Brain gliomas' variable growth patterns and locations hinder complete surgical removal, while existing clinical imaging/histological methods fail to guide intraoperative resection. To address this, we developed blue-green dual-color probes (perovskite quantum dots conjugated to antibodies) targeting glioma cells and IDH1-mutant simultaneously. These enable rapid intraoperative in vitro pathological diagnosis, helping surgeons devise resection strategies for personalized precise treatment. Tested on 56 clinical frozen sections, the combined detection using dual probes can be completed within 30 min with 91% accuracy: the glioma-targeting probe identifies tumor boundaries, while the IDH1-targeting one distinguishes subtypes for optimized margin delineation. We established a personalized resection strategy guided by these results; the dual-target probes show great potential to assist neurosurgeons in precise glioma resection.

Development of a circulating extracellular vesicle-based IDH mutant protein detection technology for diagnosis of IDH mutation status in glioma, enabling personalized resection strategies, precision medication, and disease dynamics monitoring in IDH-mutant glioma. We developed a tumor-classification strategy that discriminates tumor types by detecting the IDH1.R132H mutant protein in plasma extracellular vesicles using a bead-assisted, flow-cytometry–based assay. We assessed the differential expression’s capacity to distinguish tumor grades, analyzed pre-operative and post-operative expression variations, and verified consistency with histopathological immunohistochemistry. The method demonstrated a diagnostic sensitivity of 76.2

Abstract Background The IDH-mutant low-grade glioma (LGG) involving corpus callosum (ccLGG) is a rare type of LGG which has a poorer prognosis. To evaluate the efficacy of multimodal techniques (comprising neuronavigation, intraoperative MRI, and neuromonitoring) compared with the conventional approach guided solely by neuronavigation in the resection of IDH-mutant ccLGG, and to identify prognostic factors of ccLGG. Methods The IDH-mutant ccLGG cases that received resection in our center between 2014 and 2022 were collected and reviewed retrospectively. Comparisons were made between the multimodal and conventional groups regarding patient demographics, tumor characteristics, extent of resection (EOR), neurological function, Karnofsky Performance Status (KPS), progression-free survival (PFS), and overall survival (OS). Both univariate and multivariate analysis were employed to assess potential prognostic factors. Results Ultimately, 64 patients in the multimodal group and 34 in the conventional group were enrolled. Compared with the conventional group, the multimodal group achieved a significantly higher median EOR (100% vs. 93.55%, P = 0.001) and a greater gross total resection (GTR) rate (62.5% vs. 35.3%, P = 0.010). No significant differences were observed in postoperative neurological function or KPS between the two groups at any of the time points assessed. Compared with the conventional group, the multimodal group demonstrated significantly longer median PFS (78.5 vs. 48.1 months, P = 0.010) and OS (106.1 vs. 66.9 months, P = 0.009). Non-butterfly ccLGG, less tumor volume, genu invasion of CC (compared to splenium invasion), less volume of CC invasion, higher EOR, longer chemotherapy cycles of Temozolomide (TMZ), higher KPS on 3 months and MGMT methylation were positive factors for PFS of ccLGG. While four factors were associated with the longer OS of ccLGG, including genu of CC invasion compared to both genu and body invasion of CC, higher EOR, longer TMZ cycles and MGMT methylation. Conclusion Multimodal techniques are useful for achieving maximal safe resection and better prognosis of ccLGG. As higher EOR independently predicts improved survival in IDH-mutant ccLGG, maximal safe resection should be suggested and achieved by appropriate means tailored to available resources. The postoperative chemotherapy should also be recommended to patients with high risks. While whether postoperative radiotherapy should be performed should consider and balance many factors.

High-grade gliomas—particularly glioblastoma (GBM)—remain refractory to standard-of-care surgery followed by chemoradiation, with a median overall survival of ~15 months. Oncolytic viruses (OVs), which selectively infect and lyse tumor cells while engaging antitumor immunity, offer a mechanistically distinct therapeutic modality. This review synthesizes clinical progress of OVs in GBM, with emphasis on oncolytic herpes simplex virus (oHSV) and coverage of other vectors (adenovirus, reovirus, Newcastle disease virus, vaccinia virus) across phase I–III trials, focusing on efficacy and safety. Key observations include the encouraging clinical trajectory of oHSV exemplars—T-VEC (approved for melanoma) and G47Δ (approved in Japan for recurrent GBM)—the multi-center exploration of the adenovirus DNX-2401 combined with programmed death-1 (PD-1) blockade, and the early-stage status of reovirus (pelareorep) and Newcastle disease virus programs. Emerging evidence indicates that oHSV therapy augments immune infiltration within the tumor microenvironment and alleviates immunosuppression, with synergy when combined with chemotherapy or immune checkpoint inhibitors. Persistent challenges include GBM’s inherently immunosuppressive milieu, limitations imposed by the blood–brain barrier, intrapatient viral delivery and biodistribution, and concerns about viral shedding. Future directions encompass programmable vector design, optimization of systemic delivery, biomarker-guided patient selection, and rational combination immunotherapy. Collectively, OVs represent a promising immunotherapeutic strategy in GBM; further gains will hinge on vector engineering and precision combinations to translate mechanistic promise into durable clinical benefit.

Objective To explore the potential value of expert-identified CT and MRI imaging features in predicting the MGMT promoter methylation status in glioma. Methods A retrospective analysis was conducted in 188 patients in The First Medical Center of Chinese PLA General Hospital from January 2019 to December 2020 with pathologically confirmed glioma. Imaging features were extracted, including calcification, clear lesion margins, peritumoral edema, T2WI/T2-FLAIR mismatch, cortical involvement, subventricular zone involvement, insular involvement, homogeneous signal on T2WI, and enhanced lesions. Pyrosequencing was used to detect the MGMT promoter methylation status. Univariate and multivariate Logistic regression analyses were used to find the imaging feature factors that affect the MGMT promoter methylation status. Then, by plotting the receiver operating characteristic (ROC) curve, verify the predictive efficacy of the imaging features. For the prediction task, further train and test 4 machine learning (ML) models, namely Logistic regression (LR), support vector machine (SVM), random forest (RF), and gradient boosting (GB). Results Logistic regression analysis showed that homogeneous signal on T2WI (OR = 2.843, 95%CI: 1.055-7.658; P = 0.039) and enhanced lesions (OR = 0.146, 95%CI: 0.069-0.308; P = 0.000) were imaging feature factors affecting the MGMT promoter methylation status. The comprehensive parameters combining both had higher prediction ability compared with homogeneous signal on T2WI (Z = 3.961, P = 0.000) and enhanced lesions (Z = 2.233, P = 0.026). The prediction accuracies rates of LR, SVM, RF and GB models were 0.84, 0.76, 0.68 and 0.76, respectively. However, there were no statistically significant differences in prediction efficacy when comparing the models pairwise (P > 0.05, for all). Conclusions Imaging features based on preoperative CT and MRI show promise for non-invasive prediction of MGMT promoter methylation status in glioma.

BACKGROUND AND OBJECTIVES:Maximal and safe removal of insular gliomas by a transinsular cortex approach is challenging. In this article, a new transtemporal isthmus approach to resect insular gliomas is presented. METHODS:We retrospectively examined 53 patients with insular glioma who underwent resection through the temporal isthmus approach using magnetic resonance imaging and functional neuronavigation guidance and intraoperative electrophysiological monitoring. Extent of resection was determined using intraoperative magnetic resonance imaging. RESULTS:Fifty-three patients were included for analysis, 30 men and 23 women. The median (range) age was 45 (26-70) years. Tumor laterality was left in 22 patients and right in 31. All tumors involved at least zone III or IV (Berger-Sanai classification system), including zones I-IV were involved in 29 (54.7%) and zones III and IV in 17 (32.0%). Among the 37 low-grade gliomas, preoperative median (IQR) volume was 45.7 (31.8, 60.3) cm 3 , and gross total resection was achieved in 24 (64.9%). Among the 16 high-grade gliomas, preoperative median (IQR) volume was 45.3 (40.1, 54.0) cm 3 , and gross total resection was achieved in 14 (87.5%). The median (IQR) extent of resection of the whole group was 100% (89%-100%). The median (IQR) postoperative Karnofsky performance score 3 months after surgery was 90 (80-90). Mean temporal isthmus width was significantly higher in the affected side (involving tumor) than the contralateral one (21.6 vs 11.3 mm; 95% CI: 9.3 to 11.3, P < .01). Muscle strength was grade 4 or higher, and speech was nearly normal in all patients 3 months after surgery. CONCLUSION:Insular glioma surgery using the transtemporal isthmus approach can achieve safe and maximum resection. A widened temporal isthmus provides a surgical pathway for transisthmic resection of insular tumor.

Gliomas, aggressive and infiltrative brain tumors, pose significant diagnostic challenges due to their diffuse boundaries and pronounced heterogeneity. Although biopsy remains the clinical gold standard, its invasiveness and associated risks limit its utility. Here, we report TPAZY, a mitochondria-targeted fluorescent probe capable of simultaneously sensing microenvironmental viscosity and polarity, two key parameters linked to tumor progression. TPAZY integrates a triphenylamine-based AIEgen donor with a 4-pyridylacrylonitrile salt acceptor, and features a pyridinium moiety for precise mitochondrial localization. It exhibits outstanding responsiveness, with 206-fold and 95-fold fluorescence enhancements toward polarity and viscosity changes, respectively. TPAZY shows excellent photostability and biocompatibility, enabling real-time tracking of mitochondrial alterations and ferroptosis-associated microenvironmental dynamics. In glioma tissues, the probe achieves a similar to 2-fold increase in fluorescence contrast at tumor margins compared to surrounding normal tissues, supporting accurate delineation of tumor boundaries. These features position TPAZY as a powerful tool for non-invasive glioma diagnosis, offering enhanced diagnostic precision through dual-parameter mapping. This work presents a novel paradigm in precision oncology, bridging subcellular imaging with clinical applicability via microenvironment-sensitive fluorescence diagnostics.

ObjectiveThe objective of this study is to investigate the aggressive infiltration of glioblastoma into adjacent brain tissue, considering its challenging prognosis. Initially classified as an intergenic non-coding RNA, we aim to elucidate the functional implications of LINC01138 in glioblastoma.MethodGlioma grading was performed utilizing H&E staining, which unveiled distinct nuclear morphology in high-grade gliomas. The downregulation of LINC01138 in glioma tissues was corroborated through qRT-PCR and gel electrophoresis, concurrently identifying two previously unrecognized LINC01138 isoforms. Expression profiling of all four LINC01138 isoforms was executed in glioma cell lines (A172, SHG-44, U251, U87-MG). The impact of LINC01138 overexpression in U87-MG and U251 cells was evaluated for cell proliferation, migration, and invasion through cell counting, CCK-8 analysis, and Transwell assays. Furthermore, the suppression of LINC01138 in SHG-44 cells substantiated its involvement in fostering tumor malignancy. Transcriptome sequencing revealed the inhibitory influence of LINC01138 on IGF1 expression. These findings contribute to an enriched comprehension of glioma biology by exploring the engagement of LINC01138 through diverse methodologies, thereby elucidating its potential therapeutic significance.ResultsOur investigation elucidates the intricate involvement of LINC01138 in gliomas. High-grade gliomas are characterized by elevated cell density and distinctive nuclear features. LINC01138 demonstrates a substantial downregulation in glioma tissues, with the identification of two novel isoforms. The expression of all four LINC01138 isoforms is notably diminished in both glioma tissues and cell lines. Elevated expression of LINC01138 demonstrates inhibitory effects on tumor cell proliferation, migration, and invasion, while its downregulation exacerbates malignancy. The regulatory function of LINC01138 as a repressor of IGF1 expression was elucidated through transcriptome sequencing.ConclusionThe LINC01138 isoforms display notable tumor-suppressive effects, suggesting a promising potential for impeding glioma progression.

OBJECTIVE: This study aimed to investigate whether a simple endoscopic method was effective for the evacua-tion of traumatic subacute subdural hematomas.METHODS: A total of 51 patients with subacute subdural hematomas requiring surgery were enrolled in this study. An endoscopic hematoma evacuation was performed through a small bone window for 22 patients. Hematoma evacuation by open surgery was performed for 29 patients. The postoperative Glasgow Coma Scale scores improve-ment, surgery times, displacement of midline measure-ments, and intraoperative blood loss were recorded and analyzed for each patient.RESULTS: The average time from the initial incision to suture completion was 38.41 +/- 6.97 minutes for the endo-scopic surgery group and 74.66 +/- 9.54 minutes for the open-surgery group (P < 0.01). The average total blood loss was 41.36 +/- 10.82 ml for the endoscopic group and 250.00 +/- 58.25 ml for the open-surgery group (P< 0.01). No postoperative bleeding occurred in either group. The midline displacement measurement showed significant improvement on the day after surgery, with 5.21 +/- 1.98 mm in the study group versus 6.75 +/- 1.37 mm in the control group (P< 0.01). At the 1-month follow-up appointment, the midline measurement was normal in both groups. Computed tomography scans revealed almost no residual hematomas, representing an average evacuation rate of 100% in both groups. The average Glasgow Coma Scale scores improvement on the day after surgery were 1.77 +/- 1.93 in the endoscopic surgery group and 1.66 +/- 0.77 in the open-surgery group (P [ 0.766).CONCLUSION: Endoscopic subacute subdural hema-toma removal through a small bone window achieved satisfactory hematoma removal using a minimally invasive method when compared with an open-surgery method.

OBJECTIVE:The classic transopercular or transsylvian approach to insular gliomas removes the tumor laterally through the insular cortex. This study describes a new anteroposterior approach through the frontal isthmus for insular glioma surgery.METHODS:The authors detailed the surgical techniques for resection of insular gliomas through the transfrontal isthmus approach. Fifty-nine insular gliomas with at least Berger-Sanai zone I involvement were removed with the new approach, and extent of resection and postoperative neurological outcomes were assessed.RESULTS:Fifty-nine patients were enrolled in the study, including 35 men and 24 women, with a mean (range) age 44.3 (19-75) years. According to the Berger-Sanai classification system, the most common tumor was a giant glioma (67.8%), followed by involvement of zones I and IV (18.6%). Twenty-two cases were Yaşargil type 3A/B, and 37 cases were Yaşargil type 5A/B. The average angle between the lateral plane of the putamen and sagittal line was 33.53°, and the average width of the isthmus near the anterior insular point was 33.33 mm. The average angle between the lateral plane of the putamen and the sagittal line was positively correlated with the width of the isthmus near the anterior insular point (r = 0.935, p < 0.0001). The median (interquartile range [IQR]) preoperative tumor volume was 67.82 (57.64-92.19) cm3. Of 39 low-grade gliomas, 26 (66.67%) were totally resected; of 20 high-grade gliomas, 19 (95%) were totally resected. The median (IQR) extent of resection of the whole group was 100% (73.7%-100%). Intraoperative diffusion-weighted imaging showed no cases of middle cerebral artery- or lenticulostriate artery-related stroke. Extent of insular tumor resection was positively correlated with the angle of the lateral plane of the putamen and sagittal line (r = -0.329, p = 0.011) and the width of the isthmus near the anterior insular point (r = -0.267, p = 0.041). At 3 months postoperatively, muscle strength grade exceeded 4 in all cases, and all patients exhibited essentially normal speech. The median (IQR) Karnofsky performance score at 3 months after surgery was 90 (80-90).CONCLUSIONS:The transfrontal isthmus approach changes the working angle from lateral-medial to anterior-posterior, allowing for maximal safe removal of insular gliomas.

Pituitary adenomas (PAs) can exert pressure on the optic apparatus, leading to visual impairment. A subset of patients may observe a swift improvement in their vision following surgery. Nevertheless, the alterations in the structural connectome during the early postoperative period remain largely unexplored. The research employed probabilistic tractography, graph theoretical analysis, and statistical methods on preoperative and postoperative structural magnetic resonance imaging and diffusion tensor images from 13 PA patients. Postoperative analysis revealed an increase in global and local efficiency, signifying improved network capacity for parallel information transfer and fault tolerance, respectively. Enhanced clustering coefficient and reduced shortest path length were also observed, suggesting a more regular network organization and shortened communication steps within the brain network. Furthermore, alterations in node graphical properties were detected, implying a restructuring of the network's control points, possibly contributing to more efficient visual processing. These findings propose that rapid vision recovery post-surgery may be associated with significant reorganization of the brain's structural connectome, enhancing the efficiency and adaptability of the network, thereby facilitating improved visual processing.

Background As the largest concentration of neural stem cells in adult brain, the subventricular zone (SVZ) is considered to be a potential source of glioblastoma (GBM) occurrence in recent years. Methods In this study, 116 patients with glioblastoma treated at PLA General Hospital were retrospectively reviewed. The features of SVZ contacting glioblastoma were analyzed in terms of MR imaging and MGMT promoter methylation. We also evaluated the prognostic value of SVZ contacting in GBM patients. Results GBM with SVZ involvement on MRI is more likely to grow across the midline (36.8% vs. 6.9%, P=0.002), more often multifocal lesion (35.6% vs. 6.9%, P=0.003) and have a lower proportion of MGMT promoter methylation (36.8% vs. 69.0%, P=0.003). The median overall survival and progression-free survival of patients in the SVZ contacting group were 12 months and 7 months, while 25 months and 17 months in the non-contacting group (P<0.001, respectively). There was no significant difference in overall survival (P=0.229) and progression-free survival (P=0.808) between patients with different SVZ contacting regions. Multivariate survival analysis indicated that patients with MRI SVZ involvement showed worse overall survival (HR=2.060, 95%CI 1.195-3.550,P=0.009) and progression-free survival (HR=3.021, 95%CI 1.788-5.104,P<0.001). Conclusion This study suggested that MRI SVZ involvement at diagnosis is an independent risk factor for overall survival and progression-free survival in IDH wild-type glioblastoma patients. Based on MR imaging, we also found that SVZ contacting glioblastomas had a larger proportion of crossing midline tumors and multifocal lesions. In addition, patients with SVZ contact in our research presented a lower proportion of MGMT promoter methylation.

Histopathology plays a great role in diagnosing various diseases, which is considered as a golden standard for tumor identification. The tissue constituents must be stained by visible labels for microscopic analysis by medical experts. However, this process is time-consuming, labor-intensive, and expensive, which requires rapid pathological approaches for diagnosis in the operating room. Here, we present an easy-to-process and high-performance perovskite biological probes for rapid and visual pathological diagnosis of glioma. Perovskite quantum dots can be encapsulated by the copolymer into nanocrystals (PNCs) with a diameter of 100 nm, which is modified with chlorotoxin to achieve the specific recognition of glioma. Benefiting from the super photoluminescence quantum yield (above 93%) of EVA@PNCs aqueous solution, the glioma can be clearly imaged and captured via a smartphone under the excitation of a handheld UV lamp. To demonstrate the visualization and efficiency of PNC probes, different malignant grades of brain tumor sections can be distinguished in no more than 5 min. This strategy provides a general auxiliary diagnosis platform for achieving the histopathology analysis near the operating bed, which is currently not feasible with standard histochemical staining methods.

The chromosome 1p/19q co-deletion which is a hallmark of oligodendroglioma plays more crucial role in glioma classification especially in “The 2021 WHO Classification of Tumors of the Central Nervous System”. A more effective non-invasive method to distinguish 1p/19q co-deletion tumor from all gliomas can facilitate the strategy selection of pathologists, physicians, and surgeons. Preoperative MRI, including T1, T2, enhanced T1 and T2-FLAIR, from 61 glioma patients of our facility were reviewed. Data from 89 gliomas subjects from The Cancer Imaging Archive were recruited. Following the preprocessing, we improved the U-net and ResNet152 based on the MRI data of different modalities to determine the 1p/19q codeletion from overall gliomas. The different models were compared. The UMAP result implies that two different data share some similar traits. All the sensitivity, specificity and accuracy of U-net are higher than that of the ResNet152. The test accuracy with four modalities outperforms others significantly, reaching 92.156%. We introduce an efficient pipeline with U-net network for the identification of 1p/19q genotype status. The study implements one step judgement with multi-modal sequence MRI images. It takes a further step to suggest that machine learning can render more possibilities to conventional MRI.

Rationale and objectives: As the largest concentrated region of neural stem cells in the adult brain, the sub -ventricular zone (SVZ) is considered to have a close relationship with the origin of gliomas. An in-depth study of the characteristic manifestations associated with SVZ involvement in glioma may provide new ideas for indi-vidualized diagnosis and treatment of this fatal disease.Materials and methods: All 279 patients with glioma who underwent surgical treatment in our department from January 2016 to December 2021 were included. Clinical and imaging data were collected, and telephonic follow-up was conducted to analyze the overall survival and progression-free survival. Prognostic factors including SVZ involvement on glioblastoma patients' survival were analyzed. Next, the relationship between SVZ involvement, a set of unique imaging features and gene status were determined respectively. The chi-squared test, logistics regression, and Cox regression were used for statistical analysis.Results: The patients were divided into the SVZ involvement group (n = 198, 70.97 %) and SVZ non-involvement group (n = 81, 29.03 %). The median overall survival and progression-free survival were 13 months and 7 months for the SVZ involvement group, but 25 months and 17 months for the SVZ non-involvement group, respectively. In multivariate Cox survival analysis, MRI SVZ involvement proved an independent risk factor for the survival of patients with glioblastoma. The patients with SVZ involvement sign had a lower rate of cystic lesion (32.32 % vs. 48.48 %, p = 0.029), and a larger mean maximum diameter (5.88 +/- 1.28 vs. 3.28 +/- 1.65 cm). Compared with high grade gliomas (HGG), T1 enhancement (25.25 % vs. 10.42 %, p = 0.041) and ho-mogeneous signal on T2WI (14.14 % vs. 43.75 %, p = 0.025) were independently associated with SVZ involvement in WHO grade 2 gliomas(LGG). In the gene status analysis, the SVZ involvement group showed the lower rate of MGMT promoter methylation (57.58 % vs. 79.17 %, p = 0.017).Conclusion: SVZ involvement in MRI at diagnosis is an independent negative prognostic indicator for the survival of glioblastoma patients. Some image signs are associated with SVZ involvement in HGG and LGG respectively. The unique imaging and gene features of gliomas with SVZ involvement indicate that this kind of tumor maybe a unique subgroup of gliomas.

Objectives: Ki67 is an important biomarker of pituitary adenoma (PA) aggressiveness. In this study, PA invasion of surrounding structures is investigated and deep learning (DL) models are established for preoperative prediction of Ki67 labeling index (Ki67LI) status using conventional magnetic resonance (MR) images. Methods: We reviewed 362 consecutive patients with PAs who underwent endoscopic transsphenoidal surgery, of which 246 patients with primary PA are selected for PA invasion analysis. MRI data from 234 of these PA patients are collected to develop DL models to predict Ki67LI status, and DL models were tested on 27 PA patients in the clinical setting. Results: PA invasion is observed in 46.8% of cases in the Ki67 >= 3% group and 33.3% of cases in the Ki67 < 3% group. Three deep-learning models are developed using contrast-enhanced T1-weighted images (ceT1WI), T2-weighted images (T2WI), and multimodal images (ceT1WI+T2WI), respectively. On the validation dataset, the prediction accuracy of the ceT1WI model, T2WI model, and multimodal model were 87.4%, 89.4%, and 89.2%, respectively. In the clinical test, 27 MR slices with the largest tumors from 27 PA patients were tested using the ceT1WI model, T2WI model, and multimodal model, the average accuracy of Ki67LI status prediction was 63%, 77.8%, and 70.4%, respectively. Conclusion: Preoperative prediction of PA Ki67LI status in a noninvasive way was realized with the DL model by using MRI. T2WI model outperformed the ceT1WI model and multimodal model. This end-to-end model-based approach only requires a single slice of T2WI to predict Ki67LI status and provides a new tool to help clinicians make better PA treatment decisions.

BACKGROUND: The current transsylvian or transopercular approaches make access difficult because of the limited exposure of insular tumors. Hence, maximal and safe removal of insular gliomas is challenging. In this article, a new approach to resect insular gliomas is presented. OBJECTIVE: To determine whether the new transfrontal limiting sulcus approach is helpful for maximal and safe removal of insular gliomas. METHODS: The authors reported surgical techniques for insular gliomas resected through the transfrontal limiting sulcus approach. The authors evaluated the surgical resections of 69 insular gliomas performed through the new approach in their department. The extents of resection and postoperative neurological outcomes were analyzed to determine the value of this new approach. RESULTS: Based on the Berger–Sanai classification, most insular gliomas were giant tumors (59.42%), followed by zone I + IV tumors (24.64%). The median (interquartile range) extent of resection of all patients was 100% (91%, 100%). The total resection rate for all gliomas was (55 of 69, 79.7%), and the total resection rate for low-grade gliomas was (28 of 40, 70%), which was significantly lower than that for high-grade gliomas (27 of 29, 93.1%) ( P = .019). All patients had muscle strength greater than grade 4 3 months after surgery. Only 1 patient had a speech disorder 3 months after surgery. The median Karnofsky Performance Status score at the time of the 3-month follow-up was 90. CONCLUSION: The transfrontal limiting sulcus approach can help to achieve maximal and safe removal of insular gliomas.

目的 探讨室管膜下区(SVZ)相关胶质母细胞瘤(GBM)的特征表现及其对患者生存预后的影响.方法 回顾性分析2016年1月-2018年12月解放军总医院神经外科收治的116例GBM患者的临床资料,并进行定期随访.从MGMT启动子甲基化和生存预后方面对SVZ相关GBM的特征表现进行分析.结果 116例患者中,MRI SVZ受累组87例(75％),SVZ未受累组29例(25％).MRI中存在SVZ受累的GBM患者表现出了更低的MGMT启动子甲基化比例(P=0.003)和更大的肿瘤最大径(P＜0.001).SVZ受累组患者的中位总生存期(OS)及无进展生存期(PFS)为12个月和7个月,而未受累组的中位OS及PFS为25个月和17个月(P＜0.001).不同SVZ受累部位患者OS(P=0.229)及PFS(P=0.808)的差异无统计学意义.多因素生存分析显示,MRI SVZ受累患者表现出了更差的OS(HR=2.509,95％CI 1.368～4.602,P=0.003)和PFS(HR=4.082,95％CI 2.245～7.422,P＜0.001).结论 SVZ相关的GBM患者表现出了较低的MGMT启动子甲基化率和更大的肿瘤侵袭范围.MRI SVZ受累是一项影响IDH野生型GBM患者OS及PFS的独立危险因素.

Objective: Endoscopic port surgery is a promising alternative for the surgical treatment of intracerebral hypertensive basal ganglia hemorrhage (HBGH). The precise location of hematoma is a crucial step for surgery. The authors developed a simple, low-cost navigation method using an Android smartphone for the localization of HBGH. Methods: All patients' CT DICOM data were processed with an open-source software (3D Slicer). The volume of hematoma, angle, and length of trajectory were calculated automatically. A smartphone running the Android system and the Compass APP was used to help insert the inner introducer. An endoscopic port system was applied to create a working channel for neuro-endoscopic hematoma evacuation. Results: There were 27 patients enrolled in this study (mean age 56). All patients underwent successful surgical evacuation of HBGH with neuroendoscopic evacuation. The mean time taken for the surgical plan was 4 min. The total operation time from skin incision to final suture was 82.6 min. Compared with standard neuronavigation, mean error of trajectory was 5.1 mm. The mean preoperative hematoma volume was 44.8 ml. The optimal trajectory angle averaged 39.5and the length was 71 mm. Intraoperative blood loss was about 45 ml. Postoperative hematoma volume was 2.9 ml, and the average evacuation rate was 93.6%. One week after surgery, the mean GCS score was improved from 8.2 to 13.8 (p < 0.01). Conclusions: This simple, low-cost navigation method using 3D Slicer, an Android smartphone with the Compass APP, helps precisely insert the endoscopic working channel to the desired point, which is crucial for satisfactory evacuation of HBGH.

目的 探讨混合现实电磁导航技术在神经外科制定术前计划和术中导航的应用价值.方法运用混合现实电磁导航技术为4例神经外科患者进行术前影像资料的三维重建,生成可视化三维混合现实图像,明确病变位置及其周围解剖结构的毗邻关系,规划手术入路实施术中导航,同时应用博医来术中导航系统对混合现实导航结果进行验证.结果 应用混合现实术中神经导航技术可在手术室环境重建病变3D结构并导航病变的位置.混合现实术中神经导航结果与博医来神经导航结果一致.结论 混合现实术中导航技术易于应用且定位准确,可用于神经外科制定手术计划和术中导航.