Intracranial Lesions Research Articles

Low frequency of intracranial progression in advanced NSCLC patients treated with cancer immunotherapies.

Intracranial metastases are common in nonsmall-cell lung cancer (NSCLC) patients, whose prognosis is very poor. In addition, intracranial progression is common during systemic treatments due to the inability to penetrate central nervous system (CNS) barriers, whereas the intracranial effects of cancer immunotherapies remain unclear. We analyzed clinical data to evaluate the frequency of intracranial progression in advanced NSCLC patients treated with PD-1 blockade therapies compared with those treated without PD-1 blockade therapies, and found that the frequency of intracranial progression in advanced NSCLC patients treated with PD-1 blockade therapies was significantly lower than that in patients treated with cytotoxic chemotherapies. In murine models, intracranial rechallenged tumors after initial rejection by PD-1 blockade were suppressed. Accordingly, long-lived memory precursor effector T cells and antigen-specific T cells were increased by PD-1 blockade in intracranial lesions. However, intracranial rechallenged different tumors are not suppressed. Our results indicate that cancer immunotherapies can prevent intracranial progression, maintaining long-term effects intracranially as well as systemically. If intracranial recurrence occurs during the treatment with PD-1 blockade therapies, aggressive local therapies could be worthwhile.

Efficacy and safety of re-challenging 160 mg furmonertinib for advanced NSCLC after resistance to third-generation EGFR-TKIs targeted agents: A real-world study

BackgroundThird-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) show good selectivity for classical EGFR mutated and EGFR T790M mutated non-small cell lung cancer (NSCLC). However, resistance inevitably occurs to third-generation EGFR-TKI. This study describes the real-world characteristics, efficacy, and safety of treating post-progression NSCLC with 160 mg of furmonertinib (in combination with or without anti-angiogenic agents and chemotherapy) with third-generation EGFR-TKIs. MethodsEGFR-mutated NSCLC patients with intracranial progression pattern cohort (IP cohort) or extracranial progression pattern cohort (EP cohort) were retrospectively analyzed following progression to third-generation EGFR-TKIs receiving furmonertinib 160 mg daily as second-line or later treatment in combination with or without anti-angiogenic agents and chemotherapy. ResultsThirty-nine patients were included and categorized into two groups according to the progression pattern. Then, 22 patients in the IP cohort and 17 patients in the EP cohort, most of whom were in poor physical condition, were included and 84.6% had central nervous system metastases. In the IP cohort, the median PFS was 5.5 months (95% CI 4.67–8.72), and the median OS was 9.8 months (95% CI 7.25–11.20) for single-agent furmonertinib or combination therapy. In the EP cohort, the median PFS was 3.2 months (95% CI 2.18–4.70), and the median OS was 6.7 months (95% CI 4.99–8.75). Univariate analysis showed the association between the presence of a prior T790M mutation and a history of combined radiotherapy with longer PFS with furmonertinib (p = 0.048, p = 0.004). Overall, adverse events (AEs) of any grade occurred in 84.6% of patients (33/39), with the majority having grade 2 or lower AEs. ConclusionFurmonertinib 160 mg is an optional regimen for patients with advanced NSCLC who develop resistance after treatment with third-generation EGFR-TKIs, especially those developing resistance due to the progression of intracranial lesions, with good efficacy and an acceptable safety profile that warrants further exploration.

Characterization of Immune Infiltrates Associated With Radiation Necrosis in the Setting of Brain Metastases Following Stereotactic Radiosurgery and Immunotherapy: A Retrospective Cohort Analysis.

Radiation necrosis (RN) is caused by vascular damage and brain parenchymal injury resulting in inflammation following radiotherapy (RT) for brain metastases. The impact of immunotherapy (IO) on the immune cellular microenvironment in patients' brain metastases is unknown. The objective of this study was to characterize the inflammatory microenvironment in the setting of RN compared to recurrent metastasis and determine whether IO treatment affects the cellular infiltrates. Adult patients with brain metastases from solid tumors who received both systemic IO and RT prior to resection of intracranial lesions were retrospectively analyzed. The resection either showed biopsy-proven RN or recurrent tumor. A group of patients who developed RN and were not on IO was reviewed as well. A total of 18 patients were categorized into one of three groups: necrosis, IO+RT; tumor, IO+RT; and necrosis, RT. Surgical specimens were stained for immune and inflammatory components and reviewed by a neuro-pathologist who remained blinded during the analysis. The presence or absence of lymphocytes, perivascular cuffs, plasma cells, macrophages, and fibrinoid vascular changes was characterized in a semiquantitative manner. The median age was 61.5 years (range 37-82 years). Seventy-seven percent of primary cancers were melanoma. Patients with RN were more likely to exhibit immune infiltrates compared to patients with recurrent metastasis. Limited analysis showed 100% of patients in "necrosis, IO+RT" had quantifiable cell counts; conversely, 83.3% of patients in "tumor, IO+RT" lacked quantifiable cell counts. Additionally, 83.3% of patients in "necrosis, RT" showed immune cells, including lymphocytes, macrophages, plasma cells, and cuffing. The immune microenvironment of brain metastasis following RT and IO showed higher levels of cell infiltrates in the RN setting versus the recurrent tumor setting. Patients who received prior IO compared to those with no IO had similar immune cell infiltrates adjacent to RN. Lower levels of immune cells in tumor recurrence following IO and RT raise the possibility that an environment lacking primed immune cells may decrease the efficacy of IO.

Clinicoradiologic Risk Stratification and Outcome Assessment in Symptomatic Intracranial Arachnoid Cyst Managed Over Fifteen Years

Arachnoid cysts (ACs) are developmental anomalies formed by splitting the arachnoid membrane's layers. ACs contribute around 2% of all intracranial space-occupying lesions. ACs are more prevalent in children. Because of varied clinical presentation, there has been a constant need for clinicoradiologic risk stratification with a possible role in outcome prediction. The present study describes the management strategies and outcomes in symptomatic intracranial ACs. All biopsy-proven symptomatic patients who underwent surgical management over last 15 years were included in this study (January 2008-December 2022), while those with non-conclusive biopsies were excluded. Patients presenting with acute deterioration were managed in the emergency department with or without cerebrospinal fluid diversion and decompression of the AC. The microsurgical or endoscopic approach was the preferred surgical modality. Postoperative clinicoradiologic improvement was evaluated at 3 months follow-up visit. A total of 108 patients were analyzed in this retrospective observational study. The median age of the patients was 27.5 years (range, 1 to 76 years). Headache was the most typical clinical presentation. Supratentorial ACs (n= 59, 54.6%) were higher than the infratentorial ACs (n= 49, 45.4%). Forty-seven patients belonged to the pediatric age group (<18 years), and seizure was their presenting complaint. In this observational study, there was no statistical difference in operative duration between microsurgical technique versus endoscopic decompression (P= 0.23). ACs are uncommon brain lesions having a broad spectrum of symptoms. The location and clinical presentation of ACs decide the preferred surgical approach. Individuals in high-risk groups must be treated on priority to achieve long-term relief of symptoms.

Quiz case: a clinical reasoning challenge in the emergency stroke setting.

A right-handed woman in her 80s was admitted to the emergency department 1 h after sudden-onset global aphasia and right-sided hemiparesis. Medical history included arterial hypertension, dyslipidemia, hyperuricemia, aortic stenosis, osteoporosis, and recent pulmonary embolism. Medication consisted of apixaban, bisoprolol, hydrochlorothiazide, allopurinol, fenofibrate, and vitamin D. Vital parameters (blood pressure, heart rate, body temperature, oxygen saturation) and glycemia were all within normal range. Electrocardiogram showed a first-degree atrioventricular block. The patient was promptly transported to the emergency computed tomography (CT) scanner. Non-contrast brain CT revealed a unilateral hyperdensity in the left caudate and lentiform nuclei. No other intracranial lesion was visualized. Laboratory studies were not yet available at the time of imaging. What is your diagnosis?

LMAP-18 ADAPTING LASER INTERSTITIAL THERMAL THERAPY (LITT) FOR TREATMENT OF INTRACRANIAL LESIONS IN CANINES

Abstract Malignant gliomas are devastating intracranial tumors with dismal prognoses that impose unique therapeutic challenges. Treatment options include surgical resection, radiation, and chemotherapy, but efficacy is limited and carries associated morbidity. Promise persists for newer modalities, such as immune-based platforms, but the blood-brain barrier (BBB) restricts intracranial therapeutic access, limiting success. Laser interstitial thermal therapy (LITT) is a minimally invasive surgical intervention permitting thermal ablation of brain tumors and other intracranial lesions. During LITT, a laser probe is stereotactically introduced through a small skull burr hole into the lesion. Continuous MRI is used to conduct real-time temperature monitoring via software-based calculation of cumulative thermal dosage zones. LITT is not only capable of ablating neoplastic tissue, but can also open the BBB in peritumoral regions, and thus may synergize with other emerging therapies. We adapted a commercially available LITT system (Monteris Medical) for use in dogs with intracranial lesions. Canine cadavers were used to optimize LITT procedures before employing this platform in live dogs. Our approach consists of 1. obtaining volumetric, T1-weighted, MRI studies to plan trajectories to intracranial targets, 2. fixing canine patients to a surgical bed and registering them for surface matching to a volume rendered image, 3. using an integrated instrument holder (Varioguide, Brainlab) to guide drilling of 4.5 mm skull burr holes for placement of self-tapping titanium “mini-bolts” (Monteris Medical), and 4. introducing the laser catheter probe through the mini-bolts for lesion ablation in the MRI suite. This method allows for rigid stereotaxy, successful neuronavigation, and a minimally invasive approach. We have successfully performed LITT on four canine patients with spontaneously occurring intracranial gliomas and plan to treat additional canine patients with intracranial lesions. Future studies will explore combination therapeutic platforms, including immunotherapy and gold nanoparticles to improve the efficiency and specificity of tumor ablation.

TIPS-19 TRIAL IN PROGRESS: SECONDARY BRAIN METASTASES PREVENTION AFTER ISOLATED INTRACRANIAL PROGRESSION ON TRASTUZUMAB/PERTUZUMAB OR T-DM1 IN PATIENTS WITH ADVANCED HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2+ BREAST CANCER WITH THE ADDITION OF TUCATINIB (BRIDGET)

Abstract Despite trastuzumab-based therapy, up to half of patients with HER2+ metastatic breast cancer (MBC) will develop brain metastases (BrM). First-line therapy for HER2+ MBC, taxane/trastuzumab/pertuzumab (TP), demonstrates poor brain permeability. Isolated brain relapse with stable/absent extracranial disease remains a clinical problem in both the adjuvant and metastatic settings, and current guidelines recommend continuing current systemic therapy following local therapy. Tucatinib, a brain-penetrable HER2-inhibitor, when added to trastuzumab and capecitabine improves intracranial PFS and OS in patients with stable/active HER2+ BrMs. We hypothesize that adding tucatinib to TP or T-DM1 in patients with HER2+ MBC with isolated brain relapse or progression could delay or prevent the development of further intracranial lesions and improve OS. BRIDGET (NCT05323955) is a single arm, phase II study of tucatinib added to TP or T-DM1 after local therapy in patients with isolated brain relapse or progression. A total of 48 patients at 9 U.S. sites through HCRN with HER2+ MBC will be enrolled after 1st or 2nd BrM relapse/progression within 8 weeks of local therapy. Patients must currently be receiving TP or T-DM1 in the metastatic setting, or adjuvant trastuzumab-based or T-DM1 therapy with isolated brain recurrence. Extracranial disease must be stable per RECISTv1.1 or absent. Patients will receive tucatinib added to their current therapy. The primary objective is intracranial PFS compared to a historical control (H0: historical iPFS &amp;lt;5 months (mos), HA: iPFS &amp;gt;8 mos) of the HER2CLIMB trial. In these patients, median time from brain progression to second progression/death was 7.6 mos with tucatinib versus 3.1 mos in the control arm. Secondary endpoints include PFS by RECISTv1.1, PFS of extracranial disease, locally treated versus new distant intracranial metastasis PFS, site of first progression, OS, and toxicity. Collection of correlative specimens and patient-reported outcomes (FACT-BR, FACIT-Fatigue) are also included.

LMAP-03 OUTCOME OF BRAIN METASTASES TREATED WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY (GKSR): COHORT RETROSPECTIVE STUDY ON 205 CASES

Abstract BACKGROUND Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approximately 50% of patients diagnosed with new brain metastases have more than one brain metastasis at the time of diagnosis. OBJECTIVE We report our experience of brain metastases treated with GKSR and evaluate the outcome. METHODS Patients treated by Gamma Knife stereotactic radiosurgery (GKSR) in our institution between 2008 and 2021 for BM were recorded retrospectively. RESULTS A total of 205 patients (56.6% females) were included, with a median age of 59 (25-83) years old. Breast (n=85, 42.5%) and lung (n=76, 38%) were the common original locations for the primary tumors (Table 1). There were 103 patients (50.3%) with single BM and 102 patients (49.7%) with multiple BM⩾2. The median number of multiple BM treated was 4 (2-43). The overall mean survival time was 6.00(95% CI, 5.07-6.93) months for all BM. The median percentage of tumor control after radiosurgery treatment was 65% (20-99) over the median follow-up time of 6.00(3-84) months. In the overall population, the 1-year OS rate was 37.55%, the 2-year OS rate was 25.12%, and the 5-year OS was 18.51%. The mean survival time among patients with BM was higher in those with multiple BM than those with single BM ([10 (95%CI 6.67-13.33) months vs 5(4.21-5.70) months, P (0.03)]). Retreatment, tumor stability (control), and progression influence the overall survival of BM, whether single or multiple (P&amp;lt;0.001). CONCLUSION Stereotaxic Radiosurgery provides good results in terms of Overall survival and better Quality of Life for BM, whether single or multiple. Stability and retreatment influenced the overall survival of BM.

SDPS-09 MIXED RESPONSE OF BRAIN METASTASES TREATED WITH OSIMERTINIB PREDICTS INFERIOR SURVIVAL OUTCOMES: AN ARTIFICIAL INTELLIGENCE-BASED LESION-LEVEL ASSESSMENT FOR CRANIAL CONTROL OF EGFRMUTANT NONSMALL CELL LUNG CANCER

Abstract Osimertinib has been found to be effective for intracranial control in patients with metastatic EGFR-mutant non-small cell lung cancer (NSCLC). However, the lesion-level response of brain metastases to osimertinib has not been thoroughly evaluated. This retrospective study included 73 patients with EGFR-mutant NSCLC and brain metastases who were treated with osimertinib at a single institution from 2016 to 2021. Patients with the leptomeningeal disease were excluded. The study used an FDA-approved brain tumor management artificial intelligence (AI) platform, VBrain, to identify, track, and measure brain metastases on the baseline and follow-up MRI brain scans. Mixed response (MiR) was defined as the occurrence of progressive or new lesions along with synchronous responsive shrinking intracranial lesions at the first follow-up scan. K-means grouping was used to partition patients into two clusters according to their response heterogeneity. With a median follow-up of 23.8 months, a high MiR score (higher than 103%, n=25) was associated with worse cranial-progression-free survival (3.2 vs. 17.9 months, p&amp;lt;0.0001) and significantly inferior overall survival (12.4 vs. 30.1 months, HR=2.35, p=0.016). This poses a similar negative impact on the survivals of 18 patients with pure RANO-BM progression (HR=2.52, p=0.025). Eight patients had the highest MiR score (MiRmax), in whom synchronous new lesions and completely responsive tumors were observed. In a multivariate Cox proportional-hazards regression involving performance status, extracranial failure, tumor volume, lesion number, and RANO-BM classification as variables, MiRmax remained an independent prognosticator for inferior survival (HR=5.20, 95%CI; 2.21–12.23, p=0.002). Our study demonstrates that MiR in brain metastases from EGFR-mutant NSCLC treated with osimertinib is associated with inferior survival outcomes and a higher risk of local progression. Lesion-level response assessment using AI may provide important prognostic information and aid in treatment decision-making for these patients.

Kidney Transplant Recipient With Tumefactive Demyelinating Lesions: A Case Report and Literature Review

Tumefactive demyelinating lesions (TDLs) are rare and specific types of inflammatory demyelinating lesions. Its clinical manifestations are nonspecific, and the imaging findings are similar to those of other intracranial space-occupying lesions, which are usually misdiagnosed as tumors or abscesses and require a pathologic examination to confirm the diagnosis. Tumefactive demyelinating lesions after kidney transplantation are even rarer. This article reports a case of TDLs after kidney transplantation. A 60-year-old female patient underwent kidney transplantation 15 years ago and took anti-rejection drugs such as tacrolimus, tacrolimus, and corticosteroids after surgery. The patient was admitted with headache and left limb weakness, and magnetic resonance imaging of the head showed multiple space-occupying lesions with surrounding edema. The patient underwent a stereotactic biopsy of the encephalopathy lesion, and postoperative pathology confirmed TDLs. She was treated with corticosteroids and discharged after the improvement of her symptoms. Here, to our knowledge, we report the first case of TDLs after kidney transplantation. We report this case to provide clinicians with useful information on intracranial demyelinating disease after kidney transplantation.

Intracranial squamous papillary lesion.

Intracranial lesions with squamous differentiation raise a diagnostic challenge, which can include benign or malignant, primary and metastatic lesions. Here is the case of a 49‐year‐old woman, in which intraoperative cytology helped the differential and final diagnosis.

Correlation of cognitive function with intracranial lesions and the degree of depression and anxiety in patients with neuromyelitis optica spectrum disorders

Objective: To investigate the correlation of cognitive dysfunction with intracranial lesions and symptoms of depression and anxiety in patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: Thirty-one NMOSD patients (7/24 males/females) were enrolled in the Department of Neurology of the Sixth Medical Center of the PLA General Hospital from August 2019 to August 2022. The average age was 42±13 years, and the average education level was 12 (9, 12) years. There were 30 healthy controls, 11/19 males/females, with an average age of 47±9 years and an average education of 12 (9, 15) years. The general clinical data and imaging data were collected, and the subjects were assessed on their cognition, anxiety and depression using the assessment scale approved at home and abroad. A cross-sectional study was conducted on them. The t-test or Wilcoxon test was used for inter-group comparison, and Pearson test or Spearman test was used to explore the correlation between the cognition of NMOSD patients and their intracranial lesions, depression and anxiety. Results: Compared with the healthy control group, NMOSD patients had significantly lower scores on MoCA (Z=-3.10,P=0.002), CRAVLT-N7 (Z=-5.12, P<0.001), CRAVLT-N8 (t=-4.40, P<0.001), ROCF-R (t=-3.10,P<0.01), ROCF-C (Z=-2.72,P<0.01), PASAT-3 (Z=-2.71,P<0.01), PASAT-2 (Z=-3.14,P<0.01), and CWT-A (Z=-3.10,P<0.01)scales. Frontal lobe lesions were negatively correlated with PASAT-2 (r=-0.448, P=0.012) scores, temporal lobe lesions were negatively correlated with CRAVLT-N9 (r=-0.564, P=0.001), and parietal lobe lesions were negatively correlated with MoCA (r=-0.374, P=0.038), PASAT-3 (r=-0.426, P=0.017), and PASAT-2 (r=-0.459, P=0.009) scores; The scores of MoCA (r=-0.392, P=0.029), CRAVLT-N6 (r=-0.396, P=0.028), CRAVLT-N7 (r=-0.415, P=0.020), CRAVLT-N8 (r=-0.406, P=0.023), PASAT-3 (r=-0.537, P=0.002) and PASAT-2 (r=-0.495, P=0.005) scales were negatively correlated with the scores of HAMD assessment, and the scores of PASAT-3 (r=-0.499, P=0.004) and PASAT-2 (r=-0.452, P=0.011) were negatively correlated with the scores of HAMA. Conclusions: The cognitive function of patients with NMOSD is significantly reduced, involving multiple cognitive domains. The cognitive function is affected by the distribution of intracranial lesions and the degree of depression and anxiety.

Thromboprophylaxis practices in neurocritical care-A cross-sectional survey among neurocritical care practitioners.

Thromboprophylaxis practice patterns are quite diverse in neurocritical care patients. The risk of venous thromboembolism remains high in this group due to prolonged immobilised status, extended length of stay and multiple comorbidities. The aim was to comprehend the thromboprophylaxis practices among neurocritical care practitioners in India. The cross-sectional online questionnaire-based survey was undertaken among the neurocritical care practitioners. Two investigators framed two sets of 15 questions in the first stage and reviewed them with experts. In the second stage, a set of 22 questions was prepared by a third investigator and pretested among ten experts. The questions were emailed to the participants with a link to the survey. The responses were analysed using Statistical Package For The Social Sciences software. Of the 185 responses, 53% reported that thromboprophylaxis is practised less often in neurocritical care than in general critical care. The usage of pharmacoprophylaxis among neurosurgical cases, traumatic brain injuries and brain strokes varies widely. There was a preference to use pharmacoprophylaxis in patients with Glasgow Coma Scale (GCS) below nine among many (68.2%), and low molecular weight heparin (LMWH) was the preferred choice in such cases. The reluctance to use heparin because of fear of bleed was high (82%). Most (78.9%) believed pharmacoprophylaxis could reduce venous thromboembolic events (VTEs) and mortality. Thromboprophylaxis practices among neurocritical care patients remain quite heterogeneous. There is a dilemma in patients with intracranial haemorrhagic lesions regarding pharmacoprophylaxis.

Treatment outcome of metastasis to the pituitary gland: a case series of 21 patients with pathological diagnosis.

The aim of this study was to report the treatment course of histologically confirmed metastases to the pituitary gland (pituitary metastasis). The Mayo data explorer was used to find patients with pituitary metastasis. Twenty-one patients were identified between the years 2001 and 2021, and their data were retrospectively collected. The most common primary cancer origin was lung in men (45%) and breast in women (33%). The median age was 66 years (IQR 56-68 years). Patients presented with headache (67% [14/21]), vision problems (86% [18/21]), anterior hypopituitarism (71% [15/21]), and arginine vasopressin deficiency (38% [8/21]). Pituitary metastases were found before the diagnosis of the primary cancer in 5 patients (24%). The mean ± SD tumor size was 2.0 ± 0.7 cm, and 90% (19/21) presented as a solitary pituitary mass with no other intracranial metastatic lesions. Common radiological features were pituitary stalk thickening (90% [19/21]), cavernous sinus involvement (71% [15/21]), and constriction at the diaphragma sellae (52% [11/21]). Transsphenoidal surgery was performed in 20 patients, and subtotal resection was most frequently attained (76% [16/21]). Fourteen patients (67%) had adjuvant radiation therapy, and 15 patients (71%) were treated with systemic therapy. The median time from surgery to the initiation of radiation therapy was 16 days (IQR 11-21 days), and that from surgery to the initiation of systemic therapy was 5.0 months (IQR 1.5-14 months). During management, headaches improved in 57% (8/14) and vision problems improved in 61% (11/18) of cases; new hypopituitarism occurred in 5 patients. Six patients developed recurrence, and the median progression-free survival was 24 months (95% CI 5.4-43 months). After recurrence, 1 patient with adenoid cystic carcinoma was treated with rescue radiotherapy twice, and 4 patients responded well to systemic therapy. The median overall survival (OS) was 25 months (95% CI 7.1-43 months). The mean OS was better in patients with neuroendocrine lung tumor (261 months) and papillary thyroid carcinoma (80 months) and worse in patients with small cell lung cancer (4 months) and unknown origin (5 months). Surgery with or without adjuvant radiotherapy is effective for mass reduction, rapid symptomatic improvement of vision and headaches, and definitive diagnosis. Even after local tumor control failure, some patients still benefit from radiation and/or systemic therapy.

Computed tomography image segmentation of irregular cerebral hemorrhage lesions based on improved U-Net

ObjectiveThis paper aims to improve U-Net for more accurate segmentation of irregular intracranial hemorrhage lesions in CT images. MethodsThe residual octave convolution (ResOctConv) module was introduced to overcome the semantic gap issue in U-Net, and a hybrid attention mechanism called mixed attention mechanism (MAM) was proposed to further enhance the performance of U-Net. 40 patients with irregular cerebral hemorrhage images were selected from head CT scans performed between August and December 2022. Two radiologists independently traced the edge of each selected image three times, and the final segmentation boundary was determined by consensus. The effectiveness of the lesion segmentation was measured using the Dice coefficient, Jaccard Index, and Relative volume difference. ResultsBased on the box plot of the Dice coefficient for all 40 patients, the improved U-Net demonstrated higher accuracy in segmenting irregular intracranial hemorrhage lesions in CT images compared to the original U-Net. Moreover, the comparison of Dice coefficient, Jaccard coefficient, and RVD indicates that the improved U-Net outperforms both the original U-Net and the region growing algorithm in segmenting irregular cerebral hemorrhage lesions. ConclusionsThe proposed improved U-Net outperforms both the original U-Net and the region growing algorithm in segmenting irregular cerebral hemorrhage lesions, providing an advanced toolset for radiologists to accurately identify and diagnose irregular cerebral hemorrhage lesions.

Novel application of robot-guided stereotactic technique on biopsy diagnosis of intracranial lesions.

This study was performed to examine whether there is a link between the application of three types of robot-guided stereotactic biopsy techniques and the diagnostic rate of intracranial lesion biopsy. The study involved 407 patients who underwent robot-guided stereotactic intracranial lesion biopsy at Xuanwu Hospital of Capital Medical University from January 2019 to December 2021. Age, sex, lesion characteristics, lesion distribution, surgical method, and target path depth were assessed for their impact on the biopsy diagnostic rate. The patients' mean age was 42.1 years (range, 6 months-82 years). All patients underwent robot-assisted stereotactic brain biopsy using one of three different systems: a ROSA robotic system (n=35), the CAS-R-2 (n=65), or the REMEBOT domestic robotic system (n=307). No significant difference was found in the diagnostic rate of positive histopathological findings or the mean time of surgery among the three biopsy modalities. The diagnostic rate was 93.86%. Multiple linear regression analysis showed that age, sex, and biopsy modality did not affect the diagnostic rate n>0.05), whereas enhancing lesions and smaller-volume lesions (≤l cm3) were significantly correlated with the diagnostic rate (p = 0.01). Lesions located in the suprasellar and pineal regions were significantly associated with the negative diagnostic rate (p<0.05). The presence of enhancing lesions, lesion location, and lesion volume significantly affected the diagnostic rate of brain biopsy. Age, sex, lesion depth, and biopsy modality did not significantly affect the diagnostic rate. All three procedures had high safety and effectiveness.

Right sided facial nevus with contralateral cavernous angioma in a child with Sturge Weber syndrome

Sturge Weber syndrome is a rare sporadic neurocutaneous syndrome. It has extra -oral manifestations mostly in form of unilateral port wine stain on face that are ipsilateral to intra-cranial lesions (mostly lepto-meningeal angioma), seizures, glaucoma and intra-orally by hemangioma of ipsilateral gingiva. We case report a child with Sturge Weber syndrome with facial nevus opposite to intra-cranial lesion, intra-oral port wine stain and gum hypertrophy. Other than contralateral intracranial lesion and facial nevus, challenge was whether to see gingival manifestations as part of syndrome or as drug side effect, as child was also on phenytoin, an anti-epileptic drug widely related to this condition.

Amphiphysin-IgG autoimmune sciatic neuropathy and facial neuropathy related to primary central nervous system lymphoma: A case report

We reported a 61-year-old man presented with 10-month progressing left sciatic neuropathy and 10-day right facial neuropathy. Serum amphiphysin-IgG was positive. 18F-FDG PET/CT of the whole body showed no signs of malignancy. Treatment with plasma exchange and oral prednisone relieved the symptoms. Nine months later, right hemiparesis and seizure of right limbs developed. 18F-FDG and 18F-PBR06 (18 kDa translocator protein, TSPO) radioligand PET/MRI of the whole body revealed intense uptake in the intracranial lesions. Intracranial lymphoma was diagnosed by stereotactic needle brain biopsy. Mononeuropathies could be paraneoplastic syndromes. TSPO shows high uptake in intracranial lymphoma on 18F-PBR06 PET images.

Sex differences in time course and diagnostic accuracy of GFAP and UCH-L1 in trauma patients with mild traumatic brain injury

Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-terminal hydrolase (UCH-L1) have been FDA-approved for clinical use in mild and moderate traumatic brain injury (TBI). Understanding sex differences in their diagnostic accuracy over time will help inform clinical practice. We sought to evaluate the sex differences in the temporal profile of GFAP and UCH-L1 in a large cohort of trauma patients presenting to the emergency department. To compare the biomarkers’ diagnostic accuracy in male versus female patients for detecting mild TBI (MTBI), and traumatic intracranial lesions on head CT. This prospective cohort study enrolled female and male adult trauma patients presenting to a Level 1 Trauma Center. All patients underwent rigorous screening to determine whether or not they had experienced a MTBI. Of 3025 trauma patients assessed, 1030 met eligibility criteria and 446 declined. Initial blood samples were obtained in 584 patients enrolled within 4 h of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180-h post-injury. The main outcomes included the diagnostic accuracy in detection of MTBI and traumatic intracranial lesions on head CT scan. A total of 1831 samples were drawn in 584 patients over 7 days, 362 (62%) were male and 222 (38%) were female. The pattern of elevation was similar in both sexes. Although the pattern of elevation was similar between male and female for both biomarkers, male patients had significantly higher concentrations of UCH-L1 compared to female patients at several timepoints post-injury, particularly within 24 h of injury. There were no significant differences in diagnostic accuracy for detecting MTBI or for detecting CT lesions between male and female patients at any timepoint for both GFAP and UCH-L1. Although patterns of GFAP and UCH-L1 release in trauma patients over a week post-injury was similar between the sexes, there were significantly higher concentrations of UCH-L1 in males at several timepoints post-injury. Despite this, the overall diagnostic accuracies of both GFAP and UCH-L1 over time for detecting MTBI and CT lesions were not significantly different between male and female trauma patients.

Ptosis Revealing A Tolosa Hunt Syndrome: A Case Report

Tolosa-Hunt Syndrome is a rare condition with an undetermined etiology that manifests clinically as unilateral orbital pain and ophthalmoplegia. We report the case of a 48-year-old female who developed acute eight upper lid ptosis within 2 days, which was preceded by retro-orbital pain without other neurological deficits. Unilateral 3d, 4th and 6th cranial nerves palsy were observed. An emergent brain magnetic resonance image (MRI) revealed a cavernous sinus asymmetry, with an oblong, well-defined thickening of the right cavernous sinus. The MRI revealed no signs of cavernous thrombosis nor intracranial lesion. THS was diagnosed, and corticosteroid treatment was initiated, with complete improvement in symptoms. A non-specific inflammation of the cavernous sinus causes the Tolosa-Hunt syndrome. Diplopia and ptosis can occur as a result of nerve paralysis. THS management is challenging and should be multidisciplinary, involving ophthalmologists, neurologists, and neuroradiologists. It is characterized by rapid response to treatment with steroids.