Application of Preoperative CT/MRI Image Fusion in Target Positioning for Deep Brain Stimulation

Objective To explore the efficacy of target positioning by preoperative CT/MRI image fusion technique in deep brain stimulation.Methods We retrospectively analyzed the clinical data and images of 79 cases(68 with Parkinson's disease,11 with dystonia) who received preoperative CT/MRI image fusion in target positioning of subthalamic nucleus in deep brain stimulation.Deviation of implanted electrodes from the target nucleus of each patient were measured.Neurological evaluations of each patient before and after the treatment were performed and compared.Complications of the positioning and treatment were recorded.Results The mean deviations of the electrodes implanted on X,Y,and Z axis were 0.5 mm,0.6 mm,and 0.6 mm,respectively.Postoperative neurologic evaluations scores of unified Parkinson's disease rating scale(UPDRS) for Parkinson's disease and Burke-Fahn-Marsden Dystonia Rating Scale(BFMDRS) for dystonia patients improved significantly compared to the preoperative scores(P<0.001); Complications occurred in 10.1%(8/79) patients,and main side effects were dysarthria and diplopia.Conclusion Target positioning by preoperative CT/MRI image fusion technique in deep brain stimulation has high accuracy and good clinical outcomes.

Nontraumatic convexal subarachnoid hemorrhage:A case report

BACKGROUND Nontraumatic convexal subarachnoid hemorrhage(c SAH)is a rare type of atypical subarachnoid hemorrhage.It mainly presents as a focal and transient neurological deficit with similar manifestations as transient ischemic attack.CASE SUMMARY We report a case of a 64-year-old man who visited the hospital with paroxysmal left-sided numbness and weakness is presented in this study.Computed tomography examination indicated a high-density image of the right frontalparietal sulcus.Digital subtraction angiography showed severe stenosis at the right anterior cerebral artery A2-A3 junction(stenosis rate approximately 70%).CONCLUSION The findings of this case indicate that anterior cerebral artery stenosis may lead to the occurrence of c SAH.

Does Early Postsurgical Temozolomide Plus Concomitant Radiochemotherapy Regimen Have Any Benefit in Newly-diagnosed Glioblastoma Patients？ A Multi-center, Randomized, Parallel, Open-label, Phase II Clinical Trial

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 ofcorticosteroid and neurological status test. Hematological, biochemical, laboratory, adverse event （AE）, and neurological condition were measured for 24 months of tbllow-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.

Functioning gonadotroph adenoma

To the Editor:Pituitary gonadotroph adenoma is a type of non-functioning pituitary adenoma of which approximately 35%ecrete biologically active luteinizing hormone(LH)or follicle-stimulating hormone(FSH),and these adenomas are named functioning gonadotroph adenoma(FGA).We present three cases of FSH-secreting adenomas who were admitted to our hospital between 2014 and 2016.Case 1:A 37-year-old woman was admitted due to menstrual irregularity and galactorrhea for 2 years.The laboratory tests showed a significantly elevated estradiol 2(E2)level,and multiple cyst fusions could be observed by transvaginal ultrasonography.The pituitary magnetic resonance imaging(MRI)revealed an upper-right wing distension and detected a mass with a size of approximately 7.5 mm×10.7 mm in the saddle area,and a pituitarymacroadenoma was considered.The patient underwent a transsphenoidal microsurgical resection of the pituitary adenoma.The pathologic examination showed a positive result for FSH,LH,and SF-1,and a negative result for growth hormone,insulin-like growth factor 1,TPIT,and PIT1.

A case of subdural hematoma with a medical history of hemophilia a and a review of related literature

Background: Intracranial hemorrhage is the most common emergency in the neurology department, and patients with a medical history of hemophilia have a risk of severe bleeding. Case presentation: A 56-year-old man was admitted to the emergency department in our hospital. He was diagnosed with hemophilia A and subdural hematoma. We administered an infusion of factor VⅢ to decrease the risk of bleeding and improve the prognosis. Factor VⅢ infusion is the most important factor in treating hemophilia A patients. Conclusion: We recommend carefully checking coagulation function and the medical history once these patients are admitted, especially in the emergency department.

Xanthogranuloma of the Sellar Region

To the Editor： A 36-year-old female patient was admitted to Peking Union Medical College Hospital complaining of 6 years of headache. Magnetic resonance imaging （MRI） showed an intrasellar lesion with homogeneous hyperintense on T 1-weighted images and T2-weighted images and inhomogeneous contrast enhancement by the gadolinium administration [Figure l a and lb]. Rathke＇s cleft cyst was initially diagnosed preoperatively, and the tumor was totally resected by transsphenoidal surgery. Histopathology revealed that granulomatous tissue consisted of cholesterol clefts, lymphoplasmacellular infiltrates, marked hemosiderin deposits, and multinucleated foreign body giant cells around cholesterol clefts [Figure 1 e- 1 g].

Three acquired immunodeficiency syndrome patients with central nervous system infection: diagnostic approach and outcome of treatment

The patients w让h acquired immunodeficiency syndrome(AIDS)are prone to opportunistic infections due to immune deficiencies.Because the AIDS virus is neuropathic,10%of AIDS patients first manifested central nervous system(CNS)symptoms.111 More than 40% of untreated AIDS patients will develop CNS diseases.121 The diagnosis and treatment for AIDS complicated with intracranial lesions are mainly based on clinical experience and laboratory tests.If necessary,brain biopsies were taken into consideration to help to diagnose and choose a suitable therapy.In clinic practice,to get a specific diagnosis is very difficult.To further analyze the clinical features of such patients and to provide some suggestions for the clinical diagnosis and treatments,we retrospectively analyzed three AIDS cases with CNS infection who attended the Peking Union Medical College Hospital.

An innovative process of clad teeming for preparing slab ingot

An innovative process of clad teeming was proposed to prepare slab ingot,which featured a built-in cold core to inhibit solidification defects.A 20-kg clad ingot was prepared in the experiment,using a volume ratio of solid core to molten steel of 1:13 and a preheating temperature of cold core of 573 K.Solidification microstructures of the clad ingot were analyzed by comparing with a reference ingot without cold core.Interfacial morphologies and mechanical properties of the clad ingot were studied before and after hot rolling.The effect of cold core on heat transfer and nucleation during the solidification in clad ingot was analyzed.Results show that the solidification microstructures in the clad ingot are refined and homogenized obviously.The grain size in the center of the reference ingot is 2–3 times greater than that of clad ingot,and there is almost no columnar grain in the clad ingot.The interfacial shear strength reaches 318 MPa,which shows excellent metallurgical bonding at the interface of cold core and molten steel.Tiny defects at the interface are eliminated,and interfacial shear strength reaches 426 MPa after hot rolling with a 68.4%total reduction ratio.The experiment and analysis of this process are expected to provide a new idea to prepare large ingots with refinement and homogeneity at a low cost.

A Case of Intracranial Solitary Fibrous Tumor

To the Editor：Intracranial solitary fibrous tumor （SFT） is a kind of rare tumor.It was first identified as a distinct entity in 1996 and included by the 2000 World Health Organization classification of tumors of the nervous system.