Objective:To investigate the efficacy of surgical therapy of acoustic neuromas after failed gamma knife treatment.Methods:The clinical data of 23 patients with acoustic neuromas treated in the Department of Neurosurgery, Sanbo Brain Hospital of Capital Medical University from January 2010 to December 2021 were retrospectively analyzed. Twenty-three patients who were previously treated with gamma knife (experimental group) underwent surgical resection because of tumor progression. Functional nerve preservation was performed during the operation. Another 23 patients who had not been treated with gamma knife were defined as the control group with matching sex composition ratio, age, tumor size, texture and location. The patients were clinically followed up and the facial nerve function was evaluated by House-Brackmann (HB) grading system. The recurrence or progression of the tumor was evaluated by imaging follow-up. The baseline data, degree of surgical resection, postoperative complications, outcome of facial nerve function and recurrence were compared between the two groups.Results:The degree of adhesion between facial nerve and tumor in the experimental group was greater than that in the control group ( P<0.001). The total tumor resection rate in the experimental group (21.7%, 5/23) was lower than that in the control group (73.9%, 17/23)( χ2=12.54, P<0.001). The anatomic preservation rate of facial nerve was 100% (23/23) in both groups. Postoperative HB gradeⅠ-Ⅱ in the experimental group accounted for 73.9% (17/23), which was not significantly different from that in the control group (91.3%, 21/23) ( P=0.189). The median follow-up time was 57 months (range: 12-133 months) in the experimental group and 52 months (range: 14-120 months) in the control group. There was no tumor recurrence or progression in the two groups. At the last follow-up, the patients with HB grade Ⅰ-Ⅱ in the experimental group and control group accounted for 82.6% (19/23) and 95.7% (22/23) respectively, and there was no significant difference between the two groups ( P=0.412). Conclusions:The degree of surgical resection of advanced acoustic neuromas after failed gamma knife treatment is relatively low. Functional nerve preservation resection can optimize the results of facial nerve function and doesn′t increase the risk of tumor recurrence.

Objective:To investigate the factors influencing prognosis of patients with giant invasive pituitary adenomas who underwent surgical treatment.Methods:Clinical data of 84 patients with giant invasive pituitary adenomas who underwent surgical treatment at Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University from April 2011 to December 2016 were retrospectively analyzed. Univariate and multivariate logistic regression analysis were used to explore the influencing factors of the degree of tumor resection. Kaplan-Meier analysis and multivariate Cox regression analysis were used to investigate the influencing factors of tumor progression.Results:Among 84 patients, total resection was achieved in 13 cases (15.5%), near-total resection in 40 cases (47.6%) and subtotal resection in 31 cases (36.9%). There were 89.3% (75/84) of the patients who had been followed up for 15-83 months (46.8±19.0 months). There was no perioperative death, and 2 patients (2.4%) died due to surgical complications within 3 months. Univariate analysis showed that previous surgery or radiotherapy, maximal diameter of tumor, tumor shape, tumor invasion degree to the cavernous sinus, whether the tumor invaded the posterior cranial fossa, the enhancement characteristics of the lesions on MRI and the tumor texture could affect the degree of tumor resection (all P<0.05). Multivariate logistic regression analysis showed that the tumor invasion degree to the cavernous sinus ( OR=0.089, 95% CI: 0.009-0.850, P=0.036) and tumor texture ( OR=0.246, 95% CI: 0.077-0.786, P=0.018) were independent risk factors for tumor resection. Among 84 patients, 14 cases had tumor progression during the follow-up period. Log-rank analysis showed that the tumor resection degree, the presence of mitosis and Ki-67 index in pathological examination might be related to tumor progression (all P<0.05). Multivariate Cox analysis showed that the tumor resection degree ( HR=0.316, 95% CI: 0.107-0.932, P=0.037) was a protective factor for tumor progression, and the presence of mitosis ( HR=5.064, 95% CI: 1.726-14.859, P=0.003) was an independent risk factor for tumor progression. Conclusions:For giant invasive pituitary adenomas, it is not easy to achieve total resection for those with a high degree of invasion to the cavernous sinus (Knosp grade 3-4) and tough texture. The tumor with high degree of tumor resection is not liable to progress, while the tumor with mitotic appearance in pathological examination has a tendency to progress.

Objective:To explore the role and mechanism miR-20a/106b in the malignant progression of pediatric brainstem gliomas (BSG).Methods:A total of 13 patients with BSG (13 pediatric and 5 adult patients) who underwent surgical treatment at Department of Neurosurgery, Tianjin Huanhu Hospital(Tianjin Central Hospital for Neurosurgery and Neurology) from January 2012 to December 2017 were retrospectively enrolled into this study. The level of MICA was detected in pediatric and adult BSG tissues by immunostaining. The miRNAs regulating the expression of MICA was screened out by bioinformatics. The human glioma cell lines LN229 and U251 were used to verify the relationship between the selected miRNA and MICA by the luciferase reporter assays, and the expression of MICA following transfection of antisense miR-20a/106b into LN229 and U251 were detected by Western blotting (WB). The lactate dehydrogenase (LDH) release assay was used to detect the cytotoxic activity of immune cells against the LN229 cell line. BSG juvenile (J-rat) and adult (A-rat) models were prepared for regain of function experiments by stereotactic injection of the LN229 cell line into the pontine area of athymic juvenile (3 weeks old) and adult (10 weeks old) male Sprague Dawley rats. Each of those two groups was further divided into 3 subgroups according to the different cell lines injected, which were J-rat, J-rat-scr, J-rat-miR-20a/106b-d and A-rat, A-rat-scr, A-rat-miR-20a/106b-u subgroups with each subgroup containing 3 rats. The expression of MICA in each subgroup was detected by immunohistochemical staining, the invasion of tumors in each subgroup was detected by MCID, and the apoptosis of cells in each subgroup was detected by TUNEL method.Results:The total positive expression rate of MICA in adult patients was higher than that in children (5/5 vs. 10/13, P<0.05). The screening results showed that there were 23 miRNAs that might regulate MICA, including miR-20a and miR-106b. In the LN229 cell line, the luciferase reporter assay showed that the fluorescence activity of those transfected with wild-type pGL3-MICA plasmid was stronger than those of controls and cells transfected with mutant pGL3-MICA plasmid (both P<0.05). WB results showed that, compared with the sham control group and the nonsense sequence group, the expression of MICA in the antisense miR-20a group, antisense miR-106b group and antisense miR-20a/106b group all increased (all P<0.05). In the above experiments, similar results were obtained in U251 cell line. Under different effector to target ratios (20 ∶1, 10 ∶1, 5 ∶1), the LDH activity of the antisense miR-20a/106b group was higher than that of the control group and the group with combined blocking of MICA (all P<0.05), while the latter two groups had no significant difference (all P>0.05). The postoperative head MRI results showed that the 3 groups of juvenile rats and 3 groups of adults rats were all successfully modeled. The results of the MCID method showed that the I value of the J-rat-miR-20a/106b knockdown group of the juvenile rat model was lower than that of the J-rat group and the J-rat nonsense control group (both P<0.05). The I value of A-rat-miR-20a/106b overexpression group was higher than that of A-rat group and A-rat nonsense control group (both P<0.05). The results of immunohistochemical staining showed that the intensity of MICA staining in the J-rat-miR-20a/106b knockdown group of the juvenile rat model was higher than that of the J-rat group and the J-rat nonsense control group (both P<0.05). The staining intensity of MICA of the model A-rat-miR-20a/106b overexpression group was lower than that of the A-rat group and the A-rat nonsense control group (both P<0.05). In vivo apoptosis experiments showed that the apoptosis index of the J-rat-miR-20a/106b knockdown group in the juvenile rat model was higher than that of the J-rat group and the J-rat nonsense control group (both P<0.05). The apoptosis index of the A-rat-miR-20a/106b overexpression group in the adult rat model was lower than that of the A-rat group and A-rat nonsense control group (both P<0.05). Conclusion:The immune evasion mediated by miR-20a/106b through NKG2D is an important factor for the high malignancy of pediatric BSG.

目的 探讨颞下经岩骨嵴入路切除岩斜区脑膜瘤的手术方法及治疗效果.方法 回顾性分析15例岩斜区脑膜瘤病人的临床资料,采用颞下经岩骨嵴入路显微外科手术切除肿瘤.结果 由于术中无法完全切除颅底骨质及硬脑膜,本研究未采用Simpson分级评价.肿瘤全切除及近全切除11例,大部分切除4例.术后发生动眼神经、外展神经及面神经功能障碍各6、3、1例,术后3个月随访均不同程度恢复.无脑脊液漏和手术死亡病例.结论 颞下经岩骨嵴入路能够充分显露并切除肿瘤基底位于中、上斜坡的岩斜区脑膜瘤,手术效果满意.

目的 探讨结直肠癌脑转移的影像学特点.方法 回顾性分析10例经手术治疗的结直肠癌脑转移病人的影像学和病理学等资料.结果9例病灶MRI T2加权表现为低信号,实性结节状,呈不均匀强化,病变边缘强化明显.1例病人MRI T2加权表现为高信号,囊性,囊壁强化.5例病人术前CT检查提示病变呈不同程度的高密度,周围水肿明显.结论 根据结直肠癌脑转移所特有的MRI T2加权呈现低信号及CT扫描呈高密度的影像学特点,有利于疾病鉴别,对提高临床诊断结直肠癌脑转移有一定帮助.

Objective To summarize the clinical manifestation,diagnosis and treatment of thyroid-stimulating hormone (TSH)-secreting pituitary adenoma.Methods The clinical data of 9 patients with TSH-secreting pituitary adenoma were analyzed retrospectively.Nine patients were treated by surgery,including craniotomy in 4,transsphenoidal surgery in 5.Results The tumor was totally resected in 4 cases,subtotally in 1 and partially in 4.There were 7 patients with high TSH level preoperatively and 5 returned to normal of TSH level after operation.The postoperative complications included electrolyte disorder in 2 cases,cerebrospinal rhinorrhea in 1 and intraoperative hemorrhage in 1.The patients were followed up from 35-78 months.The cure was in 4 cases after imaging and hormone level assessment.Conclusions TSH-secreting pituitary adenomas have the characteristics of invasive growth and rigid texture.The treatment strategy needs to be individualized according to the actual situation of the patients.

总结首都医科大学三博脑科医院神经外科实施专科医师培训近一年的经验和体会.首都医科大学三博脑科医院神经外科根据中国神经外科专业医师培养标准开展的神经外科专科医师培训已经近一年.通过对近一年的神经外科专科医师培训过程中的手术病例完成、教学实施、出科考核等情况的总结,本院神经外科专培医生可以较好的完成专培任务,能够在专培过程中提升自己的能力.中国神经外科专科医师培训在我院的顺利实施应该可以达到中国神经外科专业医师培养标准的要求.

Objective: To investigate the effect of DNA dependent protein kinase catalytic subunit (DNA-PKcs) on glioma proliferation, invasion and temozolomide sensitivity, and also to explore the potential mechanisms. Methods: Human glioma cell lines H4 and U87 were chosen to carry out RNA interference transfection, and then divided into negative control group (blank group) and siRNA group (test group). The knockdown efficacy of DNA-PKcs siRNA was tested by quantitative PCR and Western blot. The MTS assay and Transwell assay were used to investigate the effect of DNA-PKcs knockdown on glioma cell growth and invasion, respectively. We also used MTS assay to investigate the IC(50) value of temozolomide in negative control group and siRNA groups. Result: Compared with blank group, DNA-PKcs specific siRNA significantly downregulated both mRNA and protein level of DNA-PKcs. MTS assay results demonstrated that 72-hours proliferation of test group were only 52.48%, 54.70% (H4) and 52.98%, 50.45% (U87) of the blank group's counterpart. Transwell assay results showed that the invasiveness abilities of blank and test groups were 1.00±0.03, 0.41±0.05, 0.39±0.04 (H4) and 1.00±0.02, 0.28±0.04, 0.27±0.04 (U87). Moreover, knockdown of DNA-PKcs significantly decreased the temozolomide IC(50) value (H4: 249±27, 97±39, 88±35; U87: 485±41, 86±49, 73±38). Further we applied the Western blot to reveal the mechanism of inhibitory effect of DNA-PKcs knockdown on glioma malignancies and temozolomide sensitivity. We found that downregulation of DNA-PKcs reduced the activity of AKT signal and the expression of its downstream effectors, such as c-Myc, MMP9, and Survivin. Conclusion: RNA interference targeting DNA-PKcs could inhibit glioma malignancies and enhance temozolomide sensitivity. The inhibitory effect of DNA-PKcs knockdown on those biological activities were mainly through inhibition of AKT signal and its downstream effectors.

Objective To establish a adenovirus vector system to co-encode two shRNAs targeting miR-221 and miR-222,respectively,which has multilevel,semiquantitative and co-modulated abilities.Methods The co-modulated shRNA-encoding adenoviruses were constructed by restriction enzyme digestion method (mutant-shmiR-221/222 and class-shmiR-221/222).The two adenovirus vectors were transduced into LN229 and U251 cells (class-shmiR-221/222 transduction group and mut-shmiR-221/222 ransduction group);and blank control group was established.The expression of miR-221/222 in the three groups was examined by quantitative real time-PCR,increase of targeted protein expression was determined by Western blotting,and flow cytometry was used to detect the cell cycle kinetecs.The cellular damage was observed under a phase contrast microscope,whereas the cell apoptosis was measured by caspase-3/7 activating assay.Furthermore,the free energy states were analyzed after applying a NCM-based algorithm for predicting the accurate binding structures.Results The co-modulated shRNA-encoding adenoviruses were successfully constructed and transduced into glioblastoma cell lines.In the blank control group,mut-shmiR-221/222 ransduction group and class-shmiR-221/222 transduction group,the miR-221/222 expression level and rate of cells at stage S decreased accordingly;p27kip1 expression level,rate of cells at G0/G1 stage and rate of cells arrested at G 1 stage increased accordingly;degrees of cells being destroyed and loss their own morphology and cell apoptosis rate increased accordingly;number of cells decreased accordingly;the differences among them were significant (P＜0.05).The free energy states revealed that the mutated type was less stable in binding with miRNA than the classic type.Conclusions ShRNA encoding adenovirus to co-modulate the expressions of miR-221 and miR-222 in glioblastoma cells is successfully established.Together with the strategy of mutation to influence the stability of binding,the modulation could yield distinct reduction results in a semi-quantitative manner.

Objective To explore the surgical skills for hypervascular acoustic neuroma in young adults. Methods The imaging data of 20 young patients and surgical skills for their hypervascular acoustic neuroma were analyzed retrospectively. Pre-operation facial nerve function was House-Brackmann GradeⅠin 18 cases and GradeⅡin 2. All the tumors were removed by performing one stage surgery. Results Tumors were totally removed in 13 cases and sub-totally in 7. During the operation, the average blood loss was 1200 ml. Post-operation facial nerve function was House-Brackmann GradeⅠ-Ⅱin 8 cases and GradeⅢ-Ⅵin 12. Facial never repair was performed in 3 cases because anatomic integrity was not achieved. Conclusions There is more blood loss in young adults with hypervascular acoustic neuroma during surgery and facial nerve function preservation rate is lower. Tumor can be removed in one-stage surgery with proper skills.

神经外科研究生的成长是一个厚积薄发的过程，研究生期间应从体力、心智和专业知识技能积累3个方面做好准备，其中以谦虚、尊重、合作为核心的心智培养尤为重要；同时导师应做到因材施教，充分发挥学生的主观能动性。

目的：总结在美国俄亥俄州立大学医学院神经外科做访问学者期间，对神经外科住院医师培养的所见所闻。方法通过观察美国俄亥俄州立大学医学院神经外科各年资神经外科住院医生每日工作和学习，了解认识其专业化培养方式。结果他们通过7年的临床和科研的培养，定期的学术活动强化了住院医师的临床医学思维，而科研工作则培养了住院医师的临床科研意识。结论美国神经外科住院医师培训中对临床和科研的强化培训值得我们在我国神经外科住院医师培养中借鉴。

Objcetive To observe the change of morphology ,serum lipoprotein,cytokines,vascular cell adhesion molecule-1 ( VCAM-1 ) expression and monocyte aggregation on ApoE -/-mice with atherosclerosis ( AS) .Verify the inhibition and mechanism of Chuanxiong to AS .Mtehods Thirty ApoE-/-mice were randomly divided into normal diet group (n=10),high-cholesterol diet(n=10) and Chuanxiong group(n=10).After 16 weeks,the animals were killed.The level of serum lipoprotein was detected .Aortas tree were prepared for HE staining,oil red staining,and immunohistochemical staining for CD68,anti-smooth muscle antibodyα(SMA-α),tumor necrosis factorα(TNF-α),VCAM-1.Then graphic analysis software was used to make semi-quantitative analysis .The data were analyzed by SPSS 11.0 software.Results The intimal area and plaque and lumen cross-sectional area ratio of Chuanxiong group ApoE -/-mice atherosclerosis plaque , was 0.362 ±0.038 , 0.094 ±0.043 , less than that of the control group 0.533 ± 0.030,0.238 ±0.053(t=5.75,P<0.01; t=4.36,P<0.01).The serum high density lipoprotein (HDL) level of Chuanxiong group and high fat diet ApoE -/-mice was(0.439 ±0.071 ) mmol/L,significantly higher than that of the control group [(0.306 ±0.075)mmol/L](t=8.47,P<0.05).The expression of TNF-α、VCAM-1 and macrophages in atherosclerosis plaque of Chuanxiong group was 0.161 ±0.046,0.343 ±0.053 , 0.381 ±0.085 ,significantly less than the control group 0.247 ±0.080 ,0.474 ±0.078 ,0.482 ±0.047 ( t=3.58,P<0.05;t=4.35,P<0.05;t=3.54,P<0.05).There were no significant differences of in serum&nbsp;TC,CHO and LDL between the two groups .Conclusion Chuanxiong can inhibit the development of AS on high-cholesterol diet ApoE -/-mice.Chuanxiong can significantly increase the level of HDL ,which may be one mechanism of the inhibition of Chuanxiong .Inhibition of inflammation , depression of arterial wall expression of VCAM-1,thereby,reducing adhesion and aggregation of mono-macrophages to the arterial wall , may involve in the anti-AS effect of Chuanxiong .

“防近”新说:护眼也护脑 现代临床神经眼科学对青少年近视眼有更深层次的认识.倘若就眼论眼,难以走出其防控的误区.几十年以来我们习惯用狭隘的视角看待青少年近视眼的形成s预防,其防控I作进展并不令人满意,以致青少年近视眼成了全社会关注的难题. 近视与否关键在于视觉环境 人们每提及近视眼必谈遗传因素.其实,单纯性近视眼,指的是发生在少年儿童时期的近视眼,此期正是脑和视觉发育的敏感时期,因此,与遗传因素基本没有关系,完全是视觉环境恶劣,即大脑视近负荷长期繁重所致.但是,倘若你的父亲和母亲都是近视眼,你同样也视近负荷加重,那么,你发生近视眼的几率会更大、发生更早、度数更高.同样地,如果学生认真配合家长、老师一起共同地为自己营造一个优良的视觉环境,持之以恒地科学用眼,他依然可以不发生近视眼.临床神经眼科学认为,幼儿和少年时期的视觉环境质量在很大程度上决定了你成年期的视力表现,少年期学会怎样正确使用眼睛的重要性就在于此.

孤立性纤维瘤多起源于脏层胸膜，最初于1931年由Klemperer和 Rabin 报道并命名［1］。此后， Carneiro 等［2］于1996年报道了首例原发于中枢神经系统的孤立性纤维瘤。至今，全世界约报道100余例，发病率较低。本文将2012年我院收治的1例原发于上矢状窦旁的非典型孤立性纤维瘤的影像学表现、病理特征及诊疗，结合文献报道如下。

Medulloblastoma ( MB) is the most frequent embryonal tumor of central nervous system , accounting for about 20%of children with intracrinal tumors ,with mostly vermis cerebelli involvement .Most cases tend to spread via cerebrospinal fluid and main treatment is surgery with chemotherapy and radiotherapy .Due to the primary location and cerebrospinal fluid spreading feature , intrathecal therapy becomes a special kind of treatments .However ,patients suffer from physiological and psychological pain for a long time.It is significant that a new treatment should be researched which combines targeting killing tumor cells and low adverse reaction .

OBJECTIVE:To study the expression level of folate receptor α (FR-α) in glioma tissue and its clinical significance.METHODS:Forty-eight human glioma specimens were collected from patients who underwent surgery from March 2012 to March 2013. These specimens were as follows:12 cases of glioblastoma (WHO IV), 6 cases of astrocytoma of each malignancy grade(WHO II, III), 6 cases of oligodendroastrocytoma of each malignancy grade (WHO II, III), 6 cases of oligodendroglioma of each malignancy grade (WHO II, III ). In addition, 6 cases of normal brain tissue resected from brain traumatic patients were taken as negative control, and one case of placental tissue (had got the consent of the parents and their families) was taken as positive control. The expression level of FR-α in tumor tissues was evaluated by Western blot analysis. The results of Western blot analysis were analyzed by t-test. The expression level of FR-α and Ki-67 in tumor tissues was evaluated immunohistochemistry, the results were analyzed by Kruskal-Wallis test and Nemenyi test. The correlation between the expression level of FR-α and cell proliferation index Ki-67 was analyzed by Pearson correlation analysis.RESULTS:Western blot analysis showed that the FR-α was not expressed in normal brain tissue and oligodendroglioma tissue, but highly expressed in astrocytoma, oligodendroastrocytoma and gliomablastoma. The expression level in WHO III astrocytoma was significantly higher than in WHO II (t = 4.497, P < 0.05). FR-α was also highly expressed in oligodendroastrocytoma and its expression level in WHO III was also significantly higher than in the WHO II (t = 2.876, P < 0.05). Foremore, immunohistochemistry analysis also showed that FR-α was not expressed in oligodendroglioma, but expressed in astrocytoma, oligodendroastrocytoma and gliomablastoma. The positive rate of FR-α of WHO III was significantly higher than the WHO II astrocytoma(57.8% ± 2.2% vs. 45.7% ± 2.3%,χ(2) = 3.871, P = 0.034). In oligodendroastrocytoma, the positive rate of FR-α of WHO III was significantly higher than the WHO II(56.5% ± 5.4% vs. 37.1% ± 5.2%,χ(2) = 4.454, P = 0.021). Moreover, the expression level of FR-α in gliomablastoma was highest in all histological types of gliomas, the positive rate of FR-α was up to 65.0% ± 4.5%. Pearson correlation analysis showed that the positive rate of FR-α was positively correlated with Ki-67 index (r = 0.903, P < 0.05).CONCLUSIONS:FR-α is expressed in astrocytoma, oligodendroastrocytoma and glioblastoma, and the expression level of FR-α is positively correlated with malignancy grade and Ki-67 index. Therefore, FR-α may be applied as a special target for diagnosis and treatment of glioma.

Objective To evaluate the surgical outcome of cystic vestibular schwannoma patients with fluid-level imaging by MRI.Methods Forty-five patients of cystic vestibular schwannoma were enrolled and divided into fluid-level (n =24) group and non-fluid-level (n =21) group by MRI.The incidence of peritumoral adhesion,incidence of complete tumor removal and postoperative facial nerve function of the two groups were recorded.Results The incidence of peritumoral adhesion in fluid-level and non-fluid-level group were 70.8％ (17/24) and 28.6％ (6/21),and the difference was significant (x2 =8.010,P ＜ 0.05).The incidence of complete tumor removal were 45.8％ (11/24) and 76.2％ (16/21) in fluid-level and non-fluid-level group,which showed significant differences between groups (x2 =4.30 ; P ＜ 0.05).Patients of House-Brackmann grade Ⅰ-Ⅲ in fluid-level group at discharge and one year after operation,were 62.5％ (15/24) and 50.0％ (8/16),and 81.0％ (17/21) and 83.3％ (15/18) in non-fluid-level group.The was significant difference at one year after operation (P ＜ 0.05) in terms of patients of House-Brackmann grade Ⅰ-Ⅲ.Conclusion The cystic vestibular schwannoma patients with fluid level have more frequency to adhere to surrounding neurovascular structures and less favorable surgical outcome.These findings may be useful in predicting surgical outcome and making surgical strategy preoperatively.

目的 观察手术前后激素替代治疗对颅咽管瘤患儿预后的影响.方法 66例颅咽管瘤患儿,根据垂体各轴系功能检测结果,术前10例给予激素替代治疗,出院前均给予激素支持治疗.术后随访,观察患儿肿瘤复发及死亡情况.结果 术中及术后无因甲状腺危象、垂体危象而死亡者.术后随访(2.47±1.47)a,存活59例,其中11.86％ (7/59)未服用任何药物,88.14％ (52/59)给予激素替代治疗；死亡7例,死亡率10.61％,全部发生于术后1 a内.初治患儿随访时8.89％ (4/45)复发,复发患儿随访时4.76％(1/21)再次复发.手术后1、2、3a及3a后新增复发人数分别为18、6、1、1例,合计26例.术后总复发率7.60％,平均复发时间12.6个月.结论 颅咽管瘤患儿在准确评估的基础上,合理给予激素替代治疗对改善预后有重要意义.

背景与目的:胶质瘤化疗敏感性与一些分子表达相关.本研究检测和分析原发性胶质母细胞瘤(glioblastoma multiforme,GBM)患者肿瘤组织中核因子κB(NF-κB)、突变型P53(TP53)及O6甲基鸟嘌呤-DNA甲基转移酶(O6-methylguanine-DNA methyltransferase,MGMT)基因启动子区甲基化与MGMT蛋白表达的相关性,以探讨调控MGMT蛋白表达的作用机制.方法:采用甲基化特异性PCR方法(methylation specific PCR,MSP)检测我院收治的120例原发性GBM患者肿瘤组织标本MGMT基因启动子区甲基化;采用免疫组化方法检测NF-κB、TP53、MGMT蛋白表达情况.采用SPSS17.0软件及Spearman相关系数分析方法进行统计学分析.结果:免疫组化表明NF-κB、TP53表达与MGMT表达呈正相关(r=-0.244,r=-0.271,P均＜0.05),NF-κB与TP53表达亦呈正相关(r=0.329,P＜0.05).MSP结果显示MGMT基因启动子区甲基化率与MGMT蛋白表达强度无相关性.结论:转录因子NF-κB与TP53对原发性GBM肿瘤组织中MGMT蛋白表达可能存在正调控作用,而MGMT基因启动子区甲基化率与MGMT蛋白表达强度无相关性.