PMC10133491_01
Preoperative MRI confirmed the tumor's location (white arrow), with T1 low signal and T2 equal high signal, invading the skull and compressing brain tissue locally (A-C).MRV suggests that it is closely related to the branches of the sagittal sinus (D,E); Preoperative CT three-dimensional reconstruction showed a slight skull bulge at the lesion site (F); Determine the skull repair scheme by three-dimensional modeling (G-I).
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March 2022, a 54-year-old male patient was treated for half a year due to paroxysmal headache. MRI and MRV examinations were performed on the same day, which showed that there were solid space-occupying lesions near the right frontal midline that were closely related to the superior sagittal sinus, mild compression of brain tissue, and local skull invasion (Figures 1A-E). According to previous experience, considering that meningioma invaded the skull, a CT plain scan and three-dimensional reconstruction were carried out to determine the invasion location and plan the skull repair area (Figures 1F-I).
During the operation, the scalp incision range was planned (A). After cutting the periosteum, the outer plate of the skull was rough and convex (B). After removing the bone flap, the inner plate of the skull was severely eroded (C). PEEK material was used for repair (D); CT plain scan (E) and three-dimensional reconstruction (F,G) were performed after operation; H&E staining pictures of pathological tissues of meningiomas after operation: 40x (H) and 200X (I).
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The dura mater of the tumor and surrounding lesions was completely removed, and the affected skull was removed at the same time, and the skull was remodeled with PEEK material (Figures 2A-D). Three days after the operation, we performed a CT scan and three-dimensional reconstruction to observe the intracranial condition and skull repair (Figures 2E-G). The histopathological examination 4 days after the operation revealed that meningioma, WHO grade 2, was absent and no lesion was found at the cutting edge (Figures 2H,I).
AIGS real-time fluorescence PCR was used for intraoperative molecular diagnosis (A). Real-time fluorescence curve (B) represents TERTp C250T mutation (FAM and Cy5 showed S-type amplification). NGS was performed at the same time after operation. The results showed that the patient had TERTp C250T mutation (C); Panel (D) represents the meaning of the other two curves detected by AIGS. (Left): TERTp C228T mutation (ROX and Cy5 showed S-type amplification), (Right): TERTp wild type (Cy5 showed S-type amplification). FAM is the C250T probe, Cy5 is the GAPDH internal reference probe, and ROX is the C228T probe.
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TERTp mutation during operation (Figure 3A). AIGS card slot. The results are given after 50 min. The FAM curve is the C250T mutation (Figure 3B), ROX is the C228T mutation (Figure 3C), and the patient is the C250T mutation. After feeding back the results to the surgeon, he consciously expanded the resection scope of the dura mater based on the original resection and provided a theoretical basis for skull remodeling rather than electrocautery. Patients underwent NGS after surgery to demonstrate the accuracy of detection, and the results indicated the presence of the TERT C250T mutation (Figure 3D).