Visual findings as primary manifestations in patients with intracranial tumors

· AIM: To evaluate the visual findings as primary manifestations in patients with intracranial tumors.·METHODS: The medical charts of the patients with intracranial tumors who initially admitted to the Neuro-ophthalmology and Strabismus Department with ocular complaints between August 1999 and December 2012 were reviewed retrospectively. The detailed clinical history and the findings of neuro-ophthalmologic examination were recorded. Ocular symptoms and signs,the types and locations of intracranial tumors, and the duration of symptoms before the diagnosis were evaluated.·RESULTS: The mean age of 11 women(61.1%) and 7men(38.9%) was 42.2±11.0(range 20-66y) at the time of intracranial tumor diagnosis. Initial symptoms were transient visual obscurations, visual loss or visual field defect in 16 cases(88.9%), and diplopia in 2 cases(11.1%). Neuro-ophthalmologic examination revealed normal optic discs in both eyes of 6 patients(33.3%),paleness, atrophy or edema of optic disc in 12 patients(66.7%), and sixth cranial nerve palsy in 2 patients(11.1%). Visual acuity ranged between normal vision and loss of light perception. Cranial imaging demonstrated craniopharyngioma(n =1), plasmacytoma(n =1),meningioma(n =6; olfactory groove and tuberculum sellae, pontocerebellar angle, anterior cranial fossa,frontal vertex, suprasellar region), and pituitary macroadenoma(n =10). The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 9.8±18mo(range 3d-6y).·CONCLUSION: The ophthalmologist is frequently the first physician to encounter a patient with clinical manifestations of intracranial tumors that may cause neurological and ocular complications. Neuro-ophthalmologic findings should be carefully evaluated to avoid a delay in the diagnosis of intracranial tumors.

Application of proton MR spectroscopy on evaluation of radiotherapy treated intracranial tumors

Objective： To evaluate the clinical application of proton magnetic resonance spectroscopy （1HMRS） in patients with radiotherapy treated intracranial tumors. Methods： Forty patients with intracranial tumors underwent multivoxel 1HMRS examination before and after radiotherapy. The concentrations of N-acetyl aspartate （NAA）, choline （Cho） and creatine （Cr） were obtained both in the tumors and the contralateral normal brain regions, The ratios of NANCr, Cho/Cr and Cho/NAA were calculated at the same time and follow-up one year. Results： （1） After radiotherapy, tumors inhibited by radiation had decreased Cho, NAA and Cr on proton MRS. Some cases showed necrotic wave. （2） During the one year follow-up, local tumor recurred in 8 cases and their Cho and Cho/NAA increased high again. Other cases without recurrence, HMRS showed no change. Conclusion： Multivoxel proton MR spectroscopy is available for study of tumor metabolites after radiotherapy and it is a valuable method in the evaluation of radiotherapy treated tumors,

Intracranial Meningiomas among Intracranial Tumors in the Neurosurgical Unit of Sylvanus Olympio Teaching Hospital

Objective: To describe the pattern of intracranial tumors in Sylvanus Olympio teaching hospital of Lomé (Togo). Method: We conducted a retrospective and descriptive study between November 2017 and December 2019. Data were obtained from the clinical records of patients with intracranial tumors treated in our neurosurgery unit, and histology obtained. Patients without a definitive histological diagnosis were excluded. Results: 53 patients were operated and had a histological diagnosis in the period of the study. The mean age at diagnosis was 32 ± 27.1 years. The majority of tumors were seen in adults at 88.7% with age range between 23 - 75 years and a mean age of 40 ± 10.5 years. Meningioma was the commonest intracranial tumor in adults (47.2%) and more seen in females. The histological type of meningioma is meningotheliomatous in our study. In children, principal tumors were medulloblastoma and ependymoma (11.3%). Conclusion: Meningioma is the most common intracranial tumor in adults, while embryonal tumors (medulloblastoma and ependymoma) are the most frequent in children in our environment.

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery MRI for intracranial tumors in comparison with post-contrast T1W spin-echo MRI

Background Contrast-enhanced fluid-attenuated inversion-recovery （FLAIR） magnetic resonance imaging （MRI） has been reported to have higher sensitivity for detecting leptomeningeal disease compared with contrastenhanced T1-weighted MRI （CE T1WI）. However, currently there are no studies showing the potential value of clinical applications of contrast-enhanced FLAIR （CE FLAIR） sequence in diagnosing intracranial tumors in a larger group of patients. The purpose of this study was to evaluate the diagnostic value of CE FLAIR in comparison with CE TlWI for intracranial tumors and to provide more information for clinical diagnosis and therapy. Methods One hundred and four consecutive cases of intracranial tumors referred for CE brain MRI were analyzed with regard to FLAIR and TlWI pre- and post-administration of Gd-DTPA. The CE FLAIR and CE TlWI were evaluated independently by two radiologists for the number of examinations with one or more enhanced lesions, the number and location of enhanced lesions per examination, signal-to-noise ratio （SNR） and contrast-enhancement ratio （CER） of lesions, as well as the size and extent of the enhanced lesions. Results In 98 of 104 cases, enhanced lesions were seen both on the FLAIR and TlW images. More lesions were seen on CE TlWI （n=120） than those on CE FLAIR sequence （n=llT）, but no differences of statistical significance were found between the two sequences （/＇〉0.05）. Four lesions were revealed only on the CE FLAIR images whereas 7 lesions were only found on CE TlWI. Enhanced lesions located in the cerebral hemisphere or the forth ventricle were revealed much more on CE T1WI than on CE FLAIR images. However, CE FLAIR images may be useful in showing superficial abnormalities and those located in the sulcus or lateral ventricle. The CER and contrast-to-noise ratio （CNR） on CE T1WI was significantly higher （t=7.10, P=0.00; t=9.67, P=0.00, respectively）, but grey matter/white matter contrast was lower （t=-2.46, P=-0.02） than those on CE FLAIR images. The SNR did not show any statistically significant difference between the two sequences （t=-1.1, P=-0.27）. The size and extent of lesions on the CE FLAIR images were significantly larger than those on CE TIWI （t=4.13, P=0.00）.

Intracranial malignant solitary fibrous tumor metastasized to the chest wall:A case report and review of literature

BACKGROUND Solitary fibrous tumor(SFT)is a rare fibroblastic mesenchymal neoplasm that affects spindle cell soft tissues with broad-spectrum biological behavior;it is predominantly benign,and rarely metastasizes.SFT occurs mainly in the tissue structure of the serosa in the pleura and the thorax,and can be found throughout the body,though extra-thoracic localization,including the cephalic region,is uncommon.We reported the first case of intracranial malignant SFT metastasized to the chest wall.CASE SUMMARY An 81-year-old Japanese man was referred to our hospital due to progressive gait disturbance and appetite loss.His medical history included partial resection due to brain tumor,four times,and 50-Gray radiation therapy at another hospital,starting when he was 74 years old.An unenhanced head computed tomography(CT)scan revealed an 8 cm×5.1 cm×6.5 cm mixed-density mass at the left frontal lobe,accompanying a midline shift,and an unenhanced chest-abdomen CT scan revealed a 6 cm×4.1 cm×6.5 cm low-density mass in the left chest wall.A CT-guided percutaneous lung biopsy was performed,and the pathological findings were SFT corresponding to brain tumor.Finally,the correct diagnosis of his brain tumor in history of past illness revealed to be SFT,and the unremovable tumor,namely present brain lesions enlarged and metastasized to the chest wall.We established a definitive diagnosis of intracranial malignant SFT metastasized to the chest wall.We notified him and his family of the disease,and offered palliative care.He passed away on the 29 th hospital day.CONCLUSION This case suggests the need for careful,detailed examination,and careful followup when encountering patients presenting with a mass.

Brain Cancer Treatment with Gene Editing

The first method is used gene editing to knock out the PD-L1 receptor located on the T cell surface so that PD-1 on the cancer cell surface cannot combine with the PD-L1,in that case,T cell can identify the abnormal cell and kill it.At the beginning,researchers use protein-guided editing technology,but it is not easy to control and not specific enough,so they choose to use CRISPR-Cas9 to edit the target gene.Comparing with the traditional protein-guided nucleases,CRISPR-Cas9 system is more easy-handle,highly specific,and it is an more efficient tool for engineering eukaryotic genomes;because CRISPR-Cas9 system aims to edit the targeting genes by tiny RNAs guiding the Cas9 nuclease to the target site by base pairing.The second treatment is mainly used“fighting cancer with cancer”.Because living tumor cells have the ability to home and target tumors,thus,if those living tumor cells can be engineered to secrete therapeutic agents,the tumor cells can be effectively cured.Shah’s team picked the agent interferon-β(IFN-β).However,this idea of treatment is limited by the premature cell death due to autocrine toxicity.The researchers solved this problem by first using CRISPR Cas9 to knock out the IFN-β–specific receptor(IFNAR1)in inherently IFN-β–sensitive syngeneic tumor cells,and subsequently engineered them to constitutively produce IFN-βfor tumor cell targeting and simultaneous immunomodulation.These therapeutic cells are further designed to coexpress granulocyte-macrophage colony-stimulating factor(GM-CSF)that facilitates the differentiation,proliferation,and recruitment of dendritic cells(DCs).The last approach can stop cancer cell repairing their DNA when it gets damaged.

Primary intracranial synovial sarcoma with hemorrhage:A case report

BACKGROUND Synovial sarcoma(SS)is a highly malignant tumor of unknown histological origin.This tumor can occur in various parts of the body,including those without synovial structures,but mainly in and around the joints,mostly in the lower extremities.Primary intracranial SSs are remarkably rare.This paper aims to report a case of primary intracranial SS with hemorrhage.CASE SUMMARY A 35-year-old male patient suffered a headache and slurred speech during manual labor and was sent to the emergency department.Through imaging examination,the patient was considered to have high-grade glioma complicated with hemorrhage and was treated with craniotomy.Postoperative pathology revealed SS.positron emission tomography/computed tomography was performed,which ruled out the possibility of metastasis to the intracranial from other parts of the body.Postoperative radiotherapy was given to the patient,during which radiation necrosis occurred.Sixteen months after craniotomy,cranial magnetic resonance imaging revealed recurrence of the tumor.CONCLUSION Primary intracranial SS is a rare malignant tumor.Primary intracranial SS with hemorrhage and radiation necrosis should be carefully monitored during postoperative radiotherapy.Surgical resection of the tumor combined with postoperative radiotherapy and chemotherapy is currently used,but the prognosis is poor.

Diabetes insipidus with impaired vision caused by germinoma and perioptic meningeal seeding:A case report

BACKGROUND Germinoma is a type of germ cell tumor that most frequently arises in the midline axis of the brain.Impaired vision is a clinical manifestation of germinnoma.Although rare,intracranial germinoma seeding to the perioptic arachnoid space is one cause of visual acuity decrease.CASE SUMMARY An 11yearold girl who presented with polyuria and polydipsia and subsequently developed diminution of vision.Imaging showed bilateral heterogeneous enhancement of the optic nerve sheaths and atrophy of the optic nerve,and transsphenoidal biopsy revealed a germinoma.The patient experienced poor visual recovery following chemotherapy and radiotherapy.Germinomas are rare and they are mostly identified in children and adolescents.The manifestations include diabetes insipidus,pituitary dysfunction,visual complaints,etc.The mechanisms that lead to visual loss include intracranial hypertension,compression of optic chiasma,and tumor invasion.A literature review was performed to summarize the cases with a tumor infiltrating the optic nerve.Most of the reported patients were adolescents and presented with anterior pituitary hormone deficiency.Enhancement of optic nerve sheaths and optic disc pallor could be identified in most of the cases.The purpose of this report is to provide awareness that in cases where a germinoma is associated with visual loss,though rare,perioptic meningeal seeding should be taken into consideration.CONCLUSION The case report suggests that children with diabetes insipidus need a complete differential diagnosis.

Cognitive Impairment and Recovery in Meningiomas and Low-Grade Gliomas

This study aims to elucidate the nature of cognitive deficits caused by intracranial tumors, as well as to examine how a surgical operation of the tumor may affect tumor-induced cognitive deficits. The patient group included 43 individuals with meningioma or low-grade glioma admitted to a surgical operation of the tumor. Neuropsychological examination was conducted preoperatively, as well as three and 12 months postoperatively. The control group comprised 31 healthy subjects. In the tumor patients, preoperative cognitive performance was compromised in several cognitive domains as compared to the controls. The tumor patients with frontal and large tumors showed impairment virtually across all cognitive domains. Postoperatively, the cognitive performance of the meningioma and the small tumor group improved in all domains, with the performance of the low-grade glioma group and the large tumor group reflecting more modest cognitive improvement. Most of this improvement did not emerge until the 12 months follow-up. Cognitive impairment due to an intracranial tumor is diffuse affecting most cognitive domains. Cognitive recovery after the surgery is more noticeable in patients with meningiomas and small tumors, and the recovery will require a minimum of one year time-wise. This evidence is of significant value when planning both clinical treatment and rehabilitation of intracranial tumor patients.

Dendritoma therapy of transferrable brain glioma in mice: An experimental study

Glioma is the most common central nervous system primary tumor,accounting for about 40%of intracranial tumors.In recent years,studies have shown that the human brain is not immune-free zone.The low immunogenicity of the tumor itself,tumor-generated immunosuppressive factors,and the low immunity of tumor patients all contribute to the“immune escape”phenomenon of glioma cells.Dendritic cells(DCs),as the strongest antigen-presenting cells in the body,play an important role in tumor immunotherapy with T-cell recognizing tumor antigens as the core.Therefore,it is necessary to adopt a strategy of culturing and sensitizing DC cells in vitro to increase their number and improve their function before returning to the body for treatment of patients with glioma.

Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection

Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.

Giant colloid cyst of the third ventricle:challenges in management

Background:Giant colloid cysts (size>3 cm) are very rare with only few reported cases in the literature. Case presentation:We report a case of 44 year female who presented with features of raised intracranial pressure, memory and gait disturbances. CT and MR imaging showed a large colloid cyst at foramen of Monro leading to obstructive hydrocephalus. The patient underwent right interhemispheric transcallosal-transforaminal approach and complete excision of the cyst. Conclusions:For a large size of colloid cyst complete surgical excision is recommended. However deep midline location, proximity to the vital structures and giant size of the lesions make surrounding vital structures vulnerable for injury.