Supratentorial Research Articles

Intracranial synovial sarcoma: A clinical, radiological and pathological study of 16 cases

IntroductionSynovial sarcoma (SS) is a tumor of unknown origin and is extremely rare in the central nervous system. Most studies on intracranial SS included only one or two cases. To better understand the disease, we review a series of primary intracranial SS. Method and materials16 primary intracranial SS in Tiantan Hospital during 2008–2017 were included. The clinical characteristics, including radiological and histological examination, operative records, and prognoses were reviewed. ResultThe case series included nine male and seven female patients with an average age of 23.8 years. Radiological results showed that the supratentorial region (81.25%) was the most common site of the brain involved. All patients were misdiagnosed as non-SS tumors. Gross total resection (GTR) was achieved in 12 cases (75.0%), and subtotal resection (STR) was achieved in 4 cases. All cases showed the characteristic SYT-SSX fusion gene, as detected by RT-PCR. The mean progression-free survival time (PFS) was 10.0 months and the mean overall survival time (OS) was 15.5 months. Multivariate analysis revealed that GTR and postoperative adjuvant radiotherapy were independent factors for PFS (HR = 6.143, 95% CI = 1.491–25.312; P = 0.012, HR = 6.143, 95% CI = 1.491–25.312; P = 0.012 respectively) and OS (HR = 9.000, 95% CI = 1.627–49.773; P = 0.012, HR = 0.017, 95% CI = 0.001–0.213; P = 0.002 respectively). ConclusionIntracranial SS were more frequently observed in the supratentorial region and in young patients without sex predilection. We recommend adjuvant radiation regardless of the extent of resection. More patients and longer follow-up periods were needed to further elucidate the biological features of intracranial SS.

Clinicopathological evaluation of PD-L1 expression and cytotoxic T-lymphocyte infiltrates across intracranial molecular subgroups of ependymomas: are these tumors potential candidates for immune check-point blockade?

Immune check-point blockade (ICB) targeting programmed cell death ligand-1 (PD-L1)/programmed death-1 (PD-1) axis has created paradigm shift in cancer treatment. 'ST-RELA' and 'PF-A' molecular subgroups of ependymomas (EPN) show poor outcomes. We aimed to understand the potential candidature of EPNs for ICB. Supratentorial (ST) Grade II/III EPNs were classified into ST-RELA, ST-YAP, and ST-not otherwise specified (NOS), based on RELA/YAP1 fusion transcripts and/or L1CAM and p65 protein expression. Posterior fossa (PF) EPNs were classified into PF-A and PF-B based on H3K27me3 expression. Immunohistochemistry for PD-L1 and CD8 was performed. RelA protein enrichment at PDL1 promoter site was analysed by chromatin immunoprecipitation-qPCR (ChIP-qPCR). Eighty-three intracranial EPNs were studied. Median tumor infiltrating CD8 + cytotoxic T-lymphocyte (CTL) density was 6/mm2, and was higher in ST-EPNs (median 10/mm2) as compared to PF-EPNs (median 3/mm2). PD-L1 expression was noted in 17/83 (20%) EPNs, including 12/31 ST-RELA and rare ST-NOS (2/12), PF-A (2/25) and PF-B (1/13) EPNs. Twelve EPNs (14%) showed high CTL density and concurrent PD-L1 positivity, of which majority (10/12) were ST-RELA EPNs. Enrichment of RelA protein was seen at PDL1 promoter. Increased CTL densities and upregulation of PD-L1 in ST-RELA ependymomas suggests potential candidature for immunotherapy.

Childhood brain tumors in Mali.

to assess epidemiologic and clinical aspects of childhood brain tumors in Mali. a retrospective, descriptive study of children aged 0-15 years with brain tumors, conducted in the pediatrics department of the Gabriel Touré University Hospital Center in Bamako, Mali, from January 31, 2007 to December 3, 2012. In all, 41 cases of brain tumors were recorded during this period (mean: 5.5 years old; range: 1-12 years). Brain tumors were most frequent in the children aged 2-5 years (53.7%) and among boys (53.7%). Late stage at presentation was relatively frequent (34.1%) with a mean time to diagnosis of 10 months. Features of elevated intracranial pressure were the most frequent mode of revelation of primary tumors (26.8%). Supratentorial tumors accounted for 83% of the cases, and gliomas were most frequently (29.3%) identified on computed tomography. Only five patients underwent surgical tumor removal. A broader study including the other hospitals in Bamako could help to assess more accurately the epidemiology of pediatric brain tumors in Mali.

Accuracy of different anatomic landmark methods in determining size of nasopharyngeal airway

Objective To evaluate the accuracy of different anatomic landmark methods in determining the size of nasopharyngeal airway. Methods Fifty-two patients of both sexes, aged 16-60 yr, of American Society of Anesthesiologists physical status Ⅰ to Ⅲ, with body mass index of 18-30 kg/m2, scheduled for elective awake craniotomy for supratentorial tumors under sedation-awake-sedation anesthesia, were included. For each patient, the distance from the apex of nose to the right tragus (NT), distance from apex of nose to the right mandibular angle (NM), and thyro-mental distance (TM) were measured and marked on a transnasal tube correspondingly. The patients were placed in supine position without pillow, topical anesthesia (nasal mucosal surface) was performed with 2% lidocaine, and patients were sedated with midazolam, propofol and dexmedetomidine. When Observer′s Assessment of Alertness/Sedation Scale score was 2 or 3 points, the tube was transnasally inserted to each marked depth. When the three marked depths mentioned above were reached, the positions of the tube′s tip were checked using a fiberoptic bronchoscope and recorded as: above epiglottis (the tip of the tube was placed between the epiglottis and the free edge of soft palate) or below epiglottis (the tip of the tube placed at or beyond the epiglottis). Results When the depth reached the NT mark, the tube′s tip was above epiglottis in 14 cases (27%), and the tube′s tip was below epiglottis in 38 cases (73%). When the depth reached the NM mark, the tube′s tip was above epiglottis in 31 cases (60%), and the tube′s tip was below epiglottis in 21 cases (40%). When the depth reached the TM mark, the tube′s tip was above epiglottis in 52 cases (100%). Compared with the NM and NT methods, the TM method had a higher probability with the tube′s tip above epiglottis when used to determine the depth of insertion (P<0.01). Conclusion TM anatomic landmark method provides higher accuracy in determining the size of nasopharyngeal airway. Key words: Anatomic landmarks; Airway management

Notch pathway in ependymoma RELA-fused subgroup: upregulation and association with cancer stem cells markers expression.

RELA-fused supratentorial (ST) ependymoma (EPN) is an aggressive subgroup with poor prognosis. Considering the putative role of Notch signaling in the maintenance of the cancer stem cells (CSC) phenotype in RELA-fused EPN, we investigated the expression of Notch pathway and its target genes in this subgroup. We also evaluated the effects of two Notch inhibitors (DAPT and RO4929097) on cell proliferation, apoptosis, colony formation, and CSCs markers gene expression on EPN cell line of the RELA-fused subgroup (BXD-1425). In addition, in silico signatures of the Notch genes and CSCs markers were analyzed on a large clinical dataset from GSE64415 study. We found that among the ST-EPN subgroups the Notch signaling (NOTCH1, JAG1, JAG2, and HES4) is specifically activated in the ST-EPN-RELA. Furthermore, treatment of the RELA-fused EPN cell line with the Notch inhibitors impaired the Notch signaling expression and revealed that Notch axis is not essential for cell proliferation and survival in this setting. NOTCH1 expression in ST-EPN was correlated with the CSCs markers VEGFA and L1CAM overexpression and JAG1 expression was correlated with the CCND1 and CDK6 overexpression. In addition, in vitro treatment with Notch inhibitors induced downregulation of CSCs markers. These findings indicate that Notch signaling can be involved in the ST-EPN-RELA CSCs maintenance by modulating the expression of genes responsible for cell phenotype and cell fate.

Characteristics intracranial epidermoid cyst between two hospital from developed vs developing institution and literature review

IntroductionIntracranial epidermoid tumors are slow-growing lesions, which may recur after incomplete resection (surgery), but may do so over many years. These slow growing benign tumors encase and surround nerves and arteries rather than displacing them and the treatment of choice is radical surgery. Therefore the clinical symptoms are varies. The incidence of intracranial epidermoids is between 0.3% and 1.8% of all brain tumors. Whether the characteristics of tumor are related with culture of clinical neurologic in different developed and developing institution has not been discussed yet. MethodsBetween 2015 until 2017, we collected data from two institutions, Keio University hospital Tokyo Japan and Hasan Sadikin Hospital Padjadjaran University Bandung Indonesia. We collect 16 patients from Keio University hospital (KUH) and 10 patients from Hasan Sadikin hospital (HSH). ResultsIn which the 11 cases is located in infratentorial and 5 cases were in supratentorial region at KUH. Meanwhile in HSH, we found that 10 patients were in infratentorial. The characteristic of cranial nerve palsy and/or neurological deficits are mainly similar in infratentorial region whether from KUH or HSH, including supratentorial epidermoid are also similar. At KUH, the location of epidermoid is located in the CPA (cerebellopontine angle) in 8 patients, 3 in suprasellar region, 1 in Meckel's cave, 1 in 4th ventricle, 1 in medulla, 1 in petroclival and 1 in occipital lobe. In HSH, the lesions are located in infratentorial in which 5 patient in CPA, 4 in petroclival region and 1 case in Meckel's cave. In infratentorial lesion the CNs (cranial nerves) palsy were found in CN IV, V, VI, VII, VIII, and none in IX, X, XI, XII. In supratentorial lesion the chief complaint was mainly headache. ConclusionThe epidermoid of the brain are mostly located in the infratentorial region rather than in supratentorial. The CNs deficit are commonly arose in infratentorial lesion meanwhile the supratentorial region symptom is headache. It is reasonable if the patient came with infratentorial multiple CNs palsy to be suspicious for epidermoid benign tumor in the intracranial. Those characteristics are found in both developed and developing hospitals.

Possibilities of verification of a short-term functional outcome prognosis in the acute period of spontaneous supratentorial intracerebral hemorrhage using modified variants of the Intracerebral Hemorrhage Scale

Мета роботи – здійснити аналіз діагностичної інформативності модифікованих варіантів Intracerebral Hemorrhage (ICH) Scale в детекції ризику несприятливого функціонального виходу гострого періоду спонтанного супратенторіального внутрішньомозкового крововиливу (ССВМК). Матеріали та методи. Провели проспективне дослідження 122 пацієнтів (середній вік 64,7 ± 1,1 року) в гострому періоді ССВМК на тлі консервативної терапії. Клініко-нейровізуалізаційне оцінювання тяжкості стану пацієнтів здійснювали під час надходження в стаціонар з використанням ICH Scale та її модифікованих варіантів (mICH-A, mICH-B). Як несприятливий функціональний вихід гострого періоду ССВМК розглядали значення >3 балів за модифікованою шкалою Ренкіна на 21 добу захворювання. Для порівняльного аналізу інформативності використаних шкал і розроблення критеріїв прогнозували, використовували ROC-аналіз. Результати. Несприятливий функціональний вихід гострого періоду ССВМК був зареєстрований у 50 (41,0 %) пацієнтів. Пацієнти з несприятливим функціональним виходом гострого періоду ССВМК в дебюті захворювання cтатистично значущо відрізнялися вищим значеннями за шкалами mICH-A (4 (3; 5) проти 2 (1; 3), p 2 балів за шкалою mICH-A (чутливість = 76,0 %; специфічність = 69,4 %; RR = 3,6 (3,1–4,1), p ˂ 0,0001) та >1 бала за шкалою mICH-B (чутливість = 76,0 %; специфічність = 68,1 %; RR = 3,2 (2,8–3,6), p ˂ 0,0001). Висновки. Модифіковані варіанти ICH Scale є інформативними інструментами верифікації короткострокового функціонального прогнозу в пацієнтів із ССВМК.

Clinical characteristics and outcomes of supratentorial subdural hematoma following microvas-cular decompression

Objective To summarize the clinical features of supratentorial subdural hematoma (SDH) following microvascular decompression (MVD). Methods A retrospective review of 4 937 consecutive patients who underwent MVD at Department of Neurosurgery, China-Japan Friendship Hospital between January 2015 and September 2017 revealed 29 patients with postoperative supratentorial SDH accounting for 5.9‰ of all MVD cases. Among the 29 patients with supratentorial SDH, 21 cases(5.7‰) occurred out of 3 656 patients following MVD for HFS (hemifacial spasm), 8(6.7‰) out of 1 197 patients for TN (trigeminal neuralgia). In addition, there were 84 cases of GN (glossopharyngeal neuralgia) and none of them developed SDH.A retrospective review of clinical features and outcomes of 29 patients with supratentorial SDH. Results The 29 patients included 11 males and 18 females. Their age ranged from 19 to 79 years old, with an average of 53.0±15.3 years old. The duration of illness was 0.5-20.0 years, with the median of 5.0 years. In 29 patients, supratentorial SDH occurred ipsilaterally in 16(55.2%) cases, contralaterally in 10(34.5%)cases, and bilaterally in 3(10.3%)cases. Hemorrhagic amount by CT analysis ranged from 2 ml to 15 ml, with the average of 6.5±3.6 ml. Among 28 patients with conservative treatment, 26 displayed complete or obvious absorption of hematomas at discharge and 2 showed hematoma absorption during follow-up. One patient turned into chronic supratentorial SDH and achieved good outcome following single-bore drainage. There was no SDH-related symptoms developed during the 6-month follow-up. Treatment of original illness remained effective in 27 (93.1%) cases. Conclusions The incidence of supratentorial SDH after MVD is much lower than other complications of MVD. Furthermore, most patients with conservative treatment seem to have good outcome. Even though, postoperative CT scan is recommended for all MVD patients. Key words: Microvascular decompression; Subdural hematoma; Disease attributes; upratentorial

Intra- and Inter-Modular Connectivity Alterations in the Brain Structural Network of Spinocerebellar Ataxia Type 3.

In addition to cerebellar degeneration symptoms, patients with spinocerebellar ataxia type 3 (SCA3) exhibit extensive involvements with damage in the prefrontal cortex. A network model has been proposed for investigating the structural organization and functional mechanisms of clinical brain disorders. For neural degenerative diseases, a cortical feature-based structural connectivity network can locate cortical atrophied regions and indicate how their connectivity and functions may change. The brain network of SCA3 has been minimally explored. In this study, we investigated this network by enrolling 48 patients with SCA3 and 48 healthy subjects. A novel three-dimensional fractal dimension-based network was proposed to detect differences in network parameters between the groups. Copula correlations and modular analysis were then employed to categorize and construct the structural networks. Patients with SCA3 exhibited significant lateralized atrophy in the left supratentorial regions and significantly lower modularity values. Their cerebellar regions were dissociated from higher-level brain networks, and demonstrated decreased intra-modular connectivity in all lobes, but increased inter-modular connectivity in the frontal and parietal lobes. Our results suggest that the brain networks of patients with SCA3 may be reorganized in these regions, with the introduction of certain compensatory mechanisms in the cerebral cortex to minimize their cognitive impairment syndrome.

Meningioma mimicking vestibular schwannoma – a case report

Meningiomas are one of the most common intracranial neoplasms, usually located in the supratentorial region. Their location within the posterior cranial fossa is rare, but even in such cases, the diagnosis is possible owing to the characteristic imaging features. In this article, we present a case report of a patient with a meningioma of an internal acoustical meatus resembling vestibulo-cochlear nerve schwannoma in its typical location, causing symptoms such as asymmetric hearing loss, tinnitus and dizziness.

Histopathological spectrum of pediatric supratentorial brain tumors in a tertiary care hospital

Histopathological spectrum of pediatric supratentorial brain tumors in a tertiary care hospital - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/2394-6792.2019.0024, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Neural Scaffolding as the Foundation for Stable Performance of Aging Cerebellum.

Although recently conceptualized as a neural node essential for a vast spectrum of associative and cognitive processes, the cerebellum has largely eluded attention in the research of aging, where it is marginalized mainly to structural analyses. In the current cross-sectional study of 67 healthy subjects of various ages (20 to 76years), we sought to provide a comprehensive, multimodal account of age-related changes in the cerebellum during predictive motor timing, which was previously shown to engage this structure. We combined behavioral assessments of performance with functional MRI and voxel-based morphometry using an advanced method to avoid cerebellar deformation and registration imprecisions inherent to the standard processing at the whole-brain level. Higher age was surprisingly associated with stable behavioral performance during predictive motor timing, despite the massive decrease of infratentorial gray matter volume of a far higher extent than in the supratentorial region, affecting mainly the posterior cerebellar lobe. Nonetheless, this very area showed extensive hyperactivation directly correlated with age. The same region had decreased connectivity with the left caudate and increased connectivity with the left fusiform gyrus, the right pallidum, the hippocampus, and the lingual gyrus. Hence, we propose to extend the scaffolding theory of aging, previously limited mainly to the frontal cortices, to include also the cerebellum, which is likewise suffering from atrophy to a far greater extent than the rest of the brain and is similarly counteracting it by bilateral hyperactivation.

Abstract TP158: Risk prediction for symptomatic Intracranial Hemorrhage (sICH) in Acute Ischemic Stroke (AIS) Patients Treated With Intravenous Thrombolysis (IVT): Does Infarct Location Matter?

Introduction: There are mounting data supporting a substantially lower risk of sICH in AIS patients with posterior circulation stroke (PCS) following treatment with IVT. However, stroke location is not included in any of the numerous risk prediction scores for sICH complicating IVT in AIS. We sought to compare the safety and efficacy of IVT for AIS with respect to the location of acute cerebral ischemia in a high-volume tertiary care stroke center. Methods: Consecutive AIS patients treated with IVT during a five-year period were evaluated. Baseline stroke severity and early hypodensity on baseline CT were assessed by NIHSS-score and ASPECTS by certified physicians. Stroke location was classified as posterior (PCS) vs. anterior circulation (ACS), and supratentorial (STN) vs. infraterorial (ITN) infarction. Safety of IVT was evaluated using the SITS-MOST sICH definition. Three-month functional status was assessed using modified Rankin Scale (mRS) scores. Results: Out of total 1008 IVT-treated AIS patients [52% men, mean age 64±15years, median baseline NIHSS-score: 8 pts (IQR: 4-4)], 181 (18%) had PC and 88 (9%) had STN location. The rates of sICH were lower in patients with PCS [2.8% vs. 6.9%; p=0.039 by Fisher’s exact test (FET)] and ITN infarction (0% vs. 6.7%; p=0.005 by FET). PCS and ITN strokes (OR computed using Firth’s penalized likelihood method for rare events: 0.11; 95%CI: 0.01-1.82) were not independently associated with lower likelihood of sICH on multivariable logistic regression models adjusting for multiple potential confounders including demographics, vascular risk factors, onset-to-treatment time, baseline stroke severity, serum glucose, BP parameters and ASPECTS, pretreatment with antiplatelets (single or dual), statins and oral anticoagulants. Conclusions: Our study indicates that infarct location appears not to be independently related to the risk of sICH in AIS patients treated with IVT.

Infratentorial immature teratoma of congenital origin can be associated with a 20-year survival outcome: a case report and review of literature

BackgroundCongenital intracranial tumors are very rare and account for less than 2% of all childhood brain tumors. Teratomas constitute about one third to one half of these, predominantly located midline in the supratentorial region. Posterior fossa location rarely occurs and, based on the cases reported in the literature, commonly has a poor prognosis.Case presentationA newborn female, diagnosed prenatally with hydrocephalus, is presented at birth with increasing head circumference and Parinaud’s syndrome. Magnetic resonance imaging scans demonstrated a huge posterior fossa tumor with obstructive hydrocephalus. At surgery, through a suboccipital craniotomy, complete excision was achieved of a histological-proven immature teratoma. The infant received adjuvant chemotherapy for 1 year. She had normal neurological development and remained tumor-free through her 20-year follow-up.ConclusionThe authors report this rare case of congenital posterior fossa teratoma with long-term outcome, and the literature is reviewed.

Intracranial volume (ICV) in isolated sagittal craniosynostosis: a retrospective case-matched-control study.

Children with sagittal craniosynostosis (SC) are at risk of developing raised intracranial pressure (ICP). This is thought to result from cephalocranial disproportion-the restriction of normal cerebral development by a small cranial vault. It remains unclear whether intracranial volume (ICV) is altered in SC. This study offers a novel volumetric analysis of the scaphocephalic skull, comparing supratentorial (ST) volume, infratentorial (IT) volume, and total ICV of patients with sagittal synostosis to normal controls. ICVs of 32 consecutive patients undergoing total calvarial vault remodelling (TCVR) for isolated SC were compared to 32 age- and sex-matched normal controls. ICV was measured with manual techniques on head computerised tomographic (CT) scans using OsiriX software. A paired t test was used to compare data between cases and controls. Mean total ICV, ST volume and IT volume were larger in SC than in controls, except in females > 6months of age. There was no statistical significance. Regression analysis demonstrated larger ICVs in diseased children than in controls younger than 10months, at which age trend lines intersected and the reverse became true for older children. This likely represents an evolving risk of cephalocranial disproportion beyond 10months of age. The IT/ST volume ratio was conserved in scaphocephaly, and very closely approximated that of controls. Sagittal craniosynostosis appears to be associated with a larger cranial vault at less than 10months and a smaller vault at greater than 10months, although statistical significance was not achieved.

A study on various patterns of cranial metastases on MRI

Introduction: The radiological imaging plays a primary role to detect, localize, and diagnose the lesion. Various modalities which can be used are radiography, Computed imaging, Magnetic resonance imaging, Nuclear medicine and angiography. Except MRI, all other modalities involve exposure to radiation. Methodology: Fifty (n = 50) patients, who underwent surgery with histopathological diagnosis were included in the study. Written informed consent was obtained from all the patients for the study. Detailed clinical history was taken in all the patients. Results: Intraaxial was the most common compared to the extra axial location. Supra tentorial was most common than infra tentorial. Skull vault involvement was seen in 10% cases and dural metastases were seen in 18% cases. Conclusion: Brain metastasis is common among patients with systemic cancer. Brain metastasis (MET) is thought to occur when the primary tumor acquires the ability to migrate away from the primary site and travels to the brain.

Role of Immunohistochemistry in the Identification of Supratentorial C11ORF95-RELA Fused Ependymoma in Routine Neuropathology.

Ependymomas (EPs) are tumors of the brain and spinal cord constituting ∼10% of the childhood central nervous system neoplasms and about 30% in children aged <3 years. Their anatomic distribution varies according to the age, with those arising in the supratentorial (ST) compartment, spinal cord being more common in older children and adults, and those at the infratentorial location are more common and occurring more frequently in infants and children. Recently, molecular classification of EP subgroups has been proposed and a supratentorial ependymoma subgroup characterized by RELA-fusion genes (ST-EP-RELA) has been established. It would be useful to define a standardized, robust method for the diagnosis of these relevant fusion genes. We used real-time polymerase chain reaction, conventional real-time polymerase chain reaction, and Sanger sequencing to characterize RELA fusion status in formalin-fixed paraffin-embedded samples from 42 ST-EPs (12 adults and 30 pediatric). We tested p65/RELA and L1CAM protein immunohistochemistry for their ability to predict RELA-fusion status. We reviewed clinical data to assess significant associations in this anatomic subgroup. Of the 42 patients, we identified RELA-fusion genes in 17 cases. L1CAM immunostaining displayed 94% sensitivity, 76% specificity, 73% positive predictive value (PPV), 95% negative predictive value (NPV). The p65/RELA immunostaining displayed 100% sensitivity, 92% specificity, 89.5% PPV, 100% NPV. Concordant double immunostaining improves PPV to 92.5% and maintains 100% NPV. Immunohistochemistry using both p65/RELA and L1CAM antibodies is valuable for ST-EP-RELA diagnosis: the negativity with both antibodies consistently predicts the absence of RELA fusions, whereas verification of fusion transcripts by molecular analyses is warranted only in single-positive or double-positive staining cases.

Risk factors and surgical outcome of secondary epilepsy arising from supratentorial meningioma

Objective To elucidate the risk factors and surgical outcome of secondary epilepsy arising from intracranial meningioma. Methods A retrospective study was conducted on the clinical data of 267 patients with intracranial meningioma admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from January 2015 to December 2015. All those patients underwent surgical operations. The seizure outcome was followed up through outpatient visits or telephone post operation. Univariate analysis and Cox proportional hazards model were applied to identify the predictive factors for epileptic seizures in patients with supratentorial meningioma. Results In this series, the incidence of epileptic seizures arising from meningioma was 17.2% (46/267). Univariate analysis demonstrated 4 predictive factors for preoperative epilepsy: tumor location (perirolandic area) (P<0.01), male patients (P=0.01), young people (less than 45 years old) (P<0.01) and hydrocephalus (P<0.01). Two independent predictors were confirmed by multivariate analysis: tumor location (perirolandic area) (HR=2.21, 95%CI: 1.23~3.97, P=0.008) and young people (HR=2.03, 95%CI: 1.11~3.68, P=0.021). A total of 213 patients were successfully followed up for an average duration of 24±13 months. Also, the status seizure free was reported in 80.4% (37/46) of the meningioma patients with preoperative seizures. Conclusions Epileptic seizures are common in patients with meningiomas and more likely to be observed in those with tumors located in motor-related areas and young people. Tumor resection could result in favorable seizure outcome. Key words: Meningioma; Epilepsy; Risk factors; Prognosis; Motor cortex

Clinical features and treatment analysis of intracranial extraventricular ependymomas

Objective To study the clinical features, imaging demonstration and treatment outcomes of intracranial extraventricular ependymomas. Methods A total of 17 patients with intracranial extraventricular ependymoma underwent surgical treatment at Department of Neurosurgery, Renmin Hospital of Wuhan University from March of 2010 to June of 2016 and were enrolled into this retrospective study. Pre-operative MR scan showed single lesion located at supratentorial region in all cases. Those lesions were located in occipital lobe (5 cases), occipitoparietal lobe (2 cases), temporal lobe (3 cases), frontal lobe (4 cases) and parietal lobe (3 cases). Among those, 7 were solid and 10 were cystic lesions. Surgical excision was performed for all lesions. Post-operative follow-up was performed for every patient through telephone and outpatient review. Results Of those cases, total resection was achieved in 15 cases, including 10 cases of WHO grade Ⅱ and 5 case of WHO grade Ⅲ, and partial resection in 2 (WHO grade Ⅲ). Intraoperative pathological diagnosis suggested that 10 cases were ependymoma (WHO gradeⅡ) and 7 cases were anaplastic ependymoma (WHO grade Ⅲ). All patients′ clinical symptoms were relieved following surgery. Four cases (grade Ⅲ), including 2 cases undergoing partial resection, received post-operative radiotherapy. The follow-up time of those patient were from 14 to 74 months, with a median of 33.2 months. During the follow-up, no case showed any signs of spinal cord metastasis. Recurrence was reported in 7 cases and 4 of them (grade Ⅲ) received post-operative radiotherapy. Among those, 1 case underwent the second tumor total resection and postoperative radiotherapy, 1 case died 3 months after the second tumor total resection, 2 cases of tumor partial resection rejected the second operation and died after 4 and 6 months, respectively, and the other 3 recurrent cases included 2 (grade Ⅱ) and 1 (grade Ⅲ) undergoing the second tumor total resection without postoperative radiotherapy and 1 (grade Ⅲ) that died of postoperative hemorrhage. Conclusions As intracranial extraventricular ependymoma has non-specific clinical and imaging features, accurate pre-operative diagnosis is difficult. Total tumor resection is the primary method of treatment, if it is possible. The choice of resection type and pathological grading could be predictive factors in postoperative evaluation. Key words: Ependymoma; Neurosurgical procedures; Treatment outcome; Intracranial extraventricular

Specific Features of Primary Central Nervous System Lymphoma in Comparison with Glioblastoma on Conventional MRI

Background: The treatments of primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) are different; therefore, accurate diagnosis is crucial for the therapeutic planning. Although there is overlap of features on conventional magnetic resonance (MR) images between PCNSL and GBM, the PCNSL has specific features, which are different from those of GBM on conventional MR images. Objectives: The current study aimed at characterizing specific features of PCNSL by comparing them with conventional MR images of GBM, and improving diagnostic accuracy at the time of initial presentation. Patients and Methods: The current study retrospectively evaluated the conventional MR images of 21 immunocompetent patients with PCNSL and 13 patients with GBM pathologically proven in Renmin Hospital of Wuhan University, Wuhan, China from January 2014 to March 2017. All patients were subjected to non-contrast and contrast enhanced MRI. Tumor location, quantity, and morphology, as well as common and specific features and patterns, peritumoral edema, and hemorrhage were recorded and compared. Results: Twenty-one patients with PCNSL exhibited 44 lesions, and 13 patients with GBM exhibited 16 lesions. PCNSL affected both infra- and supratentorial regions, while GBM only affected supratentorial regions. Deep white matter, basal ganglia, periventricular areas, and the corpus callosum were the most common sites in PCNSL. Homogeneous enhancement was presented in 95.2% of PCNSL, and all GBM lesions showed heterogeneous enhancement. PCNSLs had various appearances, whereas most of the GBMs (81.3%) had a mass-like appearance. Differences in intratumoral hemorrhage (P < 0.001), necrotic or cystic components (P < 0.001), and intratumoral vascular enhancement (P < 0.001) between PCNSL and GBM were statistically significant. “Notch sign” and open-ring enhancement were specific features for PCNSL. Conclusion: PCNSL has specific features, patterns, and locations. These features and patterns can be helpful to differentiate PCNSL from GBM at the time of initial presentation.