. [ABSTRACT FROM AUTHOR]

Objective To investigate the feasibility and reliability of virtual endoscopy (VE) as a rapid, low-cost, and interactive tool for the diagnosis and surgical planning of suprasellar arachnoid cysts (SACs). Methods Eighteen patients with SACs treated with endoscopic ventriculocystostomy were recruited, and 18 endoscopic patients treated with third ventriculostomy were randomly selected as a VE reconstruction control group. After loading their DICOM data into free 3D Slicer software, VE reconstruction was independently performed by 3 blinded clinicians and the time required for each reconstruction was recorded. Another 3 blinded senior neurosurgeons interactively graded the visibility of VE by watching video recordings of the endoscopic procedures. Based on the visibility scores, receiver operating characteristic curve analysis was used to investigate the reliability of VE to diagnose SACs, and Bland-Altman plots were used to assess the reliability of VE for surgical planning. In addition, the intraclass correlation coefficient was calculated to estimate the consistency among the results of 3 reconstruction performers. Results All 3 independent reconstructing performers successfully completed VE simulation for all cases, and the average reconstruction time was 10.2 ± 9.7 minutes. The area under the receiver operating characteristic curve of the cyst visibility score was 0.96, implying its diagnostic value for SACs. The Bland-Altman plot indicated good agreement between VE and intraoperative viewings, suggesting the anatomic accuracy of the VE for surgical planning. In addition, the intraclass correlation coefficient was 0.81, which revealed excellent interperformer consistency of our simulation method. Conclusions This study substantiated the feasibility and reliability of VE as a rapid, low-cost, and interactive modality for diagnosis and surgical planning of SACs. [ABSTRACT FROM AUTHOR]

Objective Complicated hydrocephalus, such as trapped fourth ventricle, is challenging. Aqueduct stent placement is a possible alternative to the conventional multiple shunts approach. This article discusses the indications, techniques, and clinical experiences of aqueduct stent placement. Methods We retrospectively analyzed a series of 10 consecutive patients with hydrocephalus and had aqueduct stent placement between February 2009 and May 2014. The clinical and imaging data were collected and the indications, technique, and clinical experience of aqueduct stent placement were analyzed and discussed. Results Among the 10 patients (mean age, 38 years; range, 5 months–69 years), 8 patients harbored an obstructive hydrocephalus caused by aqueductal obstruction. The underlying pathology consisted of intraventricular tumor in 3 patients, intraventricular cysticercosis in 2, and membranous or inflammatory obstruction in 3 patients. Two patients presented with trapped fourth ventricle, which resulted from Dandy-Walker malformation and shunt placement, respectively. Aqueduct stents were placed endoscopically in 8 patients, whereas the other 2 were placed microscopically. There were no deaths due to aqueduct stent placement. Postoperatively, all of the patients showed improvement or resolution of their symptoms. After an average follow-up period of 27 months (range, 1–51 months), recurrence of aqueductal obstruction has not been observed. In 1 patient, there was a complication of transient oculomotor paralysis after aqueduct stent placement. A stent migration was observed in 1 patient after remaining stable for 4 years. Conclusions Aqueduct stent placement is technically feasible and can be useful in selected patients either with endoscopy or open surgery. [ABSTRACT FROM AUTHOR]

Balancing the benefit of extensive tumor resection with the consequence of potential postoperative language deficits remains a challenge in glioma surgery involving language areas. This study is designed to evaluate the impact of intraoperative magnetic resonance imaging (iMRI) and functional neuronavigation on surgical outcome in patients with gliomas involving language areas. Two hundred seventeen patients were prospectively enrolled, 124 in the study group underwent iMRI and functional neuronavigation-guided microsurgery and 93 in the control group underwent conventional navigation-guided microsurgery. Extent of tumor volume resection (EoR) and rate of gross total resection (rGTR) were calculated perioperatively. Aphasia quotient (AQ) was assessed to evaluate the change of language function perioperatively and at 6-month follow-up. Survival outcome for glioblastoma, including progression-free survival (PFS) and overall survival (OS), were recorded. In 198 glioma patients (112 in the study group and 86 in the control group), EoR (95.50 versus 89.85 %, p < 0.001) and rGTR (69.60 versus 47.70 %, p = 0.002) were significantly higher in the study group, and language functions were also better at 6-month follow-up in the study group (87.47 versus 78.73, p = 0.001). Furthermore, postoperative new aphasia occurred in 34.8 % of the control group, whereas it occurred only in 2.3 % of the study group ( p < 0.001). In addition, PFS (12.5 versus 6.6 m, p = 0.003) and OS (19.6 versus 13.0 m, p < 0.001) for patients with glioblastomas were dramatically prolonged in the study group than in the control group. These results indicated that iMRI and functional neuronavigation may help maximize tumor resection, minimize language deficits in patients with gliomas involving language areas, and improve survival time for patients with glioblastomas. [ABSTRACT FROM AUTHOR]

Highlights: [•] AsT was successfully synthesized through conjugation with TGN, AS1411 and Cy3. [•] AsT could effectively target to glioma with high intensity. [•] AsT could be used as an effective glioma imaging probe. [Copyright &y& Elsevier]

Purpose: Subependymal giant cell astrocytoma (SEGA) is a rare, benign tumor that occurs mainly in children; complete resection can achieve cure. Guidance of surgery by combined intraoperative magnetic resonance imaging (iMRI) and functional neuronavigation is reported to achieve more radical resection and reduced complications. However, reports about the resection of SEGA with such guidance are rare. We report here our preliminary experience of the resection of SEGA guided by iMRI and neuronavigation, focusing on the feasibility, benefits, and pitfalls of this combination of techniques. Methods: We performed resection of SEGA guided by combined iMRI and functional neuronavigation in seven children. The first iMRI was performed when the surgeon believed that the tumor had been completely resected; the last iMRI was performed immediately after closure. Additional scans were performed as needed. Results: Successful resection was achieved in all seven patients using this combination of techniques. The iMRI scans detected residual tumor in three patients and a large, remote epidural hematoma in one patient. Further resection or other surgery was performed in these four patients. Complete resection was eventually achieved in all patients. There were no cases of surgery-related neurological dysfunction, except transient memory loss in one patient. No recurrence of tumor or hydrocephalus was observed in any patients during the follow-up period. Conclusions: Resection of SEGA in children guided by combined iMRI and neuronavigation is feasible and safe. This combination of techniques enables a higher complete resection rate and reduces brain injury and other unexpected events during surgery. [ABSTRACT FROM AUTHOR]