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BACKGROUND: Coronavirus disease-2019 (COVID-19) led to a global pandemic in March 2020 that has involved tens of millions of people. To date, prophylactic vaccines have been found to be the most effective method to contain the pandemic. Bullous pemphigoid (BP) is an autoimmune skin disease that mainly affects older individuals. CASE REPORTS: The authors report 2 confirmed cases of BP in patients with history of cerebral infarction who received the inactivated severe acute respiratory syndrome coronavirus 2 vaccine. A 67-year-old woman was hospitalized for a generalized rash that appeared 7 days after the first dose of inactivated COVID-19 vaccine. The rash was aggravated after the second dose. The second patient was a 66-year-old woman who was hospitalized for a generalized rash that appeared 10 days after the first dose of inactivated COVID-19 vaccine. There were no abnormalities in the baseline blood tests. Laboratory and histologic examinations confirmed the diagnosis of BP. The patients were treated with systemic glucocorticoids, antibiotics, topical corticosteroids, and emollients, which resulted in a significant reduction in pruritus and regression of lesions after 2 weeks. CONCLUSION: Two patients with a genetic background of HLA-DQB1*0302 had BP after vaccination in China. However, there is not enough evidence to indicate a requirement for genetic screening before receiving inactivated severe acute respiratory syndrome coronavirus 2 vaccines.

We aimed to explore the influence of preoperative gamma knife treatment on the clinical effect of microsurgical resection of vestibular schwannoma.The data of patients who underwent vestibular schwannoma resection in our hospital between November 2010 and December 2019 were retrospectively collected. According to the data collected retrospectively and the inclusion and exclusion criteria, we selected these patients and divided them into Group A (with preoperative gamma knife treatment) and Group B (without preoperative gamma knife treatment). The pre/postoperative clinical manifestations, neurological function grade, postoperative complications, tumor recurrence and increase were collected and compared between the two groups.There were 40 and 823 patients enrolled in Groups A and B, respectively. There were no significant differences in the general condition, tumor size and side, or neurological performance of the patients in those two groups before the operation. At the last follow-up, the number of patients with poor facial nerve function was 15 (39.5%) in Group A and 170 (20.7%) in Group B (P = 0.021 0.05). In Group A and Group B, disequilibrium occurred in 14 (36.8%) patients and 124 (15.1%) patients, respectively, after the operation (P = 0.012 0.05). Seven (17.5%) patients had pneumonia in Group A, and 21 (2.6%) patients had pneumonia in Group B (P = 0.04 0.05) after the operation.When a patient with vestibular schwannoma undergoes microsurgical surgery, the preoperative history with gamma knife treatment may make recovery from postoperative facial paralysis difficult for the patients, making them more prone to suffer from postoperative disequilibrium and postoperative pneumonia.

The current molecular classifications cannot completely explain the polarized malignant biological behavior of low-grade gliomas (LGGs), especially for tumor recurrence. Therefore, we tried to identify suspicious hub genes related to tumor recurrence in LGGs.In this study, we constructed a gene-miRNA-lncRNA co-expression network for LGGs by a weighted gene co-expression network analysis (WGCNA). GDCRNATools and the WGCNA R package were mainly used in data analysis.Sequencing data from 502 LGG patients were analyzed in this study. Compared with recurrent glioma tissues, we identified 774 differentially expressed (DE) mRNAs, 49 DE miRNAs, and 129 DE lncRNAs in primary LGGs and ultimately determined that the expression of MKLN1 was related to tumor recurrence in LGG.This study identified the potential biomarkers for the pathogenesis and recurrence of LGGs and proposed that MKLN1 could be a potential therapeutic target.

Introduction: Surgery for fourth ventricular tumors is plagued by potential CSF blockage after the tumor removal due to a plethora of reasons. We re-invented the classic Torkildsen shunt as a treatment for postoperative hydrocephalus after fourth ventricular tumor removal by placing a catheter from the aqua duct through fourth ventricle towards the cisterna magna. Materials and methods We prospectively gathered the data of patients who underwent surgery of the fourth ventricle tumor between January 2019 and December 2021 at the Department of Neurosurgery in West China Hospital of Sichuan University. In all, a total of 96 selective cases were selected among 237 fourth ventricle tumor cases because of their superior tumor extension into the aqueduct. The patients were categorized into modified Torkildsen and no modified Torkildsen groups and risks factors for the development of postoperative hydrocephalus evaluated and their clinical outcomes were compared. Result In all 20 patients developed postoperative hydrocephalus out of the 96 patients included in the study. All the 20 patients who developed postoperative hydrocephalus were in the no modified Torkildsen group. No patient in the modified Torkildsen group developed postoperative hydrocephalus. Thus, we observed a significate statistical difference between the modified Torkildsen group and no modified Torkildsen group (p = 0.0062). Conclusion The modified Torkildsen shunt can be effective in preventing postoperative hydrocephalus in selected fourth tumor patients. The procedure enables one to avoid a standard ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy (ETV), especially in cases whose tumors extended superiorly and were not totally resected.

Objective Given the rarity of patients with pineal glioblastoma (GBM), clinical characteristics, treatment, and prognostic factors are not well characterized. This study aimed to investigate these characteristics and identify the prognostic factors of overall survival (OS). Methods A retrospective analysis of newly diagnosed patients with pineal GBM, including our 3 cases and an additional 44 cases from published articles, was conducted. Survival analysis was performed by Kaplan-Meier analysis and Cox regression analysis was used to determine the prognostic factors. Results A total of 47 patients (28 males and 19 females) were enrolled, with a median age of 46 years (range, 5–74 years). Forty-four patients (90.9%) had preoperative obstructive hydrocephalus. Among 38 patients, 21 (55.3%) had distal leptomeningeal dissemination. Forty-five patients (95.7%) had resection/biopsy, 6 of whom had gross total resection, 22 had subtotal resection, 7 had partial resection, and 10 had biopsy. Adjuvant therapy included radiotherapy in 36 patients and chemotherapy in 27 patients. The median OS was 10.0 months. The 6-month, 1-year, and 2-year survival was 68.0%, 42.6%, and 17.0%, respectively. Cox regression analysis showed that patients receiving biopsy (P = 0.042) or chemotherapy (P = 0.029) had the better OS and these were regarded as independent prognostic factors. Further survival analysis showed that chemoradiotherapy had better survival benefit than other regimens. Conclusions In this study, we summarized the characteristics of patients with pineal GBM and showed the correlation between clinical characteristics and prognosis. This study may give readers a deep understanding of these rare GBMs and provide some references for future management.

Given the rarity in the population with adult thalamic gliomas (ATGs), comprehensive characteristics, treatments and survival outcome are not well characterized. This study was conducted to investigate the comprehensive characteristic and treatment of ATGs and identify the prognostic factors associated with overall survival (OS). A retrospective analysis of newly diagnosed ATGs who underwent surgical resection consecutively was conducted. Survival analysis of OS was performed by Kaplan–Meier analysis. Cox proportional hazard model was used to investigate the possible prognostic factors associated with OS. A total of 102 patients with ATG were enrolled in this study. The median age was 41 years (range 18–68 years). There were 56 (54.9%) males. Sixty-two patients (60.8%) had glioblastoma (GBM). Among these patients, 46 patients (45.1%) had GTR/NTR, 50 patients (49.0%) had STR and 6 patients (5.9%) had PR. Postoperatively, 71.6% of these patients received adjuvant therapy. The median OS was 13.6 months (range 1 week–75 months). COX regression analysis revealed that ATG patients with longer duration of symptoms (p = 0.024), better pre-KPS (p = 0.045), maximal resection (p = 0.013), or lower tumor grade (p = 0.002) had longer OS, and these predictors are considered as independent prognostic factors. Survival analysis showed that ATGs with GTR/NTR plus chemoradiotherapy had significant OS advantage compared with other treatment regimens. This study comprehensively summarized the characteristics, treatments and survival outcomes of ATGs in the largest sample size. Maximal surgical resection can bring survival benefit. Combined-modality therapy regimen of GTR/NTR plus chemoradiotherapy may be better beneficial for OS than other regimens.

PURPOSEWe aimed to explored the influence of preoperative gamma knife treatment on the clinical effect of microsurgical resection of vestibular schwannoma.METHODSThe patients who underwent vestibular schwannoma resection in our hospital between November 2010 and December 2019 were retrospectively collected. According to retrospectively collected data, the patients who met the inclusion and exclusion criteria were defined as group A. The 1:3 ratio design was adopted in this study to select the group B that was not subjected to gamma knife treatment in the same period. The pre/postoperative clinical manifestations, neurological function grade, postoperative complications, tumor recurrence and increase were collected and compared between the two groups.RESULTSThere were 40 patients in group A and 120 patients in group B. At the last follow-up, the number of patients with poor facial nerve function was 15 (39.5%) in group A and 25 (21.2%) in group B (P = 0.025). In group A and group B, disequilibrium occurred in 14 patients and 17 patients respectively after operation (P=0.003). 7 patients caught the pulmonary infection in group A and 3 patients had a pulmonary infection in group B (P=0.03) after operation. CONCLUSIONSwhen a patient with vestibular schwannoma undergoes microsurgical surgery, the preoperative history of gamma knife treatment will make a recovery from postoperative facial paralysis difficult for the patients, making them more prone to suffer from postoperative disequilibrium and postoperative pulmonary infection.

BACKGROUND Vestibular schwannoma (VS) and meningioma are the most two common tumors in the cerebellopontine angle (CPA). Accurate preoperative differentiation of the two lesions is important due to their different surgical approaches and outcomes for the preservation of hearing and facial nerve function. Magnetic resonance (MR) scan is commonly performed to preoperatively evaluate CPA tumors and to differentiate VS from meningioma in clinical routine. However, in some cases, overlaps of conventional MR imaging patterns between the two lesions could make preoperative diagnosis challenging. The purpose of this study is to investigate the ability of radiomics, a novel method providing objective and quantitative information beyond visual assessment, in differentiation between VS and meningioma located at CPA using machine learning technology. MATERIAL AND METHODS This retrospective study enrolled eligible patients who were diagnosed with VS (N = 50) or meningioma (N = 41) in the CPA. A set of mineable three-dimensional radiomic parameters were extracted from preoperative contrast-enhanced T1-weighted images. Optimal features were selected first with three selection methods including distance correlation, least absolute shrinkage and selection operator (LASSO) and gradient boosting decision tree (GBDT). Then three machine learning classification algorithms, namely linear discriminant analysis (LDA), support vector machine (SVM) and random forest were employed to build discriminative models. Area under the curve (AUC), accuracy, sensitivity and specificity were calculated to assess the performance of each model. RESULTS Nine models were established with different combinations of selection methods and machine learning classifiers. Three classifiers with the suitable selection method all represented feasible ability in differentiation with AUC more than 0.86 in the validation set, and LDA-based models seemed to show better diagnostic performance than those based on the other two classifiers. The combination of LASSO and LDA classifier was found to show the highest AUC of 0.942 in the validation set. CONCLUSION Radiomics-based models via machine learning approaches could potentially be utilized to assist in preoperative differentiation between VS and meningioma in the CPA.

Cystic meningioma in the cerebellopontine angle (CPA) is an extremely uncommon disease. It is often misdiagnosed as other diseases. Its clinical features, surgical strategies and prognosis are not clearly understood. We reported a case of cystic meningioma in the CPA with tumor invasion into the internal auditory canal (IAC). Based on the typical preoperative symptoms, signs, hearing tests, and enhanced magnetic resonance imaging (MRI), the 36-year-old female patient was diagnosed with vestibular schwannoma and underwent surgical resection. Postoperative pathology revealed that the tumor was meningioma. It was totally removed without any new neurological dysfunction, and no recurrence was observed in the follow-up within 24 months. Cystic meningioma in the CPA is considered to have a high pathological grade and recurrence rate. Considering this situation, total intraoperative resection, including the enhanced wall of the tumor and postoperative follow-up may be critical.

Rationale: Hemangioblastomas (HMGs) originating from the cerebellopontine angle (CPA) are extremely uncommon. Nevertheless, the cystic-solid form of this lesion at the above location is even rarer. Patient concerns: We present a 31-years old male with a right ear hearing loss of 3 months duration. He did not experience earache or discharge before the hearing loss. He; however, experienced visual acuity and dizziness. General physical examination did not yield much. Diagnoses: Computed tomography and magnetic resonance imaging revealed a cystic-solid mass at right CPA. We initial misdiagnosed the lesion as an acoustic neuroma with cystic changes. Immunohistochemistry studies revealed HMG. Interventions: The lesion was total surgical resection via the retro-sigmoid approach. Outcomes: The patient's symptomatology resolved after the surgery. Two years follow-up show no recurrence of the lesion and the patient is well. Lesions: Identification of feeding arteries and electro-coagulating them during the operation minimized intraoperative bleeding. The tumor should usually be dissected out whole and not piece meal fashion. Pre-operative CTA is very useful in outlining the vasculature of the tumor.

To identify the risk factors for recurrence of World Health Organization (WHO) grade Ⅱ ependymomas of spinal cord in adults after microsurgical resections.A total of 118 adult patients diagnosed with WHO grade Ⅱ ependymomas of spinal cord at west china hospital from January 2010 to December 2016 were reviewed retrospectively. To identify the risk factors for recurrence, we performed univariate analyses and multivariate logistic regression analyses successively.Twelve patients had a recurrence with a median recurrence time of 30 months [inter-quartile range (IQR) 23.5-75.5 months]. Univariate analysis showed that age (p = 0.030), STR (p 0.001), index of Ki-67 (p = 0.004), and Vimentin (+, p = 0.004) were associated with postoperative recurrence of ependymomas of spinal cord in adults, while univariate analysis showed that only STR [odds ratio (OR) = 18.838, 95 % confidence interval (CI): 3.068-115.673; p = 0.002], index of Ki-67 (OR = 1.381, 95 % CI: 1.021-1.868; p = 0.036), Vimentin (+; OR = 6.706, 95 % CI: 1.218-36.928; p = 0.029) were independent risk factors for recurrence.The recurrence rate of WHO grade Ⅱ ependymomas of spinal cord in adults was about 13.6 %. Subtotal resection is a critical risk factor for recurrence. A high index of Ki-67 is another independent risk factor for recurrence. Positive Vimentin may also play a role in this process. GTR is very important to prevent recurrence after operation if it is safe to conduct. In cases with higher index Ki-67 and Vimentin (+), close follow-ups are necessary.

Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

Atypical teratoid/rhabdoid tumor (AT/RT) is a rare, highly malignant tumor of the central nervous system with poor prognosis. Nowadays, multimodal management, including surgery, chemotherapy (CMT), and radiation therapy (RT), is advocated. However, AT/RT treatment with gamma knife surgery (GKS) was rarely reported. The aim of this study was to assess the efficacy and safety of GKS for the treatment of AT/RT.Medical records of AT/RT patients who underwent surgery from 2007 to 2014 at the West China Hospital were retrospectively reviewed and statistically analyzed.Eighteen patients (12 males and 6 females) were presented with AT/RTs. Median age during presentation was 20.5 months (range, 4-179 months). Twelve patients were 3 years and six patients were 3 years. Tumor location was supratentorial in seven patients, infratentorial in ten patients, and center area of the brain in one patient. Treatments performed were as follows: surgery alone in two patients, surgery+RT in two patients, surgery+CMT in five patients, surgery+CMT+RT in two patients, and surgery+CMT+RT+GKS in seven patients. The 2-year overall survival (OS) rate and event-free survival (EFS) rate for all 18 consecutive patients were 33.3 and 27.8%, respectively. Cox regression analyses showed that multimodal management combined with GKS was an independent positive prognostic factor for OS.Although AT/RTs are lethal cancer types, the OS of the disease was improved by using multimodal therapeutic strategies, including surgery, CMT, and RT, combined with GKS.

Introduction: Intracranial dermoid cysts are benign, ectopic squamous epithelial cysts often compose of dermal structures like hair follicles, sweat glands as well as sebaceous glands. This lesions constitutes about 0.5% of all intracranial neoplasms. Thus, the occurrence of a dermoid cyst in the posterior fossa is very rare. We report a rare case of intracranial dermoid cyst in posterior cranial fossa. Case Presentation: Our first case was a 32 years old woman who presented with headaches and dizziness with no nausea, vomiting or fever. CT scan revealed a mass at occipital cistern consistent with a cystic lesion. MRI also revealed an irregular lesion in the posterior part of the medulla oblongata with enhanced edges signifying calcifications. We attained total resection of the tumor in a piece meal approach via surgery. Histopathology confirmed dermoid cyst. Two years follow-up revealed no recurrence of the lesion and no neurological deficits. Conclusion: We advocate that, the goal in surgical decision-making should be safe and total resection while monitoring the cranial nerves with electromyographic and auditory brainstem responses.

Objectives Postoperative complications occurred in about 30% patients after vestibular schwannoma (VS) microsurgical excision. Although many specific complications have been extensively studied, postoperative pneumonia (POP) has received little attention. This study was designed to identify the risk factors for POP after microsurgery for VS. Patients and methods Patients undergoing VS microsurgical resection (n = 244) between December 2014 and November 2016 at West China Hospital of Sichuan University were retrospectively assessed for POP. Univariate and multivariate analyses were performed to identify the risk factors for POP. Results POP (Clavien–Dindo grade II or higher) was diagnosed in 29 (11.9%) patients. Univariate analysis revealed that age (≥60 years; p = 0.013), diabetes mellitus (DM; p = 0.040) and Koos grade IV ( p = 0.017) were significantly associated with POP. Multivariate analysis revealed that these factors were all independent risk factors for POP. Association between POP and prolonged postoperative hospitalization was also revealed. However, no risk factor associated with severity of POP was found in this study. Conclusion Older age, DM and Koos grade IV were identified as independent risk factors for POP after microsurgery for VS Moreover, POP caused a prolonged hospital stay.

Background Postcraniotomy meningitis is a severe complication in neurosurgery, and can result in high morbidity and mortality. Closed continuous lumbar drainage (CCLD) as an adjuvant method for treating postcraniotomy meningitis in adults is rarely assessed. This study aimed to evaluate the efficacy of CCLD in the treatment of postcraniotomy meningitis. Methods A total of 1062 patients older than 16 years with postcraniotomy meningitis were included, between January 2000 and December 2015. Of these, 474 received intravenous antibiotic therapy, steroid administration and adjuvant CCLD (experimental Group). The remaining 588 patients only received intravenous antibiotic and steroid therapies (control Group). Data were extracted from medical records. Results In the experimental group, meningitis-related mortality was 2.7%, and 77.4% individuals achieved a Glasgow Outcome Scale of 4–5. In the control group, meningitis-related mortality reached 11.6%, with only 61.1% of patients achieving a GOS of 4–5. The time to negative cerebrospinal fluid laboratory test and the duration of meningitis-related symptoms were significantly shorter in the experimental group compared with controls ( P Conclusions Intravenous antibiotic and steroid therapies, assisted by CCLD, can lead to lower mortality and improved Glasgow Outcome Scale score in patients with meningitis after craniotomy. Laboratory results negative for cerebrospinal fluid leak and meningitis-related symptom relief occurred faster in the experimental group. Intravenous antibiotic and steroid therapies combined with CCLD appear to be an effective and safe treatment for postcraniotomy meningitis.

Background: Intracranial schwannomas of the accessory nerve are very rare lesions. They are categorised according to their locations into either intrajugular or intracistemal schwannomas although most of them are intrajugular. The intrajugular type constitutes about 2% to 4% of all intracranial schwannomas described in literature. Aim: It’s very unusual for an accessory nerve to mimic glossopharyngeal nerve looking at the anatomical location of the accessory nerve. Although many authors have written on accessory nerve, none have described this unusual presentation. We present a case, management as well as review on the classification and appropriate surgical techniques we could have use to access the tumor in our patient since the choice of a particular surgical approach is based on the nature of tumor, location as well as it extension into other adjacent structures. Case Presentation: We present a case of 52-year-old woman with very unusual accessory nerve schwannoma which mimics the clinical presentation of glossopharyngeal nerve tumor. The main symptom in our case is six (6) months history of deviation of the tongue to right side with dizziness and change of voice. Conclusion: The unusual presentation in our case could be due to massive compression of glossopharyngeal nerve by the growing accessory nerve schwannoma since most lower cranial nerve schwannomas at this location will almost always course compressive symptoms.

The aim of this study was to evaluate the accuracy of novel software-CMF-preCADS-for the prediction of soft tissue changes following repositioning surgery for zygomatic fractures. Twenty patients who had sustained an isolated zygomatic fracture accompanied by facial deformity and who were treated with repositioning surgery participated in this study. Cone beam computed tomography (CBCT) scans and three-dimensional (3D) stereophotographs were acquired preoperatively and postoperatively. The 3D skeletal model from the preoperative CBCT data was matched with the postoperative one, and the fractured zygomatic fragments were segmented and aligned to the postoperative position for prediction. Then, the predicted model was matched with the postoperative 3D stereophotograph for quantification of the simulation error. The mean absolute error in the zygomatic soft tissue region between the predicted model and the real one was 1.42±1.56mm for all cases. The accuracy of the prediction (mean absolute error ≤2mm) was 87%. In the subjective assessment it was found that the majority of evaluators considered the predicted model and the postoperative model to be 'very similar'. CMF-preCADS software can provide a realistic, accurate prediction of the facial soft tissue appearance after repositioning surgery for zygomatic fractures. The reliability of this software for other types of repositioning surgery for maxillofacial fractures should be validated in the future.

Diffuse intrinsic pontine glioma (DIPG) is a fatal brain cancer. Transient response to radiotherapy, ineffective chemotherapy and aggressive biology lead to rapid...

OBJECTIVEMeningitis after microsurgery for vestibular schwannoma (VS) is a severe complication and result in high morbidity. But few studies have focused on meningitis after VS surgery alone. The purpose of this study was to identify the risk factors for meningitis after VS surgery.METHODSWe undertook a retrospective analysis of all VS patients, who underwent microsurgery of VS and at least live for 7 days after surgery, between 1st June 2015 and 30st November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM).RESULTSWe collected 410 patients, 27 of whom had POM. Through univariate analysis, hydrocephalus (p=0. 018), Koos grade IV (p=0.04), The operative duration (> 3 hours p=0.03) and intraoperative bleeding volume (≥ 400ml p=0. 02) were significantly correlated to POM. Multivariate analysis showed that Koos grade IV (p=0.04; OR=3.19; 95% CI 1.032-3.190), operation duration (> 3 hours p=0.03 OR= 7.927; 95% CI 1.043-60.265), and intraoperative bleeding volume (≥ 400ml p=0.02; OR=2.551; 95% CI 1.112-5.850) are the independent influencing factors of POM.CONCLUSIONSKoos grade IV, the duration of operation, and the amount of bleeding were identified as independent risk factors for POM after microsurgery of VS. POM caused a prolonged hospital stay.

Background Postoperative hemorrhage (POH), an uncommon complication after cranial operation, may result in prolonged postoperative hospitalization, severe neurologic impairment, or even death. Most models in studies detecting risk factors for POH include all kinds of cranial lesions; however, factors associated with POH may vary among intracranial diseases. There is a paucity of large sample studies focusing solely on POH after intracranial tumor surgery. Therefore, this study was designed to investigate the preoperative risk factors for POH after surgery for intracranial tumor. Methods Medical records of 2259 adult patients who underwent primary surgical resection of single intracranial tumor between January 2017 and June 2018 at West China Hospital of Sichuan University were retrospectively studied. Univariate and multivariate analyses were performed to identify the risk factors for POH after resection of intracranial tumor. Results POH (defined as postoperative hematoma requiring surgical evacuation) occurred in 40 of 2259 patients (1.8%). Univariate analysis revealed that older age (P = 0.037, Wilcoxon-Mann-Whitney test), higher international normalized ratio (INR) (P = 0.037, Wilcoxon-Mann-Whitney test), and larger tumor size (P = 0.001, Wilcoxon-Mann-Whitney test) were significantly associated with POH. Then it was confirmed by multivariate analysis that all of the 3 factors (older age: P = 0.033, higher INR: P = 0.044, larger tumor size: P = 0.002) were independent risk factors for POH after removal of intracranial tumor. Conclusions Older age, higher INR, and larger tumor size were identified as independent risk factors for POH after resection of intracranial tumor in adults.

Rationale: Cerebellopontine angle (CPA) ependymomas are atypical kind of ependymomas that characteristically occur in the pediatric age group. Therefore, finding a case of CPA ependymoma in a young male adult is not a common occurrence. Patient concerns: We present a case of a 28-year-old male who was involved in road traffic accident with suspected mild head injury. He did not have any antecedent complains before the accident. Diagnoses: An incidental computer tomographic scan of the head revealed an intracranial space-occupying lesion at the left CPA. Immunohistochemical staining of the specimens indicated WHO grade II ependymoma. Interventions: The tumor was surgically resected and the patient was further treated with radiotherapy. Outcomes: The patient recovered well postoperatively and 2 years follow-up revealed no tumor recurrence and the patient is currently well. Lessons: The diagnosis of ependymomas can be very challenging in adults because they are mostly mainly seen in the pediatric age group. We propose that one of the differential diagnosis of tumors in the CPA in a young adult should be CPA ependymoma.

[This corrects the article DOI: 10.1371/journal.pone.0217253.].

Introduction: Radiation induced gliomas often occurs after radiation therapy for other brain tumors. Medulloblastoma often occurs in children and its associated radiation-induced glioblastoma multiforme's (GBM) after radiotherapy often has a long latency period. Our case is very unique because the medulloblastoma was detected at an advance age and the latency period of radiation-induced GBM was relatively shorter. Patients Concerns: A 64-year-old male was first admitted at our hospital in March 2018 with dizziness, vomiting, and blurred vision. Diagnosis: Magnetic resonance imaging of brain revealed a lesion with local mixed density and mass enhancement in left cerebellar region. Histopathology established medulloblastoma (World Health Organization) grade 4 and a classic histological subtype after surgery. Intervention: Surgical resection followed by radiation therapy were the initial therapeutic modalities. Outcomes: In April 2019, the patient was readmitted with dizziness and blurred vision. Magnetic resonance imaging showed the left cerebellar hemisphere bulky enhancement lesion. Again, a multimodal therapy comprising surgical resection, radiation therapy as well as chemotherapy was adapted after histopathology established GBM. Lesion: Radiotherapy for medulloblastoma patients at advance ages is a critical predisposing factor for the development of radiation-induced GBM in a very short period of time. We suggest that, radiotherapy as adjuvant therapy for medulloblastoma patients at advance ages should be chosen with extreme caution.