Objective. High dose fluorescein sodium has been utilized for fluorescence-guided tumor resection with conflicting reports on the efficacy of this procedure. The aim of this study was to reevaluate the utility and clinical limitations of using fluorescein sodium for the treatment and resection of glioma brain tumors.Methods. Patients diagnosed with glioma were divided into two groups with a total of 22 patients enrolled in the study: 1) the study group (n=10), patients that received intravenous injection of fluorescein sodium and 2) the control group (n=12), patients that did not receive injections during surgical resection. Quality of life was evaluated according to Karnofsky Performance Scale (KPS) score and neurological status. Fluorescein sodium was intravenously injected at a dose of 15-20mg/kg of body weight. Glioma resection was evaluated preoperative and postoperatively with enhanced Magnetic Resonance Imaging (MRI).Results. Significant differences in the gross total resection (GTR) rates were observed between the two patient groups (Fisher's Exact Test p=0.047). Progressive free survival was significantly longer in the study group (Student's T-Test p=0.033) as well as in the GTR group (Student's T-Test p=0.0001) compared to the control and non-GTR groups, respectively. Three patients in the study group and four patients in the control group had transient neurological deterioration. One patient in the control group had permanent hemiplegia.Conclusion. The intraoperative utility of using fluorescein sodium can significantly increase the GTR rate without obvious deterioration. In addition, we find that it is better to apply the fluorescein sodium in the cases with BBB (blood-brain barrier) disruption, which had been enhanced in preoperative MRI.

Neurocysticercosis, involvement of the central nervous system by taenia solium, is one of the most common parasitic diseases of the CNS. However, spinal involvement by neurocysticercosis is uncommon. Here, we reported a 40-year-old woman with intramedullary cysticercosis in the thoracic spinal cord. MRI revealed two well-defined round intramedullary lesions at T4 and T5 vertebral levels, which were homogeneously hypointense on T1WI and hyperintense on T2WI with peripheral edema. Since the patient had progressive neurological deficits, surgery was performed to decompress the spinal cord. Histopathology examination of the removed lesion proved it was intramedullary cysticercosis. In this report, we also discussed the principles of diagnosis and treatment of intramedullary cysticercosis in combination of literature review.

Background: This systematic review and meta-analysis aimed to investigate and compare the passing rates of Massive Open Online Courses (MOOCs) with Traditional Courses to indicate how to improve the teaching efficiency in Medicine Education.Methods: A systematic search of relevant published literature was conducted to collect relevant retrospective cohort studies that compared the teaching efficiency of MOOCs and Traditional Courses.Results: There are three retrospective cohort studies included in the final meta-analysis. There were no significant differences in the passing rates of MOOCs and Traditional Courses.Conclusions: it is necessary for universities to invest in online education to promote the development of MOOCs, which will probably have an advantage over Traditional Courses for postgraduate medical education in the near future.

Intracranial mature teratoma is a rare lesion in adults. Despite several intracranial mature teratomas had been reported not to be located at the midline region, no one was found to be within cerebral falx. Herein, we reported a 37-year-old female patient with an intracranial mature teratoma confined within frontal cerebral falx. Her main complaint was intermitted headache, which could not be relieved recently by taking painkiller. Excepting for mild papilledema, we did not find positive neurological signs on physical examination. CT scanning showed it was a round homogenously hypodense lesion with hyperdense signal at its rim. MRI revealed the lesion was 3.5cm×3.6cm×4.5cm in volume, with uniformed hypointensity on T1WI, hyperintensity on T2WI and enhancement in the capsule. It was totally removed via inter-hemispheric approach, and we found the lesion was confined within the frontal cerebral falx. Postoperatively, it was proved histologically to be a mature teratoma. At three years of fellow up, neither neurological deficits nor recurrent sings on MRI was found. To our best knowledge, this is the first case of intracranial mature teratoma within cerebral falx.

Hypoglossal schwannomas are rare skull base tumors. Furthermore, cystic hypoglossal schwannomas are extremely uncommon. We report the first case of a large cystic hypoglossal schwannoma with a fluid-fluid level. A 36-year-old woman presented with increased intracranial pressure and cerebellar signs without hypoglossal nerve palsy. Magnetic resonance imaging showed a predominantly cystic mass with a fluid-fluid level in the foramen magnum region extending into the hypoglossal canal. The intracranial tumor was largely removed via a midline suboccipital subtonsillar approach, leaving only a tiny residue in the hypoglossal canal. Histology confirmed a schwannoma with relative hypervascularity. Twenty months later, the tumor recurred and presented as a multicystic dumbbell-shaped lesion, extending intra-and extracranially through the enlarged hypoglossal canal. A complete resection of the intracranial and intracanalicular parts of the tumor was achieved with a small extracranial remnant treated by radiosurgery. Histology revealed a focal increased K i 67 proliferative index. In this report, we discuss the possible reasons for the absence of hypoglossal nerve palsy and the potential mechanism of the formation of the fluid-fluid level, and we consider the treatment of this lesion.KEYWORDS: Hypoglossal schwannoma, cystic, fluid-fluid level, schwannoma Schwannomas are benign, slow-growing neoplasms of the myelin-producing Schwann cells in the peripheral sensorimotor nervous system. In more than 90% of cases, these present as vestibular schwannomas. 1Schwannomas that arise from the hypoglossal nerve, a pure motor nerve, are very rare, accounting for only 5% of all nonacoustic intracranial schwannomas. 2 To date, around 100 cases of hypoglossal schwannoma have been reported in the English literature. Hypoglossal schwannoma usually originates intracranially but can also extend extracranially through the hypoglossal canal in a so-called ''dumbbell'' fashion or can arise purely from the extracranial portion of the XII nerve. According to Kaye et al's 4 classification of the jugular foramen neurinomas, the hypoglossal schwannomas documented in the literature are divided into three types: type A, intracranial in 31.5%; type B, dumbbellshaped or extra-and intracranial in 50%; type C, extracranial in 18.5%. 5Schwannomas are frequently solid masses, and cystic patterns are uncommon. A fluid-fluid level has been observed in a few intracranial cystic schwannomas on magnetic resonance image (MRI), such as schwannomas that originate from the V, VIII, and IX nerves. 6-8Here we describe a unique case of a monocystic hypoglossal schwannoma with fluid-fluid level. To our