Supratentorial Research Articles

Altered static and dynamic spontaneous neural activity in patients with ischemic pontine stroke.

The purpose of the study was to investigate the abnormality both of static spontaneous brain activity and dynamic temporal variances following a pontine infarction. Forty-six patients with chronic left pontine infarction (LPI), thirty-two patients with chronic right pontine infarction (RPI), and fifty healthy controls (HCs) were recruited for the study. The static amplitude of low-frequency fluctuations (sALFF), static regional homogeneity (sReHo), dynamic ALFF (dALFF), and dynamic ReHo (dReHo) were employed to detect the alterations in brain activity induced by an infarction. The Rey Auditory Verbal Learning Test and Flanker task were used to evaluate the verbal memory and visual attention function, respectively. Receiver operating characteristic curve analysis was used to reveal the potential capacity of these metrics to distinguish the patients from HCs. There were significant variations of these static and dynamic metrics in patients with chronic pontine infarction. The altered regions involved the supratentorial regions, including cortex and subcortical. Moreover, the altered metrics were significantly correlated with verbal memory and visual attention. In addition, these static and dynamic metrics also showed potential in distinguishing stroke patients with behavior deficits from HCs. The pontine infarction-induced cerebral activation changes are observed in both motor and cognitive systems, indicating the functional damage and reorganization across the global cerebral level in these patients with subtentorial infarction, and there is a reciprocal effect between motor and cognitive impairment and repair.

Pediatric low-dose head CT: Image quality improvement using iterative model reconstruction.

To evaluate the differences in pediatric non-contrast low-dose head computed tomography (CT) between filtered-back projection and iterative model reconstruction using objective and subjective image quality evaluation. A retrospective study evaluated children undergoing low-dose non-contrast head CT. All CT scans were reconstructed using both filtered-back projection and iterative model reconstruction. Objective image quality analysis was performed using contrast and signal-to-noise ratios for the supra- and infratentorial brain regions of identical regions of interest on the two reconstruction methods. Two experienced pediatric neuroradiologists evaluated subjective image quality, visibility of structures, and artifacts. We evaluated 233 low-dose brain CT scans of 148 pediatric patients. There was a ∼2-fold improvement in the contrast-to-noise ratio between gray and white matter in the infra- and supratentorial regions (p < 0.001) using iterative model reconstruction compared to filtered-back projection. The white and gray matter signal-to-noise ratio improved more than 2-fold using iterative model reconstruction (p < 0.001). Furthermore, radiologists graded anatomical details, gray-white matter differentiation, beam hardening artifacts, and image quality using iterative model reconstructions as superior to filtered-back projection reconstructions. Iterative model reconstructions had better contrast-to-noise and signal-to-noise ratios with fewer artifacts in pediatric CT brain scans using low-dose radiation protocols. This image quality improvement was demonstrated in the supra- and infratentorial regions. This method thus comprises an important tool for reducing children's exposure while maintaining diagnostic capability.

Perfusion Deficits in Different Mechanisms of Two Subtypes of Acute Stroke with Diffusion MRI Confirmation.

Branch atheromatous disease (BAD) and lacunar infract (LI) are the different mechanisms of subtypes of acute stroke. We aimed to investigate perfusion deficits and clinical characteristics of the different mechanisms of two subtypes of acute stroke. Five hundred and ninety-nine CTP examinations were retrospectively reviewed between January and December 2021 in patients with acute stroke symptoms with CTP within 12 hours and MRI within 7 days of symptom onset. Based on diffusion MRI, the patients were assigned to one of two subtypes: BAD and LI. Lesion volumes were measured on NCCT, CTA, CBV, CBF, MTT, and TTP maps by region-of-interest analysis and were confirmed by follow-up MRI. One hundred thirty-three patients met the inclusion criteria (26.3% female). The BAD group was present in 104 of 133 (78.2%), and the LI group 29 of 133 (21.8%). Based on CT perfusion, 42 of 78 (53.8%) BAD group and 5 of 18 (27.8%) LI group had perfusion deficits in the supratentorial region. BAD had a higher proportion of abnormal perfusion than LI patients, with a significant difference (P < 0.05). The sensitivity of CTP ranged from 21.4% (CBV) to 90.5% (TTP); specificity ranged from 97.2% (TTP) to 100% (CBV, CBF, and MTT) in BAD patients. CTP has high specificity in identifying BAD. Compromised perfusion deficits are more presented in BAD patients compared with LI. CT perfusion imaging may be useful for determining the clinical significance of perfusion abnormalities in BAD occurrence.

Characterization of MRI White Matter Signal Abnormalities in the Pediatric Population.

(1) Background and Purpose: The aim of this study was to retrospectively characterize WMSAs in an unselected patient cohort at a large pediatric neuroimaging facility, in order to learn more about the spectrum of the underlying disorders encountered in everyday clinical practice. (2) Materials and Methods: Radiology reports of 5166 consecutive patients with standard brain MRI (2006-2018) were searched for predefined keywords describing WMSAs. A neuroradiology specialist enrolled patients with WMSAs following a structured approach. Imaging characteristics, etiology (autoimmune disorders, non-genetic hypoxic and ischemic insults, traumatic white matter injuries, no final diagnosis due to insufficient clinical information, "non-specific" WMSAs, infectious white matter damage, leukodystrophies, toxic white matter injuries, inborn errors of metabolism, and white matter damage caused by tumor infiltration/cancer-like disease), and age/gender distribution were evaluated. (3) Results: Overall, WMSAs were found in 3.4% of pediatric patients scanned at our and referring hospitals within the ten-year study period. The majority were found in the supratentorial region only (87%) and were non-enhancing (78% of CE-MRI). WMSAs caused by autoimmune disorders formed the largest group (23%), followed by "non-specific" WMSAs (18%), as well as non-genetic hypoxic and ischemic insults (17%). The majority were therefore acquired as opposed to inherited. Etiology-based classification of WMSAs was affected by age but not by gender. In 17% of the study population, a definite diagnosis could not be established due to insufficient clinical information (mostly external radiology consults). (4) Conclusions: An "integrated diagnosis" that combines baseline demographics, including patient age as an important factor, clinical characteristics, and additional diagnostic workup with imaging patterns can be made in the majority of cases.

Distinct lesion features and underlying mechanisms in patients with acute multiple infarcts in multiple cerebral territories.

To determine the etiology spectrum and lesion distribution patterns of patients with acute multiple infarcts in multiple cerebral territories (AMIMCT) and provide guidance for treatment and prevention strategies in these patients. Patients with acute ischemic stroke diagnosed using diffusion-weighted imaging (DWI) were consecutively included in this study between June 2012 and Apr 2022. AMIMCT was defined as non-contiguous focal lesions located in more than one cerebral territory with acute neurological deficits. We retrospectively analyzed the clinical and imaging characteristics, etiology spectra and underlying mechanisms in patients with and without AMIMCT. Infarct lesion patterns on DWI and their relevance to etiology were further discussed. A total of 1,213 patients were enrolled, of whom 145 (12%) were diagnosed with AMIMCT. Patients with AMIMCT tended to be younger (P = 0.016), more often female (P = 0.001), and exhibited less common conventional vascular risk factors (P < 0.05) compared to those without AMIMCT. The constitution of the Trial of Org 10,172 in Acute Stroke Treatment classification was significantly different between patients with and without AMIMCT (P = 0.000), with a higher proportion of stroke of other determined causes (67.6% vs. 12.4%). For detailed etiologies, autoimmune or hematologic diseases were the most common (26.2%) etiologies of AMIMCT, followed by periprocedural infarcts (15.2%), cardioembolism (12.4%), tumor (12.4%), large artery atherosclerosis (10.3%), and sudden drop in blood pressure (8.3%). Hypercoagulability and systemic hypoperfusion are common underlying mechanisms of AMIMCT. Distinctive lesion distribution patterns were found associated with stroke etiologies and mechanisms in AMIMCT. Most of patients with large artery atherosclerosis (73.3%), autoimmune/hematologic diseases (57.9%) manifested the disease as multiple infarct lesions located in bilateral supratentorial regions. However, 66.7% of cardioembolism and 83.8% of cardiovascular surgery related stroke presented with both supratentorial and infratentorial infarct lesions. The etiologies and mechanisms of patients with AMIMCT were more complex than those without AMIMCT. The distribution characteristics of infarct lesions might have important implications for the identification of etiology and mechanism in the future, which could further guide and optimize clinical diagnostic strategies.

Clinical characteristics and prognosis of Glioblastoma patients with infratentorial recurrence

BackgroundGlioblastoma (GBM) infrequently recurs in the infratentorial region. Such Infratentorial recurrence (ITR) has some clinically unique characteristics, such as presenting unspecific symptoms and providing patients a chance to receive additional radiotherapy. However, the clinical significances of ITR are not well studied.MethodsWe reviewed newly diagnosed isocitrate dehydrogenase (IDH)-wildtype GBM patients treated at our institution between October 2008 and December 2018. ITR was defined as any type of recurrence in GBM, including dissemination or distant recurrence, which primarily developed in the supratentorial region and recurred in the infratentorial region.ResultsOf 134 patients with newly diagnosed IDH-wildtype GBM, six (4.5%) were classified as having ITR. There was no significant difference in median duration from the first surgery to ITR development between patients with and without ITR (12.2 vs. 10.2 months, P = 0.65). The primary symptoms of ITR were gait disturbance (100%, n = 6), dizziness (50.0%, n = 3), nausea (33.3%, n = 2), and cerebellar mutism (16.7%, n = 1). In four cases (66.7%), symptoms were presented before ITR development. All patients received additional treatments for ITR. The median post-recurrence survival (PRS) of ITR patients was significantly shorter than that of general GBM patients (5.5 vs. 9.1 months, P = 0.023). However, chemoradiotherapy contributed to palliating symptoms such as nausea.ConclusionsITR is a severe recurrence type in GBM patients. Its symptoms are neurologically unspecific and can be overlooked or misdiagnosed as side effects of treatments. Carefully checking the infratentorial region, especially around the fourth ventricle, is essential during the GBM patient follow-up.

One-stop hybrid operation versus microsurgery for treating brain arteriovenous malformation in children-a retrospective case series.

Brain arteriovenous malformation (BAVM) is one of the most common causes of cerebral hemorrhage in children. The effectiveness of one-stop hybrid operation in the treatment of BAVM in adults has been widely confirmed, but there are few study for the case in children. The aim of this study was to retrospectively analyze of the role and significance of one-stop hybrid surgery versus microsurgery in the treatment of BAVM in children. A total of 57 children (≤18 years old) with BAVM who were admitted to The 900th Hospital and Fujian Children's Hospital between September 2018 and August 2022 were retrospectively analyzed. According to the inclusion and exclusion criteria, 38 patients were included, and they were divided into a microsurgical group (25 patients) and a hybrid operation group (13 patients) according to the treatment modality. The following clinical characteristics were observed: sex, age, initial symptoms, presence or absence of signs, Glasgow Coma Scale (GCS) score, Hunt-Hess grade, imaging characteristics such as the location of the BAVM, Spetzler-Martin (S-M) grade, presence of intraventricular hemorrhage, treatment and prognostic indicators such as intraoperative blood loss, operation time, imaging cure, postoperative complications, length of hospital stay, and 3- and 6-month modified Rankin score (mRS) after the operation. The proportions of female patients (P=0.042), patients whose BAVM were located in the supratentorial region (P=0.034) and patients whose S-M grade was above grade III (P=0.003) were greater in the hybrid operation group than those in the microsurgical group. The intraoperative blood loss (P<0.001), operation time (P<0.001) and postoperative hospital stay (P=0.024) of patients in the microsurgical group were greater than those in the hybrid operation group. The presence of signs and the S-M grade may be relevant factors in predicting the surgical approach, and the probability of selecting a hybrid operation for each step of increasing the S-M grade was 3.046 times that of microsurgery. A one-stop hybrid operation is effective and safe for the treatment of BAVM in children. High S-M grades of BAVM are more suitable for hybrid operation.

Early Post-stroke Seizures in Acute Ischaemic Stroke: A Retrospective Study

Introduction: Seizures represent an important complication of ischaemic stroke causing a substantial burden to post-stroke patients. Seizures occurring within one week after acute stroke onset are called early onset seizures. Several studies have tried to identify the risk factors for early seizures after stroke with controversial results. Aim: To determine the risk factors of early post-stroke seizures in a retrospective cohort of acute ischaemic stroke. Materials and Methods: This retrospective cohort study included medical records of 552 adult patients with acute ischaemic stroke between March 2017 to September 2022 admitted at Travancore Medical College Hospital, Kollam, Kerala, India. The patients were divided into two groups-stroke patients with early onset seizures and stroke patients without early onset seizures. The following parameters were compared between the two groups-age, gender, presenting symptoms, ischaemic subtype (TOAST {Trial of Org 10172 in Acute Stroke Treatment} classification), vascular territory involved, lesion location and lateralisation, infarct size, stroke severity based on National Institute of Health Stroke Scale (NIHSS), vascular risk factors, treatment (thrombolysis, antiplatelets, anticoagulants use) and related complications (haemorrhagic transformation, infection, gastrointestinal haemorrhage, hyponatraemia). Univariate analysis was done using Chi-square test and multivariate analysis using logistic regression test. Statistical Package for the Social Sciences (SPSS) version 27.0 statistical software was used, p-value&lt;0.05 was considered statistically significant. Results: Among 552 patients, 76 (13.8%) were stroke patients with early onset seizure group and 476 (86.2%) were stroke patients without early onset seizure group. A total of 84.2% of patients developed seizure within 24 hours of stroke onset. A total of 409 (74.1%) patients were males. Patients with early onset seizures were younger. The most common seizure type was unknown onset to bilateral tonic-clonic seizures (85.5%). Multivariate analysis identified severe NIHSS, supratentorial, cortical location, large artery disease, anticoagulation use, haemorrhagic transformation and hyponatraemia as independent factors for early onset seizures. Conclusion: Severe NIHSS at presentation, large artery disease, supra tentorial, cortical location of infarct, use of anticoagulants, haemorrhagic transformation and hyponatraemia were significant risk factors of early seizures in acute ischaemic stroke. An early identification and understanding of these risk factors would help to prevent seizures in acute stroke patients.

A CASE REPORT OF RARE LOCALİZATİON FOR CAVERNOMA İN MİDBRAİN

Cavernous malformations are classified as a group of vascular malformations of the central nervous system. It usually occurs in the supratentorial region, rarely in the brainstem. When they are symptomatic, headache, brain stem signs, sensory and motor changes can usually occur. But it can be confused with a stroke in the case of acute developing lateralizing sensory-motor symptoms, especially in the absence of brainstem signs. It can be distinguished from hematoma by its well-circumscribed and nodular appearance. Although the prognosis is generally good, it can lead to serious deficits in patients with malformations in the brainstem. In our case report, it was found that it is worth presenting a case that started acutely without brain stem findings and had a good prognosis at 3-month follow-up with loss of strength on the right side and was treated conservatively.

Novel CT-based parameters assessing relative cross-sectional area to guide surgical management and predict clinical outcomes in patients with acute subdural hematoma.

Acute subdural hematoma (aSDH) is one of the most devastating entities secondary to traumatic brain injury (TBI). Even though radiological computed tomography (CT) findings, such as hematoma thickness (HT), midline shift (MLS), and MLS/HT ratio, have an important prognostic role, they suffer from important drawbacks. We hypothesized that relative cross-sectional area (rCSA) of specific brain regions would provide valuable information about brain compression and swelling, thus being a key determining factor governing the clinical course. We performed an 8-year retrospective analysis of patients with moderate to severe TBI with surgically evacuated, isolated, unilateral aSDH. We investigated the influence of aSDH rCSA and ipsilateral hemisphere rCSA along the supratentorial region on the subsequent operative technique employed for aSDH evacuation and patient's clinical outcomes (early death and Glasgow Outcome Scale [GOS] at discharge and after 1-year follow-up). Different conventional radiological variables were also assessed. The study included 39 patients. Lower HT, MLS, hematoma volume, and aSDH rCSA showed a significant association with decompressive craniectomy (DC) procedure. Conversely, higher ipsilateral hemisphere rCSA along the dorso-ventral axis and, specifically, ipsilateral hemisphere rCSA at the high convexity level were predictors for DC. CT segmentation analysis exhibited a modest relationship with early death, which was limited to the basal supratentorial subregion, but could not predict long-term outcome. rCSA is an objectifiable and reliable radiologic parameter available on admission CT that might provide valuable information to optimize surgical treatment.

A subtle connection between crossed cerebellar diaschisis and supratentorial collateral circulation in subacute and chronic ischemic stroke

ObjectivesIt has not been reported whether collateral circulation, a factor closely related to the prognosis of patients with cerebral infarction, is related to the occurrence of crossed cerebellar diaschisis(CCD) or not. Our research attempts to verify the relationship between the collateral circulation grade and the occurrence of CCD, mainly by means of CTA and CTP. Materials and methodsA total of 47 patients were divided into a CCD-positive (Kim et al., 2019) or a CCD-negative group Furlanis et al. (2018) by calculating the asymmetry index (AI) value (<10%) of bilateral cerebellar cerebral blood flow (CBF). A 4-scale grading method was used to evaluate collateral circulation in the supratentorial infarct area, and the four perfusion parameters of the supratentorial and subtentorial brain regions were analyzed and compared between the two groups. The extent of vascular lesions was evaluated by MR sequences including DWI and MRA. ResultsAmong the four perfusion parameters, except for CBV, were significantly different between the bilateral cerebellum in the CCD-positive group, but only TTP in the supratentorial cerebral infarction area was statistically different in the two groups. Moreover, the collateral circulation sore in the CCD-positive group was significantly lower than that in the CCD-negative group. But no statistical difference was found in the comparison of DWI positive rates between the two groups. ConclusionThe collateral score in the supratentorial infarct area is correlated with the occurrence of CCD,which may be used to explain the effect of CCD on the prognosis of patients.

Gross Tumor Resection Followed by Post-Operative Radiation Optimizes Local Control in Patients with Meningeal Hemangiopericytoma: An Update on a Single Institutional Experience

<h3>Purpose/Objective(s)</h3> Meningeal hemangiopericytomas (M-HPCs) are vascularized mesenchymal tumors with aggressive behavior, commonly arising intracranially. The ideal treatment regimen for M-HPC varies from institution to institution, given its rare incidence. We have previously reported that both gross tumor resection (GTR) and post-operative radiotherapy (PORT) independently correlate with improved local control (LC), and that GTR followed by PORT at a dose ≥ 60 Gy improves LC. Here, we provide an update to those initial findings with extended follow-up in an expanded cohort of patients. <h3>Materials/Methods</h3> A single-institution retrospective analysis was conducted by reviewing the medical records of patients presenting with localized M-HPC at to a tertiary referral cancer center, between 1979 and 2021. The Kaplan-Meier method was used estimate actuarial LC, metastasis-free survival (MFS), and overall survival (OS). <h3>Results</h3> We identified 82 patients diagnosed between 1979 and 2021 with localized M-HPC that were treated with surgery alone (n=36) or surgery + PORT (n=46). Most patients were male (n=48, 59%), with a median age of 41 years (interquartile range 34-52). Median follow-up was 114 months. Most patients had intracranial tumors arising in the supratentorial region (n=50, 61%). There were also 5 patients who presented with disease in the cervical spine (6%). GTR was accomplished in 39 patients (49%) versus subtotal resection (STR) in 29 (37%), and unknown status in 14 patients (14%). PORT was delivered to the majority of patients (n=46, 56%). For the entire cohort, 5- and 10-year OS were 91% and 66%, and 5- and 10-year LC were 65% and 34%. Additionally, 5- and 10-year MFS were 82% and 41%. Undergoing GTR was associated with improved LC (HR 0.40, p=0.014). Similarly, PORT resulted in improved LC relative to patients who underwent surgery alone (HR 0.27, p<0.0001). Patients who underwent a GTR followed by PORT had superior LC compared to patients who had GTR alone (HR 0.18, p=0.001). Among intracranial tumors, patients receiving adjuvant radiation equivalent-dose in 2 Gy fractions (EQD2) ≥ 60 Gy (n=15) had improved LC relative to EQD2 doses of < 60 Gy (n=16) (HR 0.20, p=0.011). Age, gender, and PORT did not correlate with differences in OS or MFS. <h3>Conclusion</h3> Our data in this expanded cohort with prolonged follow-up demonstrate that among patients with M-HPC, PORT and GTR each independently improve LC. However, the combination of both GTR followed by PORT is superior to GTR alone for LC and should remain standard of care. Additionally, for patients with intracranial disease, PORT EQD2 doses ≥ 60 Gy should be used to improve LC.

Radiomics features based on MRI predict BRAF V600E mutation in pediatric low-grade gliomas: A non-invasive method for molecular diagnosis

ObjectiveTo investigate the clinical application value of radiomics features based on preoperative magnetic resonance imaging for predicting B-Raf proto-oncogene serine/threonine-protein (BRAF) V600E mutation in pediatric low-grade gliomas. Materials and methodsThe clinical, imaging, and pathological data from 113 pediatric patients with low-grade gliomas patients were retrospectively analyzed. Using open-source software, three-dimensional imaging features were extracted on the basis of FLAIR sequences, and the radiomics process was analyzed to dichotomize BRAFV600E mutant and wild type. All cases were randomly divided into the training and test sets according to a 7:3 training and test group ratio, and a 5-fold cross-validation was performed on the training set. The optimal hyperparameters were selected to build the prediction model, and the test set was used for external validation to assess the diagnostic value of the model using the receiver operating characteristic curve. ResultsThe training set comprised 79 patients (47 males, 32 females, mean age 9.86 ± 5.20) and the test set comprised 34 patients (20 males, 14 females, mean age 10.97 ± 5.14). Sex, age, and brain side were not significant predictors of BRAF, and tumor location on the supratentorial region was a BRAF predictor (p < 0.05). The radiomics model constructed by principal component analysis for dimensionality reduction, Kruskal–Wallis for filtering of features, and random forest as a classifier performed best. In the training set, the mean area under the curve (AUC) with a five-fold cross-validation was 0.72 ( ± 0.057; 95 % confidence interval (CI), 0.602–0.831) and AUC of the test set was 0.875 ( ± 0.062; 95 % CI, 0.731–0.983). ConclusionThe use of a radiomics model based on FLAIR sequences can help predict BRAF V600E mutations in pediatric low-grade gliomas.

Systematic Review and Meta-analysis of Language Symptoms due to Cerebellar Injury.

To date, cerebellar contribution to language is well established via clinical and neuroimaging studies. However, the particular functional role of the cerebellum in language remains to be clarified. In this study, we present the first systematic review of the diverse language symptoms in spoken language after cerebellar lesion that were reported in case studies for the last 30years (18 clinical cases from 13 papers), and meta-analysis using cluster analysis with bootstrap and symptom co-occurrence analysis. Seven clusters of patients with similar language symptoms after cerebellar lesions were found. Co-occurrence analysis revealed pairs of symptoms that tend to be comorbid. Our results imply that the "linguistic cerebellum" has a multiform contribution to language function. The most possible mechanism of such contribution is the cerebellar reciprocal connectivity with supratentorial brain regions, where the cerebellar level of the language network has a general modulation function and the supratentorial level is more functionally specified. Based on cerebellar connectivity with supratentorial components of the language network, the "linguistic cerebellum" might be further functionally segregated.

Metric magnetic resonance imaging analysis reveals pronounced substantia-innominata atrophy in dementia with Lewy bodies with a psychiatric onset.

BackgroundDementia with Lewy bodies (DLB) is a type of dementia often diagnosed in older patients. Since its initial symptoms range from delirium to psychiatric and cognitive symptoms, the diagnosis is often delayed.ObjectivesIn our study, we evaluated the magnetic resonance imaging (MRI) of patients suffering from DLB in correlation with their initial symptoms taking a new pragmatic approach entailing manual measurements in addition to an automated volumetric analysis of MRI.MethodsA total of 63 patients with diagnosed DLB and valid 3D data sets were retrospectively and blinded evaluated. We assessed atrophy patterns (1) manually for the substantia innominata and (2) via FastSurfer for the most common supratentorial regions. Initial symptoms were categorized by (1) mild cognitive impairment (MCI), (2) psychiatric episodes, and (3) delirium.ResultsManual metric MRI measurements revealed moderate, but significant substantia-innominata (SI) atrophy in patients with a psychiatric onset. FastSurfer analysis revealed no regional volumetric differences between groups.ConclusionThe SI in patients with DLB and a psychiatric-onset is more atrophied than that in patients with initial MCI. Our results suggest potential differences in SI between DLB subtypes at the prodromal stage, which are useful when taking a differential-diagnostic approach. This finding should be confirmed in larger patient cohorts.

INTRAPARENCHYMAL BRAIN ABSCESS BY ODONTOGENIC SOURCE: CASE REPORT

Brain abscess is an infectious inflammatory process that has intracerebral purulent collection as a consequence. Odontogenic infections are possible causes for this condition, mostly because of the anaerobic feature of oral bacterial flora. In this case report, a 50-year-old female patient with hypertension and diabetes had a progressive frontotemporal migraine on the left side and a behavioral disturbance of 1-month evolution, becoming aphasic with difficulty in eating and movement. The patient was hospitalized and diagnosed by magnetic resonance imaging with an intraparenchymal brain abscess in the supratentorial region, drained during a brain surgery. On dental exam, teeth 17 and 48 presented degree III mobility and previous toothache history and were removed. Other infectious foci were negative by hemoculture and lumbar puncture, and no abnormalities were found on electrocardiogram, indicating a brain abscess with an odontogenic source. The patient was discharged and is in outpatient follow-up.

Incidence and Surgical Outcome of the Intracranial Epidermoid Cyst at Punjab Institute of Neurosciences Lahore, Pakistan

Objectives: The incidence and microsurgical outcomes of intracranial epidermoid cysts in the Department of Neurosurgery III, Punjab Institute of Neurosciences (PINS), Lahore, Pakistan, are described in this case series.&#x0D; Materials and Methods: This study was a data analysis of a case series of 15 patients (mean age, 40 years) of both gender with intracranial epidermoid cysts who had microsurgical surgical excision over five years.&#x0D; Results: This study comprised 11 (73.3%) male and 4 (26.7%) female patients, 11 (73.3%) cases were infratentorial and 4 (26.7%) cases were in supratentorial region. The epidermoid was located in the CP angle in 11 (73.3%) patients, 3 (20%) in the midline supra sellar region, and 1 (6.66%) in the frontotemporal region. The presenting complaints were mainly headache in 11 (73.33%), cranial nerve palsy and cerebellar signs in 8 (53.3%) patients, Trigeminal neuralgia in 3 (20%) patients, Fits and hydrocephalus in 2 (13.3%) patients. There were 14 (93.3%) patients with GTR (gross total resection), 1 (6.6%) patients STR (subtotal resection). According to Karnofsky's performance scoring (KPS), 3 (20%) patients improved, 11 (73.3%) patients had the same KPS, and 1 (6.6%) patient had a lower KPS.&#x0D; Conclusion: The epidermoid cysts in the brain are usually found in the infratentorial region rather than the supratentorial region. Infratentorial lesions typically cause cranial nerve deficits, whereas the supratentorial area symptom is a headache.

Crossed cerebellar diaschisis-related supratentorial hemodynamic and metabolic status measured by PET/MR in assessing postoperative prognosis in chronic ischemic cerebrovascular disease patients with bypass surgery

ObjectiveCerebral ischemic status is an indicator of bypass surgery. Both hemodynamics and glucose metabolism are significant factors for evaluating cerebral ischemic status. The occurrence of crossed cerebellar diaschisis (CCD) is influenced by the degree of supra-tentorial perfusion and glucose metabolism reduction. This study aimed to investigate the relationship between the CCD-related supra-tentorial blood flow and metabolic status before bypass surgery in patients with chronic and symptomatic ischemic cerebrovascular disease and the prognosis of surgery.MethodsTwenty-four participants with chronic ischemic cerebrovascular disease who underwent hybrid positron emission tomography (PET)/magnetic resonance (MR) before bypass surgery were included. Arterial spin labeling (ASL)-MR and FDG-PET were used to measure blood flow and metabolism, respectively. The PET images were able to distinguish CCD. The supratentorial asymmetry index (AI) and volume in the decreased blood flow region, decreased metabolism region and co-decreased region on the affected side, except for the infarct area, were respectively obtained before bypass surgery. The neurological status was determined using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. Differences between CCD-positive (CCD +) and CCD-negative (CCD−) groups were investigated.ResultsFourteen (58%) of the 24 patients were diagnosed as CCD +. Before surgery, the NIHSS and mRS scores of the CCD + were significantly higher than those of the CCD− (1.0(1.0) vs. 0.0(1.0), P = 0.013; 1.0(1.5) vs. 0.0(1.5), P = 0.048). After the surgery, the NIHSS and mRS scores of the CCD + showed a significant decrease (0.0(1.0) to 0.0(0.0), P = 0.011; 0.0(0.5) to 0.0(0.0), P = 0.008). Significant differences were observed in the supra-tentorial decreased metabolism region (all Ps ≤ 0.05) between the CCD + and CCD− groups, but no differences were observed in the preprocedural decreased supratentorial blood flow region (P > 0.05). The preprocedural NIHSS score was strongly correlated with the metabolism AI value in the decreased metabolism region (r = 0.621, P = 0.001) and the co-decreased region (r = 0.571, P = 0.004).ConclusionsSupratentorial blood flow and metabolism are important indicators of CCD. This study showed that CCD + patients benefited more from bypass surgery than CCD− patients. Staging based on CCD-related supra-tentorial blood flow and metabolic status by hybrid PET/MR may help to personalize treatment.

Abstract 3886: 3D genome conformation analysis in ST-EPN-ZFTA ependymoma identifies RCOR2 as a potential target

Abstract Ependymoma (EPN) is a tumor of the central nervous system that occurs in children and adults. Childhood EPNs are one of the most aggressive pediatric brain tumors, arising both in infratentorial and supratentorial (ST) regions of the brain. Molecular profiling has identified distinct subgroups of ependymomas, including ST-EPN-ZFTA and PF-EPN-A as the most common and most aggressive ones in children. To this date, the only curative and indispensable treatment option is surgical resection followed by radiation. Unfortunately, there are no targeted therapies in clinical use. However, EPN cells have been extremely difficult to culture and expand in vitro, which explains why molecular studies on EPN cells have been hampered. This shortcoming has recently been overcome by establishing EPN models including human cell lines and organoids as well as patient derived xenografts (PDX). 3D genome conformation analysis has emerged as a powerful approach to understand tumor development and to identify novel drug targets for the treatment of different tumors. In this project we have used genome-wide chromosome conformation capture (Hi-C), complemented with H3K27ac (active enhancers) as well as gene expression in primary ependymoma tumors and cell lines to identify regulatory mechanisms underlying aberrant expression of genes that are essential for ependymoma tumorigenesis. Results of this study showed that the fusion between ZFTA and RELA leads to the formation of new regulatory environments that are recurrently associated with aberrant overexpression of RCOR2 only in ST-EPN-ZFTA ependymoma cells. Indeed, compared to all other ependymoma subgroups as well as to normal brain, RCOR2 is significantly upregulated only in ST-EPN-ZFTA patient samples. To test oncogenic relevance of RCOR2 for growth and maintenance, we depleted RCOR2 by RNAi and observed a strongly reduced cell survival in several ST-EPN-ZFTA cell lines but not or to a lesser extent in PF-EPN-A cells. Since RCOR2 is an adaptor protein lacking enzymatic activity, we looked at the expression of the proteins known as an interacting partner of RCOR2. Lysine-histone demethylase 1 (LSD1) is one of them and its expression in ST-EPN-ZFTA significantly correlates with RCOR2 expression. We therefore hypothesized that ST-EPN-ZFTA cells may be sensitive to LSD1 depletion, too. Indeed, depletion of LSD1 by RNAi resulted in a strong growth inhibition in ST-EPN-ZFTA cells, but not in PF-EPN-A cells. However, none of the tested LSD1 inhibitors exerted anti-proliferative activity at clinically reachable doses in the ST-EPN-ZFTA cells indicating a potential LSD1 non-enzymatic function in this particular tumor type. In summary, our study nominates RCOR2 as a oncogenic gene specific for ST-EPN-ZFTA ependymomas. Current studies focus on the identification of other interacting partners of the RCOR2-LSD1 complex and how to target these for therapeutic approaches. Citation Format: Aylin Camgöz, Konstantin Okonechnikov, Owen Chapman, Monika Maurmann, Frank Buchholz, Stefan Pfister, Lukas Chavez, Marcel Kool. 3D genome conformation analysis in ST-EPN-ZFTA ependymoma identifies RCOR2 as a potential target [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3886.

EPEN-22. Molecularly aggressive ependymomas treated with Image guided pencil beam proton therapy: consecutive patient Indian experience

AIM: To assess the toxicities and early clinical outcomes in patients of primary and recurrent ependymomas treated with image guided pencil beam scanning proton beam therapy (PBS-PBT). MATERIALS AND METHODS: Between January 2019- December 2021, we analyzed consecutive patients of ependymomas treated with image guided PBS-PBT. They were also analyzed molecularly, and all recurrent/re-irradiated patients were considered for craniospinal irradiation (CSI). Acute toxicities were assessed based on NCI CTC v5.0, local control and radiological response by 3-monthly MRI post therapy. RESULTS: Seventeen consecutive patients with ependymoma (13 Grade III and 4 Grade II) (median age-9 years) were analyzed. 9 patients were primary, 7 were treated at first recurrence and 1 at second recurrence. Majority had posterior fossa (PF) tumors (12) followed by supratentorial (ST) (3) and spine (2). Among PF ependymomas, 10 had global loss of H3K27me3, whereas amongst ST, 1 had YAP1 fusion, 1 had L1CAM positivity and other, negative L1CAM and p65/RELA on immunohistochemistry. Gross/near-total resection was achieved in 87% patients. Primary ependymomas were treated with focal radiotherapy; and among recurrent cases, 7 received CSI followed by primary site boost to a total median dose of 55CGE (50.2-55.8CGE). Grade 2 dermatitis, grade 2 and 3 hematological toxicities (CSI) were noted in 3,2 and 2 patients respectively. Grade 2 fatigue noted in 53% of all and 71% receiving CSI. With a median follow-up of 10 months (2-24 months), local control (LC) and disease-free survival (DFS) was 87.5% (primary-100%, recurrent-75%) and overall survival (OS) was 94% (primary-100%, recurrent-88%). CONCLUSION: Our experience of treating patients of ependymoma with complete resection followed by PBS-PBT including CSI is encouraging with low acute toxicities. Recurrent/molecularly aggressive cases may be considered for CSI. Keywords: PT, proton beam therapy, ependymomas, primary and recurrent