钙化脊膜瘤的显微外科治疗

目的总结钙化脊膜瘤的显微手术经验。方法回顾性分析24例钙化脊膜瘤患者的临床资料。肿瘤位于颈椎管内2例、颈胸段椎管内2例、胸椎管内20例;24例患者均行显微手术治疗。结果术中发现肿瘤呈部分钙化者19例,骨片状钙化者3例,完全钙化者2例;手术时间平均为181.6min,术中出血量平均为189.6ml。22例肿瘤全切除(simpsonⅠ级5例,其余为simpsonⅡ级),2例次全切除。术后病理学结果均为脊膜瘤,均伴有钙化。术后21例患者症状均有不同程度改善;3例恶化,经保守治疗后好转。结论钙化脊膜瘤手术难度大,术后神经功能障碍发生率高,合理应用显微神经外科技术可提高手术疗效。     

一种基于图割的交互式脑膜瘤核磁共振图像分割方法

摘要：为实现脑膜瘤核磁共振（MR）图像的精确分割,本文提出了一种新的基于图割的交互式图像分割算法。该方法首先
提取高维图像特征,然后利用加权KNN（K-Nearest Neighbor）分类器估计待分类像素属于肿瘤与背景区域的概率,并构造
新的能量函数;最后采用图割优化方法对能量函数优化求解。对脑膜瘤MR图像的分割实验表明,本方法较基于灰度信
息的图割方法在精度上有明显提高。     

Methylation of O6-Methyl Guanine Methyltransferase Gene Promoter in Meningiomas - Comparison between Tumor Grades I,II, and III

Background: Meningiomas are the second most common primary intracranial tumors after gliomas. Epigeneticbiomarkers such as DNA methylation, which is found in many tumors and is thus important in tumorigenesiscan help diagnose meningiomas and predict response to adjuvant chemotherapy. We investigated aberrant O6-methyl guanine methyltransferase (MGMT) methylation in meningiomas. Materials and Methods: Sixty-onepatients were classified according to the WHO grading, and MGMT promoter methylation status was examinedvia the methylation-Specific PCR(MSP) method. Results: MGMT promoter methylation was found in 22.2% ofgrade I, 35% of grade I with atypical features, 36% of grade II, and 42.9% of grade III tumors. Conclusions:There was an increase, albeit not statistically significant, in MGMT methylation with a rise in the tumor grade.Higher methylation levels were also observed in the male gender.     

基层医院开展脑膜瘤手术治疗31例临床体会

目的 阐述脑膜瘤的手术治疗及效果。方法31例脑膜瘤均采用开颅手术治疗,3例术前采用同侧颈外 动脉结扎术。结果全部成功,无一例死亡,未见肿瘤复发:结论脑膜瘤适合手术切除,效果好。     

Possible interaction between ionizing radiation, smoking, and gender in the causation of meningioma

Data on the association between smoking and meningioma are inconsistent. The aim of this study was to assess the role of smoking in radiation- and non-radiation-related meningiomas. The study was designed as a 4-group case-control study, balanced for irradiation, including 160 irradiated meningioma case patients, 145 irradiated control subjects, 82 nonirradiated case patients, and 135 nonirradiated control subjects. The sources of these groups included a cohort of individuals who underwent radiotherapy (mean dose, 1.5 Gy to the brain) during childhood for treatment of tinea capitis, claims filed for radiation damage in the framework of a compensation law, and the Israel Cancer Registry. All tests of statistical significance were 2-sided. A statistically significantly elevated risk of meningioma was found among men who had ever smoked, compared with those who were never smokers (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.09-4.15), increasing with smoking pack-years from 1.67 to 2.69 for <10 to >20 pack-years, respectively. Among women, an interaction between radiation and smoking was observed, expressed by a significant protective effect for meningioma (OR, 0.32; 95% CI, 0.14-0.77), with a strong dose-response association (P < .01) in non-irradiated women and a nonsignificant increased risk of meningioma among those who were irradiated (OR, 1.23; 95% CI, 0.68-2.23). Variation in the association between smoking and meningioma may be explained by effects of distinct host factors, such as past exposure to ionizing radiation and/or hormonal factors.     

复发性脑膜瘤的再手术治疗

目的：探讨复发性脑膜瘤的再手术治疗效果。方法：总结我科1998年1月至2003年6月对37例复发性脑膜瘤采用Simpson 0～Ⅱ级手术再治疗的效果,与第一次手术间隔期平均为230．5周。再手术前Karnoifsky perform score(KPS)为20～90(平均57)。结果：再次手术后平均存活期为185．2周。27例术后1月KPS较术前改善。结论：再手术治疗复发性脑膜瘤是可行的。     

A phase II trial of erlotinib in patients with recurrent malignant gliomas and nonprogressive glioblastoma multiforme postradiation therapy

Patients with (a) recurrent malignant glioma (MG): glioblastoma (GBM) or recurrent anaplastic glioma (AG), and (b) nonprogressive (NP) GBM following radiation therapy (RT) were eligible. Primary objective for recurrent MG was progression-free survival at 6 months (PFS-6) and overall survival at 12 months for NP GBM post-RT. Secondary objectives for recurrent MGs were response, survival, assessment of toxicity, and pharmacokinetics (PKs). Treatment with enzyme-inducing antiepileptic drugs was not allowed. Patients received 150 mg/day erlotinib. Patients requiring surgery were treated 7 days prior to tumor removal for PK analysis and effects of erlotinib on epidermal growth factor receptor (EGFR) and intracellular signaling pathways. Ninety-six patients were evaluable (53 recurrent MG and 43 NP GBM); 5 patients were not evaluable for response. PFS-6 in recurrent GBM was 3% with a median PFS of 2 months; PFS-6 in recurrent AG was 27% with a median PFS of 2 months. Twelve-month survival was 57% in NP GBMs post-RT. Primary toxicity was dermatologic. The tissue-to-plasma ratio normalized to nanograms per gram dry weight for erlotinib and OSI-420 ranged from 25% to 44% and 30% to 59%, respectively, for pretreated surgical patients. No effect on EGFR or intratumoral signaling was seen. Patients with NP GBM post-RT who developed rash in cycle 1 had improved survival (P < .001). Single-agent activity of erlotinib is minimal for recurrent MGs and marginally beneficial following RT for NP GBM patients. Development of rash in cycle 1 correlates with survival in patients with NP GBM after RT.