Xiao-Qiang Wang

Electroacupoint stimulation for postoperative nausea and vomiting in patients undergoing supratentorial craniotomy.

Objects We evaluated the effectiveness of transcutaneous electrical acupoint stimulation (TEAS) at the P6 acupoint for prevention of postoperative nausea and vomiting in patients undergoing supratentorial craniotomy. Methods The study population was patients aged 20 to 60 years who underwent supratentorial craniotomy under general anesthesia. Exclusion criteria were obesity, diabetes mellitus, and a history of motion sickness, postoperative nausea and vomiting, or smoking. Patients were randomized into 2 groups: stimulation and control. In the former, transcutaneous stimulation electrodes were placed at the right P6 acupoint. In controls, electrodes were positioned at a nonacupoint site. Patients received a standard general anesthesia. Ondansetron was given as a routine antiemetic treatment for each patient before skin closure. Postoperatively, metoclopramide (10 mg, i.v.) was administered as a rescue antiemetic. Result Forty patients received TEAS and 40 were controls. In the TEAS group, 18% of patients had nausea compared with 37% of the controls. The cumulative prevalence of vomiting was 12.5% with acustimulation and 32.5% in controls (P<0.05). The prevalence of nausea, vomiting was significantly lower with TEAS at the P6 acupoint. Conclusions TEAS at the P6 meridian points is an effective adjunct to standard antiemetic drug therapy for prevention of nausea and vomiting in patients undergoing supratentorial craniotomy.

Imaging characteristics of Rosai-Dorfman disease in the central nervous system

BACKGROUND AND PURPOSE Rosai-Dorfman disease (RDD) is a rare, lymphoproliferative disorder of uncertain etiology. The Central Nervous System (CNS) is a very rare site for RDD and only a few imaging appearances have been described. The purpose of this study is to present the largest series of cases in the CNS imaging literature to increase familiarity with this entity and further identify features that may distinguish RDD from meningioma. MATERIALS AND METHODS Findings from imaging examinations in 10 patients with pathologically confirmed RDD were retrospectively reviewed. Two radiologists evaluated the lesion location, shape, size, number, edge, cerebral edema, homogeneous or heterogeneous appearance, attenuation and signal intensity, degree of enhancement, and the relation between lesions and meninges. RESULTS RDD in CNS showed similar features in imaging: an extra-axial, well-circumscribed, dura-based mass, isodense or hyperdense on CT, isointensity on T1-weighted imaging and isointensity with hypointensity on T2-weighted imaging. The mass enhanced markedly and homogeneously after the administration of contrast agent and demonstrated dural tail sign in all cases. Significant perifocal edema was associated with the masses. Remarkably, seven patients (77.8%) showed strong hypointensity within isointensity on T2-weighted or FLAIR images and no calcification was observed in CT images or pathologic specimens. CONCLUSIONS Although RDD in the CNS is a rare process, it should be considered in the differential diagnoses for meningioma. We believe that a typical representation of hypointensity irrelevant to calcification on T2-weighted or FLAIR images can suggest the diagnosis of RDD.

Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases.

Objective To investigate the features of pathologically confirmed gliosarcomas using computed tomography (CT) and magnetic resonance (MR) imaging. Methods We retrospectively reviewed the cross-sectional CT and MR images of 54 patients (37 males and 17 females; mean age, 44.5 years; range, 13–74 years) with gliosarcomas confirmed by histopathology. Results Across all patients, there were 59 lesions. On nonenhanced CT and MR images, tumors were predominantly inhomogeneous. On the postcontrast CT and MR images, 50 (84.7%) irregular lesions had thick walls with a strong rim- and ringlike enhancement, whereas the remaining 9 (15.3%) round or oval lesions had even thin walls with an enhanced peripheral ring. Magnetic resonance spectroscopy showed increased choline and lactate values, along with decreased N-acetylaspartate and creatine values. On diffusion-weighted imaging, the tumor was slightly or markedly hyperintense compared with the white matter. Conclusion A well-demarcated mass located peripherally, with rimlike or ring enhancement, is a common presentation of gliosarcoma on CT and MR images. In addition, magnetic resonance spectroscopy and diffusion-weighted imaging can be used to make a differential diagnosis.

Clear cell meningioma: clinical features, CT, and MR imaging findings in 23 patients.

Background Clear cell meningioma (CCM) is a rare meningioma, with radiologic features not well characterized in literature. The purpose of this study was to describe and characterize the clinical features and imaging findings of CCM. Materials and Methods The computed tomography (n = 16) and magnetic resonance (n = 23) images of 23 patients (12 men and 11 women; mean age, 34.6 years) were retrospectively reviewed. All of the patients underwent surgical resection. Follow-up was performed through clinical observations. Results Cerebellopontine angle was the most frequently presenting location (n = 10). The tumors were isointense (n = 12) or hypointense but associated with isointense (n = 7) appearance to gray matter on T1-weighted images. However, the tumors seemed to be isointense (n = 6) or isointense and hyperintense (n = 13) on T2-weighted images. On gadolinium-enhanced T1-weighted images, heterogeneous enhancement was seen in 14 lesions. Four lesions had amorphous calcifications, 18 showed peritumoral edema, 14 had cystic areas, 2 had bone hyperostosis, and 8 manifested bone destruction. On initial surgery, 17 patients underwent complete resection, whereas 5 patients underwent subtotal resection of their tumors. The operative result for the remaining patient was unknown. Follow-up was possible in 22 patients. Eleven patients had recurrence and 2 had died. Conclusions Clear cell meningioma is a rare subtype of meningioma that occurs in younger patients and often recurs. Cerebellopontine angle is the most affected area in this series. The extent of initial surgical resection is the most important prognostic factor. In radiological studies, CCM tends to have marked heterogeneous enhancement, prominent peritumoral edema, intratumoral cystic components, and involvement of the adjacent bone.

Clinical features and treatment of intracranial chordoid meningioma: a report of 30 cases.

To discuss the clinical characteristics and prognosis of chordoid meningioma (CM).

Clinical features and treatment of World Health Organization grade II and III meningiomas in childhood: report of 23 cases.

OBJECT High-grade meningiomas in childhood are rare, and their clinical features are unknown. The objective of this study was to determine the clinical characteristics and prognosis of childhood high-grade meningiomas. METHODS Twenty-three patients with childhood high-grade meningiomas were treated at the Huashan Hospital. Clinical data were collected, tumor samples were reexamined, and prognoses were attained through follow-up visits and telephone interviews. Survival probability was calculated using the Kaplan-Meier method. A 2-sided probability level of 0.05 was chosen for statistical significance. RESULTS The series included 18 males and 5 females (mean age 12.1 years). The most common symptoms were headache and vomiting (43%). Three patients had accompanying neurofibromatosis type II (NF2). The high-grade meningioma cases with NF2 had larger tumor diameters than those without NF2 (p = 0.010). The skull base was the most common tumor site (39%). Complete resections were achieved in 11 patients after their initial operations. Adjuvant radiation therapy was performed in 9 cases. Follow-up evaluations were performed for 20 patients (mean follow-up 70 months). Ten patients experienced recurrences, 2 patients had lung metastases, and 7 patients died of the recurrence. The extent of surgery was significantly related to progression-free survival (PFS; p = 0.038). A negative progesterone receptor combined with strongly positive Bcl-2 immunoreactivity was significantly related to PFS (p = 0.001) and overall survival (p = 0.002). The MIB-1 labeling index was significantly related to overall survival (p = 0.018), whereas postoperative radiation therapy was not significantly related to PFS (p = 0.087) and overall survival (p = 0.40). CONCLUSIONS Childhood high-grade meningioma is a rare tumor type. Childhood high-grade meningioma has a male predominance and the basilar region is the most common tumor location. Patients with these tumors have high recurrence and mortality rates. The extent of resection is an important prognosis factor. A negative progesterone receptor combined with a strongly positive Bcl-2 immunoreaction might predict cancer recurrence. The MIB-1 labeling index correlates with the prognosis, and an MIB-1 labeling index > 3% increases the risk of recurrence in childhood high-grade meningioma. More cases should be collected, and longer follow-up periods should be obtained, to evaluate the effects of postoperative radiation therapy in childhood high-grade meningioma.

Solitary fibrous tumors of the central nervous system: clinical features and imaging findings in 22 patients.

Introduction Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm originating in the central nervous system (CNS), with imaging features currently not well known. The purposes were to describe and characterize clinical features and imaging findings of CNS SFT. Methods We retrospectively reviewed computed tomographic (CT; n = 10) and magnetic resonance (MR) images (n = 18) of 22 patients with SFT (13 males and 9 females; mean, 47.6 years) with associated clinical records. Results Each lesion was found as a solitary, well-defined mass, ranging in size from 12 to 70 mm (mean, 38 mm). The tumor shape was roundlike in 16 cases (72.7%) and irregular in 6 cases (27.2%). The cerebellopontine angle zone was the most affected area (n = 6). On precontrast CT scans, 10 cases showed predominantly hyperattenuation (n = 9) and isoattenuation (n = 1). No lesion contained calcification, and 2 cases showed bone invasions. All 18 tumors examined by MR imaging showed homogeneous hypointensive (n = 5) or isointensive (n = 7) signal intensity and heterogeneous mixed isointense and hypointense signal intensity (n = 6) on T1-weighted images, whereas most tumors were predominantly isointense (n = 13) and hypointense (n = 4) to the cortex on T2-weighted images; on postcontrast CT and MR images, enhancement was marked homogeneous (n = 10) or heterogeneous (n = 12). Fourteen tumors had thickening of the meninges adjacent to the tumor. Conclusions Although SFT is a rare neoplasm in the CNS, it should be considered in the differential diagnosis. The most affected area is the cerebellopontine angle zone. Solitary fibrous tumor tends to have some imaging features, such as high attenuation on CT, isointense to hypointense signal intensity on MR images, and marked enhancement.

Erratum: Clinical features and treatment of World Health Organization Grade II and III meningiomas in childhood: report of 23 cases: Clinical article

459 To The Editor: Thank you for publishing our paper entitled “Clinical features and treatment of World Health Organization Grade II and III meningiomas in childhood: report of 23 cases. Clinical article” (J Neurosurg Pediatr, published online ahead of print on August 31, 2012; DOI: 10.3171/2012.7.PEDS12179). After our paper was published online, we realized that the superscripted numbers linking authors to department affiliations were incorrect. The corrected list of authors and affiliations is shown below: