Degree Of Tumor Resection Research Articles

Exploration of technique for preservation of external-middle ear structure in surgery of jugular foramen paraganglioma （appended 2 case reports）

Objective:To investigate the feasibility and effect of the modified surgery of the classic infratemporal fossa type A approach for the surgical treatment of jugular foramen paraganglioma with preservation of the external and middle ear structures. Methods:The medical data of 2 patients with jugular foraminal paraganglioma treated by sublabyrinthic-transmastoid approach were retrospectively analyzed. The clinical feature, degree of tumor resection, postoperative facial nerve function and hearing retention, and the incidence of postoperative complications were evaluated. Results:Two patients were both female, and were pathologically confirmed as paraganglioma. The tumor of case 1 was staged as C2De1, and case 2 as C1De1. Tumors were completely resected in both patients. Case 1 suffered infection after surgery, with residual tympanic membrane perforation and mixed deafness. Case 2 developed mild facial paralysis（grade Ⅱ） after surgery, and recovered after symptomatic treatment. There was no tumor residue or recurrence during half a year of follow-up. Conclusion:Surgical treatment of certain paragangliomas in the jugular foramen with a combined sublabyrinthic-transmastoid and upper neck approach might achieve both complete resection of the tumor and preserving the structure and function of the outer-middle ear. This procedure is suitable for paragangliomas restricted in the jugular foramen area, with no or limited involvement of the internal carotid artery（C1 or C2）, and with no or mild hearing loss.

Surgical outcome of endoscopic endonasal approach as a modality of management for large and giant pituitary adenomas: a retrospective case series

BackgroundLarge and giant pituitary adenomas (defined as tumors of maximal diameter ≥ 3–3.9 cm and ≥ 4 cm, respectively) present considerable surgical challenges regarding the extent of resection and perioperative morbidity. Endoscopic endonasal resection is considered the most effective treatment for pituitary adenomas. It allows for better visualization, maneuverability, and access to distant and lateral tumor compartments, ultimately enhancing the extent of resection. This article evaluates our initial experience with endoscopic endonasal resection of large and giant pituitary adenomas. The clinical outcomes, perioperative complications, and extent of tumor resection would be specifically addressed.Patients and methodsThe primary goal of surgery was to decompress the optic pathways, and the secondary goals were to achieve maximal safe resection and hormonal control in hormone-secreting adenomas. The degree of tumor resection was classified as gross-total resection (100%), near-total resection (90–100%), subtotal resection (70–90%), and partial resection (< 70%).Results42 patients were included in this study. A good visual outcome achieved with 80% improvement in visual symptoms. Gross-total resection (GTR) was achieved in 19 patients (45.2%), near-total resection (NTR) was achieved in 12 patients (28.6%), subtotal resection (STR) in 6 patients (14.3%), and partial resection in the remaining 5 patients (11.9%). Subgroup analysis revealed that GTR, NTR rates were higher in large, compared to giant tumors. GTR, NTR rates of large adenomas were 59.3%, and 29.6%, compared to 20%, and 26.7% in giant adenomas respectively (p-value: 0.01428). Surgical complications were observed in 19 patients (45.2%) with CSF leakage being the most common complication (11 patients, 26.2%). Post-operative diabetes insipidus was observed in 5 patients (11.9%), major vascular injury in one case (2.4%), transient post-op 6th nerve palsy observed in 3 patients (7.1%), while two patients (4.8%) presented with post-operative paranasal sinuses infection.ConclusionsEndoscopic endonasal transsphenoidal resection of large and giant pituitary adenomas is a safe and efficient procedure. Large adenomas (3–3.9 cm) have excellent resection rates and lower complications than giant adenomas (≥ 4 cm), which may require extending our approach to achieve more tumor resection rates in the future. However, only adequate resection of these giant adenomas can be enough to achieve the main surgical goals of visual improvement, hormonal control, and decompression of surrounding structures.

Efficacy of Operative Ultrasonography Plus Neuronavigation for Brain Glioma Surgery: 2 – Year Single Center Experience in a Developing Country

Background: preoperative MRI data has been the gold standard for the diagnosis and therapy of malignant gliomas for decades, and operative ultrasonography for the management of patients with neurological pathologies that require surgical treatment has been also used for many years as it provides additional image guidance for surgical procedure to neuronavigation techniques. The main objective of this study is to find out if the use of operative ultrasonography in glioma surgery could give greater benefit in the total resection of brain gliomas and how improvement influences the degree of neoplastic resection on the survival of patients. Methods: prospective case-control study that was performed at the ISSEMyM Licenciado Arturo Montiel Rojas Medical Center, of patients with a histopathological diagnosis of cerebral glioma treated by the neurosurgery service in the period between January 2018 and December 2020. Results: Thirty - two patients were included, with 13 patients (40.6%) with grade IV astrocytoma. Operative USG + NNV was used in 17 patients and a subtotal or total resection was achieved in 75% of the patients, with a significantly lower postoperative volumetry in patients operated on by NNV + USG (5.6mm3 + 2.5), compared to NNV alone (8mm3 + 2.8) However, these results did not affect tumor-free time, which was comparable between both groups. Conclusions: Surgical treatment of brain gliomas with USG + NNV has a good degree of tumor resection compared to those treated with NNV only, but the main factor affecting survival is the hystophatological grade of the tumor.

Appearance of intracranial cottonoids on intraoperative magnetic resonance imaging.

To our knowledge, this is a unique report of intraoperative magnetic resonance imaging (iMRI) of an intracranial cottonoid. The current literature describes images of cottonoids as a post-operative finding in the setting of an unintentionally retained foreign body; however, the iMRI images we present are important as the use of iMRI in the resection of complex tumors and epilepsy foci increases. This series of images was obtained during a craniotomy for tumor resection of a patient with dysembryoplastic neuroepithelial tumor. To determine both the degree of tumor resection and the amount of residual tumor, cottonoids were left in our patient's resection cavity and underwent iMRI. The ability to distinguish cottonoids in these images is important for intraoperative localization of resection margins and to prevent the retention of cottonoids.

Progression-free survival after first recurrence in patients with glioblastoma.

Relevance. Despite all the treatment glioblastoma recurs as an aggressive and therapy-resistant tumor, and patients quickly die from these neoplasms. The study of glioblastoma recurrence processes and search for prognostic factors of the disease should lead to the improvement of survival rates of patients with this pathology. Purpose of the study. To study the influence of clinical and molecular-genetic factors on the median second recurrence-free period. Materials and methods. Progression-free survival after first recurrence in 34 patients aged 28 to 81 years with recurrent glioblastoma was analyzed. The diagnosis was established according to the WHO 2021 classification of CNS tumors. In each observation we studied such clinical parameters as patient’s age, functional status according to the Karnovsky scale pre- and postoperatively, peculiarities of neuroimaging picture (prevalence of tumor process, localization of recurrence, tumor volume), conducted treatment and molecular-genetic characteristics of the tumor (determination of mRNA expression level of genes: MGMT, VEGF, PDGFRA, β-tubulin III, ERCC-1, TOP2A). Results. Among the clinical and demographic characteristics, the median of the survival was influenced by the patients’ age and functional status after surgery. The median of the survival was more than 2 times higher in the group of patients under 50 years old, compared to patients over 50 years old (18.5 vs 8 weeks). The dependence of the median of the survival on the post- operative functional status (according to the Karnovsky scale) was determined (p = 0.001). The median of the survival in case of a single brain lobe lesion was more than 5 times higher than in case of widespread tumor process, though without statistical reliability (p = 0.09, 21.5 vs 4 weeks). Survival rates were higher when recurrence was localized within 2 cm of the area of removal of the primary neoplasm. After disease progression, the MGMT gene lost its predictive value. Patients with low expression of the TOR2A gene had a higher survival rate than those with medium and high expression (47.5 vs 3 weeks, p = 0.001; 47.5 vs 22.5 weeks, p = 0.06). The median of survival was higher than at high levels at low and medium PDGFRA gene expression levels (29 vs 0 weeks, p = 0.04; 21 vs 0 weeks; p = 0.05, respectively). Maximum survival rates were recorded in the group of patients after total and subtotal removal of tumor recurrence (22 and 18.5 weeks, p = 0.05). Administration of second-line chemotherapy with temozolomide statistically significantly increased the median of the second BRS (p = 0.01). Conclusion. Recurrent glioblastomas are characterized by an extremely aggressive course. Therefore, such prognostic factors as patient age, degree of tumor resection, tumor process prevalence, degree of tumor resection and 2nd line chemotherapy come to the forefront. It should be noted that the MGMT gene loses its predictive value during disease progression, while the TOR2A gene and PDGFRA gene become prognostic markers.

Gross-total resection in optic nerve sheath meningiomas: minimally invasive and cosmetic pleasing

PurposeThe optic nerve sheath meningioma (ONSM) is one of the most challenging tumors in orbital surgery. From the perspective of mental health and patient needs, we analyzed the necessity and importance of the endoscopic transnasal approach (ETA) combined with optic nerve transection (ONT) in gross-total resection (GTR) in ONSM patients with residual vision and aim to broaden the use of ONT for specific people.MethodsThe authors included patients with ONSMs who were treated between 2014 and 2022. We divided those cases into two groups named ETA group and lateral orbitotomy approach (LOA) group. We present the application of ETA and analyze the preoperative indication of the ONT and compared the advantages and disadvantages between ETA and LOA. The degree of tumor resection was based on imaging and surgical evaluation.ResultsA total of 23 patients with ONSM were included. Sixteen patients underwent ETA, and seven underwent LOA. Among ETA cases, GTR was achieved in 14 patients with ONT and most patients maintained normal eye movement function (75%) and morphology (93.75%). In the ETA group, 14 patients experienced vision loss, while two other patients saw improvements in vision. And proptosis was alleviated (5.20 ± 2.34 vs 0.27 ± 0.46, p < 0.0001). Six patients with blindness and proptosis of the LOA group resulted in GTR with ONT and ophthalmectomy. Although intracranial extension and recurrence included no cases in the two groups, a significant psychological gap was presented due to cosmetic problems.ConclusionsUnder the premise of reducing damage and improving aesthetics, the selection of ETA combined with ONT to gross-total resect ONSMs successfully provides a minimally invasive access with acceptable complications. As an important adjunct to GTR in the surgical treatment of ONSM, the scope of ONT application should be expanded to relieve the patient’s psychological burden.

Transoperative Magnetic Resonance Imaging in Awake Glioma Surgery: Experience in a Latin American Tertiary-Level Center

Analyze the usefulness, efficacy, and safety of transoperative magnetic resonance imaging (tMRI) in glioma surgery in awake patients. Retrospective, single-center, analytical study of a cohort of patients who underwent awake surgery for gliomas by the same surgeon in a third-level Argentine center, in the period between 2012 and 2022. Only patients with pathology-confirmed gliomas, with 6-month follow-up, who had preoperative and postoperative volumetric magnetic resonance imaging, were included in this sample. Subsequently, we analyzed which patients received surgery with the tMRI protocol and the results using multivariate regression analysis. A total of 71 patients were included. A tMRI study was performed on 22 (31%) of these patients. The use of tMRI increased the percentage of resection by 20% (P=0.03), thereby increasing the possibility of gross total resection. However, using tMRI significantly extended surgical time by 84minutes (P<0.001). In 55% of the patients in whom tMRI was performed, the resection was continued after it. The use of tMRI did not increase the rate of infections or the development of surgically associated neurological deficits in the long term, despite the fact that 47% of the patients showed the development of a new deficit or worsening of a previous one during the intraoperative period. The use of tMRI in awake glioma surgery proved to be a safe tool that contributes to increasing the degree of tumor resection, compared to the use of neurophysiological mapping and neuronavigation, at the expense of increased surgical times and costs. We consider tMRI in awake glioma surgery should be used in properly selected cases.

Endoscope-Assisted Microsurgery for Posterior Fossa Skull Base Meningioma Surgery: Technique and Results.

Surgery of posterior fossa meningiomas is extremely challenging even for experienced skull base surgeons because of the close proximity to cranial nerves and tight spaces. Endoscope-assisted surgery for posterior fossa meningiomas can enable a high degree of tumor resection even when using small approaches. This study describes the advantage of endoscope-assisted microneurosurgery in resection of posterior fossa skull base meningiomas and the clinical outcome. All endoscope-assisted surgeries for resection of posterior fossa meningiomas performed between 2002 and 2016 in our department were retrospectively analyzed. For data acquisition, the patient files were used. Tumor size and extent of resection were evaluated on pre- and postoperative magnetic resonance imaging. The value of endoscope assistance was assessed according to the intraoperative videos and the surgical notes. Complications and long-term outcomes were evaluated. We identified 39 female and 10 male patients. The mean age of the patients at the time of surgery was 55 years, ranging from 25 to 78 years. The mean follow-up was 93.8 months. A total of 41% of the tumors were large to giant. The retrosigmoid approach was used in most patients (45). A gross total resection could be achieved in 38 patients (78%). In 11 patients (22%), a near total resection was performed. In 27 patients (55%), a hidden residual tumor, which could not been visualized with the operating microscope, was identified with the endoscope. In 6 patients (22.2%), the internal auditory canal was visualized, in 9 patients (33.3%), the Meckel's cave was visualized, and in 5 patients (18.5%), both were visualized under endoscope assistance. In 26 of those patients (96.3%), the residual tumor was resected under endoscopic view. Endoscope-assisted surgery for posterior fossa skull base meningiomas enables a high degree of tumor resection, avoids more invasive skull base approaches, and reduces the amount of cerebellar retraction.

Minimally invasive approach for skull base meningiomas

IntroductionSkull base meningiomas constitute a complex group of skull base tumors. The endoscopic endonasal approaches (EEA) and endoscopic Keyhole have a minimally invasive philosophy with high effectiveness, safety, and a significant decrease in postoperative morbidity in these tumors. ObjectiveTo describe the results of the use of minimally invasive approaches to skull base meningiomas. MethodA descriptive, retrospective study was carried out in 140 patients at the "Hermanos Ameijeiras" Hospital who underwent surgery for cranial base meningiomas using minimally invasive approaches to the cranial base. The degree of tumor resection, tumor recurrence, reinterventions, and complications were evaluated. ResultsESA were used in 72.8% of the study, while endoscopic Keyholes were used in 26.4% and combined approaches in 0.7%. In relation to total tumor resection, 91.9% was generally achieved. Overall tumor recurrence and reinterventions were less than 8.5% and 4%, respectively. Complications in ESA were: cerebrospinal fluid (CSF) fistula (2.1%), diabetes insipidus, hydrocephalus, cerebral infarction, surgical site hematoma, worsening of cranial nerves I-IV (1.4%) respectively. While in the Keyhole type approaches: seizures (2.9%), hydrocephalus (1.4%), CSF fistula (1.4%), worsening of Nerves IX-XII (0.7%). ConclusionsThe following study reaffirms that minimally invasive approaches for skull base meningiomas constitute advanced surgical techniques for these tumors, associated with a low rate of postoperative complications.

BIOM-24. PREDICTION OF DISTANT RECURRENCE IN GLIOBLASTOMA PATIENTS TREATED WITH STANDARD THERAPY

Abstract BACKGROUND Infiltrative growth is a hallmark of glioblastoma (GBM) and is a major factor in therapeutic failure. We aimed to identify clinical and molecular factors associated with distance recurrence in glioblastoma patients treated with standard therapy (radiotherapy with concomitant and adjuvant temozolomide). METHODS Two prospective cohorts of consecutive, non-selected GBM patients administered standard therapy as primary treatment between year 2005-2016 (Cohort 1) and 2016-2021 (Cohort 2) at Rigshospitalet, Copenhagen were included. Distant recurrence was defined as a new contrast-enhancing tumor &amp;gt; 2 cm from the gross tumor volume. Clinical and molecular factors were screened for association with time to distant recurrence using univariate Cox regression analysis. The final model was generated employing multivariate analysis. RESULTS Cohort 1 and 2 included 628 and 395 patients, respectively. Out of the recurrence pattern evaluable patients, distant recurrence was observed in 117 patients (23%) in Cohort 1 and 73 patients (22%) in Cohort 2. PRELIMINARY RESULTS In Cohort 1, multivariate analysis showed that corticosteroid use, age, multifocal disease, ECOG performance status, and degree of tumor resection were not associated (p &amp;gt; 0.10) with distant recurrence. Two factors were independently associated with a higher likelihood of distant recurrence, namely non-methylated promoter of the MGMT gene (HR = 1.93; 95% CI:1.27-2.95; p = 0.002) and positive expression of Epidermal Growth Factor Receptor (EGFR) (HR = 3.70; 95% CI: 1.61-8.33; p = 0.002). In Cohort 2, the EGFR status was not available but the association of non-methylated MGMT with distant recurrence was validated (HR = 2.67; 95% CI: 1.62-4.42; p = 0.0001). CONCLUSION Non-methylated MGMT and positive EGFR expression were independent predictors of distant recurrence. Non-methylated MGMT was validated in Cohort 2 and can be used for risk stratification and to enrich clinical trials aiming at improved local or distant tumor control.

Clinical Value of a Nomogram Model Based on Apparent Diffusion Coefficient Values Within 1 cm of the Tumor Cavity to Predict Postoperative Progression of Glioma

To explore the clinical value of constructing a nomogram model based on apparent diffusion coefficient values within 1cm of the residual tumor cavity to predict the postoperative progression of gliomas. Clinical data of patients with glioma who underwent surgery were retrospectively retrieved from the First Hospital of Qinhuangdao. The mean apparent diffusion coefficient (mADC) was measured using a picture archiving and communication system. The Kaplan-Meier survival curve was constructed with the optimal mADC threshold determined by the X-tile. A nomogram was developed based on the independent risk factors determined using the Cox proportional hazards model (Cox regression model) to predict the progression of postoperative glioma. A receiver operating characteristic curve was drawn to evaluate the prediction accuracy of the model, and decision curve analysis was performed to assess the clinical value of the nomogram. There was good agreement between the mADC values of the 2 repeated measurements before and after, with a consistency correlation coefficient of 0.83. Multivariate Cox regression analysis showed that peritumoral mADC values, degree of peritumoral enhancement, age, pathological grading, and degree of tumor resection were independent risk factors for predicting postoperative progression of glioma (all P<0.05). The receiver operating characteristic curves of the nomogram predicting 1, 2, and 3years postoperative progression were 0.86, 0.82, and 0.91, respectively. The calibration curve showed good consistency between the observed and predicted values in the model. The curve showed that the nomogram model has a good clinical application value. The peritumoral mADC values, degree of peritumoral enhancement, age, pathological grade, and degree of tumor resection were independent factors affecting the postoperative progression of glioma. The nomogram model established for the first time based on mADC values within 1cm of the tumor can predict the postoperative condition of patients with glioma intuitively and comprehensively. It can provide a relatively accurate prediction tool for neurosurgeons to individualize the evaluation of survival and prognosis, and formulate treatment plans for patients.

Clinical Features of Recurrent Spinal Cord Tumors.

Only a few reports have described the clinical features of recurrent spinal cord tumors. This study aimed to report the recurrence rates (RRs), radiographic imaging, and pathological features of various histopathological recurrent spinal cord tumors using a large sample size. This study adopted the retrospective observational study design using a single-center study setting. We retrospectively reviewed 818 consecutive individuals operated for spinal cord and cauda equina tumors between 2009 and 2018 in a university hospital. We first determined the number of surgeries and then the histopathology, duration to reoperation, number of surgeries, location, degree of tumor resection, and tumor configuration of the recurrent cases. A total of 99 patients (46 men and 53 women) who underwent multiple surgeries were identified. The mean duration between the primary and second surgeries was 94.8 months. A total of 74 patients underwent surgery twice, 18 patients thrice, and 7 patients 4 or more times. The recurrence sites were broadly distributed over the spine, with mainly intramedullary (47.5%) and dumbbell-shaped (31.3%) tumors. The RRs for each histopathology were as follows: schwannoma, 6.8%; meningioma and ependymoma, 15.9%; hemangioblastoma, 15.8%; and astrocytoma, 38.9%. The RRs after total resection were significantly lower (4.4%) than that after partial resection. Neurofibromatosis-associated schwannomas had a higher RR than sporadic schwannomas (p<0.001, odds ratio [OR]=8.54, 95% confidence interval [95% CI]: 3.67-19.93). Among the meningiomas, the RR increased to 43.5% in ventral cases (p<0.001, OR=14.36, 95% CI: 3.66-55.29). Within the ependymomas, partial resection (p<0.001, OR=2.871, 95% CI: 1.37-6.03) was found to be significantly correlated with recurrence. Dumbbell-shaped schwannomas exhibited a higher RR than non-dumbbell-shaped ones. Furthermore, dumbbell-shaped tumors other than schwannoma had a higher RR than dumbbell-shaped schwannomas (p<0.001, OR=16.0, 95% CI: 5.518-46.191). Aiming for total resection is essential to prevent recurrence. Dumbbell-shaped schwannomas and ventral meningiomas exhibited higher RR requiring revision surgery. As for dumbbell-shaped tumors, spinal surgeons should pay attention to the possibilities of non-schwannoma histopathologies.

Risk factors analysis of clinical features with surgical resection rate and prognosis of petroclival meningioma with main body in posterior fossa

ObjectiveOur retrospective study aimed to investigate the relation of clinical features with surgical resection degree and prognosis of petroclival meningioma (PCM) whose main body in the posterior fossa and summarized the experience of surgery. We worked on improving the cure rate of PCM patients from both clinical data analysis and surgical experience. MethodsWe retrospectively analyzed 62 patients of the main body of PCM locating in the posterior fossa. Clinical data included basic information of patients, video of surgery, and post-operation follow-up. Clinical results were evaluated by Karnofsky Performance Score (KPS). The degree of surgical resection was evaluated by Simpson grade. Tumor resection degree and postoperative complications were performed by univariate and multivariate analyses. ResultsThe analyses showed gross total resection achieved in 50 cases (81.97%), and subtotal resection in 11 cases (18.03%). There were 38 cases (62%) without complications after operation. The preoperative KPS score of 19 cases were ≥ 80, and the postoperative KPS score of 51 cases were ≥80. The results showed that resection degree and quality of life were connected to Edema and adhesion of the brainstem, and postoperative complications were associated with age, tumor size and wrap of vessel. ConclusionsEdema and adhesion of the brainstem caused by tumor compression is an independent risk factor of surgical resection degree and quality of life in patients with PCM; Age, tumor size and wrap of vessel are independent risk factors of postoperative complications in patients with PCM.

Mapping of cortical speech zones and arcuate tract in patients with gliomas of temporal lobe of left hemisphere (analysis of a series of 27 observations)

Introduction. Craniotomy in conscious patients is a possible tool for optimizing of tumor resection degree (Extent of Resection) while maintaining the quality of life. Traditionally, the main focus during these operations is on the cortical speech areas. At the same time, there is a shortage of studies on mapping of long associative tracts during the removal of gliomas of dominant speech hemisphere.Aim. To analyze the data of intraoperative mapping and the postoperative state of speech function in patients with temporal lobe gliomas of left hemisphere (including those involving arcuate bundle) operated by the use of method of craniotomy in consciousness.Materials and methods. Gliomas of temporal lobe of left hemisphere were removed in 27 patients aged 14 to 67 years (median age 43 years). In 10 patients, the tumor was localized in middle parts of temporal lobe (at the level of middle and upper temporal gyri), in 9 patients – in posterior parts of temporal lobe and exited into the supramarginal zone, in 8 it spread partially from temporal lobe to insular area. Gliomas of high degree of malignancy were detected in 21 patients, 6 had tumors of low degree of malignancy. Surgical intervention was performed with intraoperative “awakening”. All patients underwent cortical electrophysiological stimulation in order to control localization of cortical speech zones, subcortical stimulation was performed in 21 cases to identify terminals of arcuate bundle. Speech disorders before and after surgery (on day 4–6) were evaluated by neuropsychologist using the method proposed by A. R. Luria, an automated test with the naming of pictures was additionally used intraoperatively. The average current strength of direct electrical stimulation was 3 (1.9–6.5) mA. In 12 cases, magnetic resonance (MR) tractography with construction of arcuate tract was performed before and after the surgery.Results. Cortical temporal speech zones during intraoperative electrical stimulation were detected in 20 (74 %) of 27 patients. In 10 patients, the arcuate tract was mapped in form of appearance of mixed speech disorders in the depth of surgical wound. In 23 (85.2 %) of 27 patients in early postoperative period, an increase in speech disorders was noted of which 13 people had disorders of temporal type only and 10 people (surgery on deep posterior parts of temporal lobe) had a combination of temporal and frontal types of speech disorders (conduction aphasia). Postoperative MR‑tractography (performed in 12 patients) revealed direct intraoperative tract lesion in 5 cases and ischemia of the tract area passage in 2 cases. These 7 patients had combined speech disorders after surgery. Gross sensory aphasia after surgery was manifested in 4 patients, in 2 of them ischemia was revealed according to postoperative magnetic resonance imaging, and 2 more had hemorrhagic impregnation in the removed tumor bed.Conclusion. When removing tumors of temporal lobe in “awakening” conditions it is necessary to map speech zones not only in the cortical, but also in the subcortical area with terminals of arcuate bundle. Mapping of speech zones in these different localizations makes it possible to identify fundamentally different speech disorders.

Prediction of Vestibular Schwannoma Surgical Outcome Using Deep Neural Network

To compare shallow machine learning models and deep neural network (DNN) model in prediction of vestibular schwannoma (VS) surgical outcome. One hundred eighty-eight patients with VS were included; all underwent suboccipital retrosigmoid sinus approach, and preoperative magnetic resonance imaging recorded a series of patient characteristics. Degree of tumor resection was collected during surgery, and facial nerve function was evaluated on the eighth day after surgery. Potential predictors of VS surgical outcome were obtained by univariate analysis, including tumor diameter, tumor volume, tumor surface area, brain tissue edema, tumor property, and tumor shape. This study proposes a DNN framework to predict the prognosis of VS surgical outcomes based on potential predictors and compares it with a series of classic machine learning algorithms including logistic regression. The results showed that 3 predictors of tumor diameter, tumor volume, and tumor surface area were the most important prognostic factors for VS surgical outcomes, followed by tumor shape, while brain tissue edema and tumor property were the least influential. Different from shallow machine learning models, such as logistic regression with average performance (area under the curve: 0.8263; accuracy: 81.38%), the proposed DNN shows better performance, where area under the curve and accuracy were 0.8723 and 85.64%, respectively. Based on potential risk factors, DNN can be exploited to achieve preoperative automatic assessment of VS surgical outcomes, and its performance is significantly better than other methods. It is therefore highly warranted to continue to investigate their utility as complementary clinical tools in predicting surgical outcomes preoperatively.

Risk for hydrocephalus, hygroma, and tumor dissemination after ventricular opening during resection of supratentorial neoplasms in children.

The possibility that ventricular opening generates postoperative complications after surgical tumor treatment often restricts the degree of tumor resection. This study aims to determine whether the ventricular opening is associated with more complications in surgeries for resectioning supratentorial intra-axial brain tumors in the pediatric population. A retrospective review analysis was performed of patients treated at IOP/GRAACC between 2002 and 2020 under 19years of age and underwent surgery for supratentorial intra-axial primary brain tumor resection. Data were collected from 43 patients. Glial tumor was more common than non-glial (65% vs. 35%, p = 0.09). The ventricular opening was not related to neoplastic spreads to the neuroaxis (6% vs. 0, p > 0.9) or leptomeningeal (3% vs. 0, p > 0.9). Of the patients whose ventricle was opened, 10% developed hydrocephalus requiring treatment, while none of the patients in the group without ventricular opening developed hydrocephalus (p = 0.5). There was also no statistical difference regarding ventriculitis. Postoperative subdural hygroma formation correlated with the ventricular opening (43% vs. 0, p = 0.003). The survival at 1, 5, and 10years of cases with the ventricular opening was 93.2%, 89.7%, and 75.7%, respectively, while in cases without ventricular opening, it was 100%, 83%, and 83%, respectively, respectively, with no statistical difference between the mortality curves. Our study demonstrated that ventricular violation was not associated with the occurrence of significant complications. It was related to the formation of subdural hygroma, which did not require additional treatment.

Clinical effect of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement.

The objective of the study is to investigate the surgical methods and clinical effects of high-flow revascularization in microsurgery combined with endoscopic endonasal surgery for skull base tumors with intracranial and extracranial involvement. The relationships between skull base tumors and internal carotid artery (ICA), tumor location and size, and the extent of tumor invasion were assessed. Preoperative CT perfusion (CTP), magnetic resonance (MR) perfusion-weighted imaging (PWI) (MR-PWI), and digital subtraction angiography (DSA) were performed to evaluate collateral circulation and brain tissue perfusion. Then craniotomy through the fronto-orbitozygomatic approach was performed, based on which four cases received extended middle skull base approach+Dolenc approach + Fukushima bypass type I, and six cases received extended middle skull base approach+Fukushima bypass type III. After surgery, DSA, CT angiogram (CTA), and CTP/PWI were performed to evaluate the patency of the reconstructed vessels and cerebral perfusion, and contrast-enhanced MRI to evaluate the degree of tumor resection. All patients were followed up for 6-12months. Among the 10 cases investigated, gross total resection was achieved in 8 cases, subtotal resection in 1 case, and partial resection in 1 case, as confirmed by CT and enhanced MRI. The patency of revascularization vessels was observed using fluorescein angiography during the operation in all patients and via DSA and CTA postoperatively in nine patients. One patient underwent ventilator-assisted ventilation because of respiratory failure and failed to undergo DSA and CTA. Regarding postoperative complications, one patient developed watershed cerebral infarction on the operated side but no sequelae after drug treatment, three patients developed facial numbness, which improved after 3months, and two patients experienced worsened diplopia. After 6 to 12months of follow-up on the nine evaluable patients, the Glasgow Outcome Scale (GOS) was 4-5 after surgery. In addition, 6-month follow-up results showed that one patient with clival chondrosarcoma developed recurrence on contrast-enhanced MRI, while no relapse was observed in the other patients. For skull base tumors with intracranial and extracranial invasion and involving the ICA, revascularization might improve the total resection rate and reduce the recurrence rate and risk of intraoperative bleeding and postoperative ischemia.

Analysis of the personalized treatment and the relevant prognostic factors in children with medulloblastoma

<b>Purpose:</b> The present study summarized cases of children (<i>n</i> = 32) with medulloblastoma (MB) who were treated using stratified therapy based on risk grading and also discussed the factors affecting prognosis. <b>Methods:</b> According to the risk stratification criteria, the cases were divided into the following four risk groups: low, standard, high, and very high. The 5-year overall survival (OS) and progression-free survival (PFS) rates were summarized. Further, the effects on the prognosis of tumor size, tumor stage, degree of resection, treatment mode, metastatic recurrence, molecular typing, and risk stratification were analyzed. <b>Results:</b> In the present study, following surgery, 3 cases abandoned radiotherapy (RT) and chemotherapy (CHT), 7 cases (<3 years of age) received only CHT, and 22 cases received combined RT and CHT. Total and near-total tumor resections were performed in 29 cases (90.6%). Subtotal resections were performed in 3 cases, and there were no surgery-related deaths. The average follow-up duration was 47 months. The average 5-year PFS and OS rates were 57.3% ± 7.2% and 68.7% ± 8.6%, respectively. The OS and PFS rates were significantly correlated with tumor-risk stratification, molecular staging, tumor stage, treatment mode, and recurrence after surgery (<i>p</i> < 0.01). The degree of tumor resection, pathological type, and the presence of preoperative implantation were secondary factors affecting the prognosis (<i>p</i> < 0.05). Age was correlated with the PFS rate. There was no correlation between age/tumor location/tumor size and prognosis (<i>p</i> > 0.05). Favorable prognostic factors in the low- and standard-risk groups were stage M0, wingless-type MB, postoperative RT combined with CHT, no postoperative recurrence, age ≥3 years, and total tumor resection. <b>Conclusions:</b> Personalized treatment strategies based on the risk stratification of MB and postoperative stratified comprehensive treatment could help improve the prognosis for MB.

PEDT-5 PREOPERATIVE MAGNETIC RESONANCE IMAGING AND INTRAOPERATIVE BLOOD LOSS IN CHILDHOOD POSTERIOR FOSSA TUMORS

Abstract Background and Purpose For removal of childhood posterior fossa tumors, it is important to control bleeding while internally decompressing the tumor. Evaluation of tumor vascularity by preoperative magnetic resonance imaging (MRI) is thought to be effective in predicting and controlling blood loss. In this study, we evaluated the relationship between imaging features, mainly susceptibility-weighted imaging (SWI), and the amount of intraoperative blood loss. Methods Among childhood posterior fossa tumors operated on by the same surgeon between January 2016 and March 2022, 9 cases in which preoperative MRI data could be analyzed and total or subtotal resection was achieved were included. The SWI: intratumoral susceptibility signals (ITSS) grade, an index of tumor vascularity, was used to evaluate the association between the degree of vascularity (ITSS: 0-2 vs. ITSS: 3) and multiple factors, including intraoperative blood loss, in a univariate analysis. In addition, the intraoperative blood loss was analyzed by multivariate analysis. Results There were 3 males and 6 females with a median age of 6 years (5-11). Seven medulloblastomas, one atypical teratoid/rhabdoid tumor, and one ependymoma were included. Univariate analysis showed that patients with higher vascularity (ITSS: 3) had significantly higher intraoperative blood loss (p=0.016) and larger tumor volume (p=0.032). In multivariate analysis with age, degree of contrast enhancement, degree of vascularity, tumor volume, and degree of tumor resection as independent variables, the degree of vascularity was not significantly associated with intraoperative blood loss (p=0.477), but only with tumor volume (p=0.036). Conclusion Although the degree of tumor vascularity may be related to intraoperative blood loss, there was a strong correlation between the degree of vascularity and tumor volume, and multivariate analysis of intraoperative blood loss showed that only tumor volume was a significant factor. Higher tumor vascularity was associated with larger tumor volume, which may result in increased intraoperative bleeding.

Clinical Characteristics and Prognostic Risk Factors of Parasellar Chondrosarcoma.

Background: Parasellar chondrosarcomas are extremely rare. This study describes the characteristics of parasellar chondrosarcoma and analyzes the risk factors and prognosis based on the resection degree. Methods: Fifteen patients with pathologically diagnosed parasellar chondrosarcoma were retrospectively analyzed for the clinical data, surgical methods, and prognosis to identify relationships between the surgical resection degree, tumor recurrence, and imaging characteristics. Results: Twelve patients had eye dysfunction and ptosis. Differentiation from other parasellar tumors by imaging is difficult. The preoperative Karnofsky Performance Scale (KPS) score positively correlated with the tumor resection degree (p = 0.026) and negatively correlated with the maximum tumor diameter (p = 0.001). Tumor recurrence negatively correlated with the resection degree (p = 0.009). The postoperative KPS score positively correlated with the preoperative KPS score (p < 0.001) and tumor resection degree (p = 0.026), and negatively correlated with the maximum tumor diameter (p = 0.016) and age (p = 0.047). An improved KPS score positively correlated with the tumor resection degree (p = 0.039). Patients who underwent total resection of the chondrosarcoma had longer progression-free survival than those who underwent partial resection (p = 0.0322). Conclusion: Parasellar chondrosarcomas are difficult to resect completely. Preoperative KPS score is an important factor for the degree of resection. KPS score, age, maximum tumor diameter, and resection degree may be important prognostic factors.