Cancer stem cells are thought to be closely related to tumor p rogression and recurrence, making them attractive therapeutic targets. Stem cells of various tissu es exist within n ich es main taining their stemness. Glioblastoma stem cells (GSCs) a re located to tu mo r cap illaries, perivascular niche, which are cons idered to have important ro le in maintaining GSCs . There were some extracellu lar matrixes (ECM) on th e perivascular connective tissu e, includin g type1 co llagen. We here evalu ated wheth er type1 collagen has a potential of niche fo r GSCs. Imu nohistochemical staining of type1 collagen and CD133 , one o f the GSCs markers , on gliob lasto ma (GBM) tissues showed CD133-positive cells were located in immed iate proximity to typ e1 collagen aro und tu mor vessels. We cultured human GBM cell lines, U87MG and GBM cells obtained from fresh surgical tissu es, T472 and T555, with serum-containin g med ium (SCM) or serum -free medium with some growth facto rs (SFM) and in non-coated (No n-coat) or type1 collag en-coated cell line cultu red in the Col/SFM had Capabilities of sp here formation and tumo rigenesis. Type1 co llagen was fou nd in the perivascular area and showed a p ossibility to maintain GSCs. These fin dings su ggest th at type1 collagen could be one impo rtant co mponent of niche fo r CD133 p ositive GSCs and main tain GSCs in adheren t cultu re.
BACKGROUND
Adequate surgical planning includes a precise understanding of patient-specific anatomy and is a necessity for neurosurgeons. Although the use of virtual reality (VR) technology is emerging in surgical planning and education, few studies have examined the effectiveness of immersive VR during surgical planning using a modern head-mounted display.
OBJECTIVE
To investigate if and how immersive VR aids presurgical discussions of cerebrovascular surgery.
METHODS
A multiuser immersive VR system, BananaVisionTM, was developed and used during presurgical discussions in a prospective patient cohort undergoing cerebrovascular surgery. A questionnaire/interview was administered to multiple surgeons after the surgeries to evaluate the effectiveness of the VR system compared to conventional imaging modalities. An objective assessment of the surgeon's knowledge of patient-specific anatomy was also conducted by rating surgeons’ hand-drawn presurgical illustrations.
RESULTS
The VR session effectively enhanced surgeons’ understanding of patient-specific anatomy in the majority of cases (83.3%). An objective assessment of surgeons’ presurgical illustrations was consistent with this result. The VR session also effectively improved the decision-making process regarding minor surgical techniques in 61.1% of cases and even aided surgeons in making critical surgical decisions about cases involving complex and challenging anatomy. The utility of the VR system was rated significantly higher by trainees than by experts.
CONCLUSION
Although rated as more useful by trainees than by experts, immersive 3D VR modeling increased surgeons’ understanding of patient-specific anatomy and improved surgical strategy in certain cases involving challenging anatomy.
For better characterization of gliomas and for risk assessment, the results of metabolic PET imaging should be revised after obtaining the pathological report, because oligodendroglial differentiation may positively influence the substrate metabolism and thus complicated the preoperative evaluation.
The purpose of this study was to distinguish pseudoprogression (PP) from early true progression in patients with glioblastoma (GBM) based on the presence of a mutation in isocitrate dehydrogenase 1 (IDH1). We retrospectively surveyed 32 patients with GBM or GBM with oligodendroglioma component (GBMO) who underwent biopsy or maximal tumor resection followed by concurrent radiotherapy and temozolomide (TMZ). We then selected patients with early radiological progression in magnetic resonance imaging within 6 months after concurrent radiotherapy and TMZ treatment. DNA was extracted from their tumor blocks. The IDH1 mutation was analyzed in the genomic region by direct sequencing as a biomarker for PP. Twenty-eight patients were diagnosed with GBM and four with GBMO. Eleven patients were discovered to have early radiological progression. PP was detected in two patients (6.3%) diagnosed with GBMO and one patient with GBM. Both of the GBMO patients with PP had the IDH1 mutation, the one GBM patient with PP and the other eight patients with early true progression with wild type. The sensitivity and specificity of the IDH1 mutation for detecting PP were 66.7 and 100%, respectively. This study suggests the IDH1 mutation may become a novel molecular biomarker for PP. Analyzing the IDH1 mutation, in the case of recognizing early radiological progression, may enable distinction of PP from early true progression, and we could determine the need for second-look surgery.
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