Brain mapping in glioma surgery

The aims of brain glioma surgery are to potentiate adjuvant therapies and to extend survival with maximizing the quality of resection, while minimizing the risk of postoperative neurologic deficits. However, it is often limited by the location and spatial extent of the tumor and its relationship to the eloquent tissue. Moreover, there is interindividual anatomofunctional variability and so, each patient should be evaluated for cortical functional organization, effective connectivity and potential for plasticity. Recently, “maximum safe resection” has been made possible by preoperative functional neuroimaging, intraoperative imaging and image-guided surgery, and intraoperative functional mapping. In each patient, preoperative evaluation of cortical functional organization and relationship between tumor and surrounding brain tissue, and intraoperative evaluation of anatomo-functional connectivity and short-term plasticity using repeated cortical and subcortical stimulation during resection made tailored resection of glioma in eloquent area possible. With continuous accumulation of neuroanatomical & neurophysiological knowledge and experience of preoperative and intraoperative mapping, we could understand more and better about dynamic functional anatomy of brainope

Usefulness and Limitation of Perfusion Weighted Magnetic Resonance Imaging in Patients with Brain Tumors

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성장호르몬 분비 뇌하수체선종의 침윤과 연관된 생체표지자의 개발에 관한 연구

Dept. of Medicine/박사MicroRNAs (miRNAs) have been implicated in the pathogenesis of many human tumors. miRNAs act not only as a tumor suppressor but also as an oncogene in some malignancies, including thyroid cancer, prostate cancer, and pancreatic cancer. However, few studies have been reported about the role of miRNAs on pituitary adenoma. It was hypothesized that miRNAs might be involved in tumor size and invasiveness of growth hormone (GH) secreting pituitary adenoma. miRNA for microarray was extracted and purified from 6 GH secreting pituitary adenoma patients. Three of them had the pituitary adenoma of Hardy classification I (non-invasive) and the others had the one of Hardy classification IV (invasive). The significance of data from microarray was re-evaluated with in-vitro condition using rat GH-producing cell (GH3) line before and after estradiol (E2) treatment. There was significant difference in expression profile of miRNA according to the invasiveness of pituitary adenoma. miRNA-338 and miRNA-652 was significantly up-regulated but miRNA-432 was significantly down-regulated in invasive pituitary adenoma. Several candidate transcripts from microarray were further explored with GH3 cell line. The most strongly differentially expressed miRNA was miRNA-338. In E2 treated GH3 cell, the expression of miRNA-338 increased as rising concentration of E2 treatment. p27 expression in GH3 was down-regulated after miRNA-338 inhibitor treatment. These data suggest that specific miRNA, especially miRNA-338 might influence on the progression of GH secreting pituitary adenomaope

Prevention of cerebrospinal fluid rhinorrhea after transsphenoidal surgery by collagen fleece coated with fibrin sealant without autologous tissue graft or postoperative lumbar drainage

BACKGROUND: Autologous tissue grafting and postoperative lumbar cerebrospinal fluid (CSF) drainage (PLD) have been used to prevent CSF rhinorrhea after transsphenoidal surgery. OBJECTIVE: To describe the technical details and efficacy of our techniques of using collagen fleece coated with fibrin sealant (TachoComb, Nycomed, Linz, Austria) instead of an autologous tissue graft and refraining from the use of PLD. METHODS: We retrospectively reviewed 307 consecutive patients who underwent a transsphenoidal surgery for pituitary adenoma from November 2005 to February 2008. Among them, 90 cases of intraoperative CSF leaks were repaired with TachoComb without an autologous tissue graft or PLD. The repair procedures were tailored according to CSF leakage type, and we used only Bioglue (Cryolife Inc, Atlanta, Georgia) for sellar floor reconstruction. RESULTS: The overall rate of CSF rhinorrhea was 2.2% (2 of 90 cases). The 2 cases of CSF rhinorrhea resulted from large arachnoid defects, and there were no adverse effects from TachoComb such as transmission of viral disease or infection. CONCLUSION: Our technique is an alternative method to the traditional autologous tissue graft technique. PLD is not an essential procedure for the prevention of CSF rhinorrhea if the intraoperative CSF leak is completely sealed off during the transsphenoidal surgery. However, in cases of large arachnoid defects, aggressive repair of the arachnoid defect and sellar floor reconstruction with bone or bony substitutes should be considered in conjunction with our methods.ope

An endodermal cyst mimicking an intra-axial tumor in the medulla oblongata

INTRODUCTION: Endodermal cysts, also known as enterogenous, neurenteric, foregut, epithelial, bronchogenic, or respiratory cysts, are rare benign lesions lined by columnar epithelium of a presumed endodermal origin. Endodermal cysts are rarely intracranial, but when this occurs, the cysts are frequently located in the posterior fossa with the most common locations being anterior to the brainstem and within the fourth ventricle. However, an endodermal cyst located in the medulla oblongata is extremely rare. CASE REPORT: Here, we present a case of a 23-year-old man with an endodermal cyst located in the medulla oblongata. Although rare, clinicians should be aware that this lesion is differentiated from other cystic lesions of the posterior fossa by the absence of a mural nodule. DISCUSSION: Total resection of endodermal cysts in the medulla oblongata is recommended, despite their location and adhesion to surrounding structures, due to its frequent recurrenceope

Application of intraoperative indocyanine green videoangiography to brain tumor surgery

BACKGROUND: Videoangiography using indocyanine green (ICG) has been used in the ophthalmologic field for a long time. It was introduced to the neurosurgical field several years ago but has been limited to vascular surgeries. We applied ICG videoangiography to brain tumor surgery and evaluated the usefulness. METHODS: Twenty-three patients with a brain tumor who underwent microsurgical resection were analyzed. The pathological diagnosis was meningioma in 15 patients, metastasis in three, glioma in three, and hemangioblastoma in two. A microscope with a special filter and infrared excitation light to illuminate the operating field was used in this study. The intravascular fluorescence was imaged with a video camera attached to the microscope. ICG was injected intravenously with the dose of 5-25 mg, and overall, ICG was injected intraoperatively 32 times. RESULTS: ICG videoangiography allowed for an excellent evaluation of blood flow in the tumoral and peri-tumoral vessels both before and after the resection in all cases. CONCLUSIONS: ICG videoangiography is a useful method for monitoring blood flow in the exposed vessels during microsurgery for a brain tumor. This noninvasive method is simple, safe, cost-effective, and easily repeatable. Before resection, it provides information on the tumoral and peri-tumoral circulation including sequential visualization of vessels or direction of the blood flow. After resection, it checks the patency of the peri-tumoral vessels and is especially useful for the vein. This ICG videoangiography can be an alternative tool to intraoperative angiography or Doppler ultrasonography in selective cases.ope

The Korean Society for Neuro-Oncology (KSNO) Guideline for Antiepileptic Drug Usage of Brain Tumor: Version 2021.1

Background: To date, there has been no practical guidelines for the prescription of antiepileptic drugs (AEDs) in brain tumor patients in Korea. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for AED usage in brain tumors since 2019. Methods: The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of the keywords. Results: The core contents are as follows. Prophylactic AED administration is not recommended in newly diagnosed brain tumor patients without previous seizure history. When AEDs are administered during peri/postoperative period, it may be tapered off according to the following recommendations. In seizure-naive patients with no postoperative seizure, it is recommended to stop or reduce AED 1 week after surgery. In seizure-naive patients with one early postoperative seizure (<1 week after surgery), it is advisable to maintain AED for at least 3 months before tapering. In seizure-naive patients with ≥2 postoperative seizures or in patients with preoperative seizure history, it is recommended to maintain AEDs for more than 1 year. The possibility of drug interactions should be considered when selecting AEDs in brain tumor patients. Driving can be allowed in brain tumor patients when proven to be seizure-free for more than 1 year. Conclusion: The KSNO suggests prescribing AEDs in patients with brain tumor based on the current guideline. This guideline will contribute to spreading evidence-based prescription of AEDs in brain tumor patients in Korea. Keywords: Antiepileptic drug; Brain tumors; Guideline; Korean Society for Neuro-Oncology; Practice