Venous phase timing during balloon test occlusion as a
criterion for permanent internal carotid artery sacrifice.
Department of Interventional Neuroradiology, Fondation Rothschild, Paris,
PURPOSE: The purpose of this study was to evaluate the reliability of
angiography-based balloon test occlusion (BTO) criteria to decide whether to
perform internal carotid artery (ICA) permanent occlusion. METHODS: From
March 1999 to August 2004, 60 patients underwent therapeutic ICA occlusion.
Angiographic BTO was performed systematically in all patients under general
anesthesia (GA). No clinical examination test was performed. After balloon
inflation, contralateral carotid and vertebral arteries angiograms were
obtained. The symmetry of the venous phases of each hemisphere was assessed.
Occlusion was considered to be feasible when the delay between the venous
drainage of the injected and the occluded hemisphere was not >2 seconds.
Venous drainage delay >4 seconds was considered as contraindication to
ICA permanent occlusion. In patients with venous drainage delay of 2-4
seconds, the occlusion was performed only in selected cases. RESULTS: From a
total of 60 patients, 44 had exact symmetry of the venous phase, 10 had
delay of 1 second, and 3 other patients had 2-second delays. Clinical
outcome for these 57 patients was uneventful. Three patients had venous
drainage delay of 3 seconds. One of them had delayed watershed area
infarction without clinical consequences at the time of hospital discharge.
No periprocedural complications were observed. CONCLUSION: Venous
opacification symmetry in the tested and control vascular territories was a
reliable predictor of a subject's ability to tolerate carotid occlusion
without developing neurologic deficit. Carotid sacrifice was found to be
possible when the delay was <3 seconds.
PMID: 16286409 [PubMed - indexed for MEDLINE]
Radiologic morphology of low-grade primary central
nervous system lymphoma in immunocompetent patients.
Department of Hematology, Oncology and Transfusion Medicine,
Charite-Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin,
BACKGROUND AND PURPOSE: Primary central nervous system lymphomas (PCNSLs)
are usually high-grade and are rarely low-grade non-Hodgkin lymphomas (NHLs).
On MR imaging, PCNSLs typically present as contrast-enhancing lesions in
contact with the subarachnoid space without evidence of necrosis. We
evaluated the radiologic morphology and clinical characteristics of
low-grade PCNSLs, hypothesizing that they may differ from high-grade PCNSLs.
METHODS: Records were reviewed from 332 patients screened for inclusion in 3
multicenter prospective trials. MR imaging scans were obtained from all
patients and were centrally reviewed by 2 consultant neuroradiologists.
RESULTS: Ten patients (3%) with low-grade PCNSLs (7 men and 3 women; median
age, 59 years; age range, 19-61 years) were identified. Four patients had
one lesion, 2 patients 2 lesions, and 4 patients had multiple lesions. The
following radiologic features infrequently seen in high-grade PCNSLs were
found in a substantial proportion of patients: location in deep structures
or spine (n = 6); lack of periventricular location (n = 5); hyperintensity
on T2-weighted images (n = 10); moderate or absent contrast enhancement (n =
6); and heterogeneous contrast enhancement (n = 5). In 8 patients, >2 of
these features were present in at least one lesion, and, thus, the
radiologic appearance was assessed atypical of high-grade PCNSLs. The
atypical radiologic appearance in combination with atypical or mild symptoms
resulted in a false or delayed diagnosis. CONCLUSION: Low-grade PCNSLs may
have a variable and atypical radiologic morphology compared with high-grade
PCNSLs with the risk of false or delayed diagnosis.
PMID: 16286384 [PubMed - indexed for MEDLINE]
2006 Feb 8; [Epub ahead of print]
Survival rates and patterns of care for patients
diagnosed with supratentorial low-grade gliomas: data from the SEER program,
Department of Epidemiology and Public Health, Yale University School of
Medicine, New Haven, Connecticut.
BACKGROUND: Detailed population-based estimates of long-term survival as
well as patterns of care for patients with low-grade gliomas examined by age
at diagnosis, gender, and race have not been widely available. METHODS: Time
to death was examined among 2009 individuals diagnosed with a supratentorial
low-grade glioma and reported to the Surveillance, Epidemiology, and End
Results (SEER) program of the National Cancer Institute from 1973-2001 using
Kaplan-Meier estimation. A Cox proportional hazards model was used to assess
the effect of age at diagnosis, race, gender, histology, anatomic location
within the brain, first course of treatment, and year of diagnosis upon this
risk. RESULTS: The cumulative 5-, 10-, 15- and 20-year survival rates among
all individuals initially diagnosed with a supratentorial low-grade glioma
were 59.9% (95% confidence interval [95% CI], 57.6-62.2); 42.6% (95% CI,
39.9-45.2); 31.9% (95% CI, 29.0-34.8); and 26.0% (95% CI, 22.7-29.2),
respectively. Improved survival was significantly associated with female
gender (hazard ratio [HR], 0.84; 95% CI, 0.74-0.95), younger age, white race
(HR, 0.70; 95% CI, 0.54-0.93), histology, and later year of diagnosis.
Surgical treatment was associated with increased survival. The use of
radiation therapy as a first course of treatment for these lesions has
significantly decreased over time with the majority of patients receiving
only surgery as a first course of treatment. CONCLUSIONS: Data for patients
diagnosed with low-grade gliomas revealed increasing survival times over the
past 25 years with a subset of patients surviving for decades. Differences
in survival by race, gender, histology, and first course of treatment were
appreciated. These data suggested that the clinical course of low-grade
glioma for some patients may be more encouraging than previously perceived
and that the identification of this group of patients may allow refinement
of current treatment protocols. Cancer 2006. (c) 2006 American Cancer
PMID: 16470608 [PubMed - as supplied by publisher]
Radiation-induced changes in gene expression involve
recruitment of existing messenger RNAs to and away from polysomes.
la Pena L, Barker
Molecular Radiation Therapeutics Branch, National Cancer Institute, 6130
Executive Boulevard, Rockville, MD 20892-7440, USA.
Although ionizing radiation has been shown to influence gene transcription,
little is known about the effects of radiation on gene translational
efficiency. To obtain a genome-wide perspective of the effects of radiation
on gene translation, microarray analysis was done on polysome-bound RNA
isolated from irradiated human brain tumor cells; to allow for a comparison
with the effects of radiation on transcription, microarray analysis was also
done using total RNA. The number of genes whose translational activity was
modified by radiation was approximately 10-fold greater than those whose
transcription was affected. The radiation-induced change in a gene's
translational activity was shown to involve the recruitment of existing
mRNAs to and away from polysomes. Moreover, the change in a gene's
translational activity after irradiation correlated with changes in the
level of its corresponding protein. These data suggest that radiation
modifies gene expression primarily at the level of translation. In contrast
to transcriptional changes, there was considerable overlap in the genes
affected at the translational level among brain tumor cell lines and normal
astrocytes. Thus, the radiation-induced translational control of a subset of
mRNAs seems to be a fundamental component of cellular radioresponse.
PMID: 16424041 [PubMed - indexed for MEDLINE]
ZD6474, a novel tyrosine kinase inhibitor of vascular
endothelial growth factor receptor and epidermal growth factor receptor,
inhibits tumor growth of multiple nervous system tumors.
Department of Medicine, Duke University Medical Center, Durham, North
Carolina 27710, USA. email@example.com
PURPOSE: Primary central nervous system (CNS) tumors represent a diverse
group of tumor types with heterogeneous molecular mechanisms that underlie
their formation and maintenance. CNS tumors depend on angiogenesis and often
display increased activity of ErbB-associated pathways. Current nonspecific
therapies frequently have poor efficacy in many of these tumor types, so
there is a pressing need for the development of novel targeted therapies.
EXPERIMENTAL DESIGN: ZD6474 is a novel, orally available low molecular
weight inhibitor of the kinase activities associated with vascular
endothelial growth factor receptor-2 and epidermal growth factor receptor.
We hypothesized that ZD6474 may provide benefit in the treatment of several
CNS tumor types. RESULTS: In mice bearing established s.c. tumor xenografts
of CNS tumors (malignant glioma and ependymoma) or rhabdomyosarcoma, a
limited course of ZD6474 treatment produced significant tumor growth delays
and a high rate of partial tumor regression in most models examined. Mice
with i.c. malignant glioma xenografts treated with ZD6474 experienced a
significant prolongation of survival. Tumors from mice treated with ZD6474
displayed a lower proliferative index and disrupted tumor vascularity.
Notably, some of these models are insensitive to low molecular weight kinase
inhibitors targeting only vascular endothelial growth factor receptor-2 or
epidermal growth factor receptor functions, suggesting that the combined
disruption of both epidermal growth factor receptor and vascular endothelial
growth factor receptor-2 activities may significantly increase tumor
control. CONCLUSIONS: In conclusion, ZD6474 shows significant activity
against xenograft models of several primary human CNS tumor types.
Consideration for clinical development in this disease setting seems
PMID: 16299247 [PubMed - indexed for MEDLINE]
Modeling Radiation Dosimetry to Predict Cognitive
Outcomes in Pediatric Patients with CNS Embryonal Tumors Including
Division of Radiation Oncology, St. Jude Children's Research Hospital,
Memphis, TN, USA, and.
PURPOSE: Model the effects of radiation dosimetry on IQ among pediatric
patients with central nervous system (CNS) tumors. METHODS AND MATERIALS:
Pediatric patients with CNS embryonal tumors (n = 39) were prospectively
evaluated with serial cognitive testing, before and after treatment with
postoperative, risk-adapted craniospinal irradiation (CSI) and conformal
primary-site irradiation, followed by chemotherapy. Differential dose-volume
data for 5 brain volumes (total brain, supratentorial brain, infratentorial
brain, and left and right temporal lobes) were correlated with IQ after
surgery and at follow-up by use of linear regression. RESULTS: When the dose
distribution was partitioned into 2 levels, both had a significantly
negative effect on longitudinal IQ across all 5 brain volumes. When the dose
distribution was partitioned into 3 levels (low, medium, and high), exposure
to the supratentorial brain appeared to have the most significant impact.
For most models, each Gy of exposure had a similar effect on IQ decline,
regardless of dose level. CONCLUSIONS: Our results suggest that radiation
dosimetry data from 5 brain volumes can be used to predict decline in
longitudinal IQ. Despite measures to reduce radiation dose and treatment
volume, the volume that receives the highest dose continues to have the
greatest effect, which supports current volume-reduction efforts.
PMID: 16472938 [PubMed - as supplied by publisher]
Ototoxicity in children receiving platinum chemotherapy:
underestimating a commonly occurring toxicity that may influence academic
and social development.
Department of Neurology, Neurosurgery, and Pediatric Audiology, Oregon
Health and Science University, Portland 97201, USA.
PURPOSE: To describe the frequency and severity of ototoxicity in a series
of pediatric patients treated with platinum-based chemotherapy. PATIENTS AND
METHODS: Serial audiologic evaluations were conducted for 67 patients aged 8
months to 23 years who received platinum-based chemotherapy. Audiologic data
was analyzed to determine time to hearing-loss using American
Speech-Language-Hearing Association (ASHA) criteria, and the effects of
treatment and patient characteristics on the incidence and severity of
ototoxicity. RESULTS: Bilateral decreases in hearing were seen in 61% of
patients (median time to hearing loss, 135 days). Children treated for
medulloblastoma, osteosarcoma, and neuroblastoma had greater incidence and
severity of hearing loss. Agreement between the usually reported National
Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and
ASHA criteria was inadequate. CONCLUSION: Traditional reporting of toxicity
data (CTCAE) has under-reported ototoxicity and minimized the significance
of hearing loss in children. As pediatric patients experience improved
survival, the effects and implications of high-frequency hearing loss with
regard to academic achievement and speech and language development are
important considerations, especially in patients younger than 5 years.
PMID: 16314621 [PubMed - indexed for MEDLINE]
Is protracted low-dose temozolomide feasible in glioma
Department of Medical Oncology, University Hospital of Padova, Padova,
The authors investigated the safety of 75 mg/m2 temozolomide for 21 days
every 28 days in glioma patients. This schedule could lead to DNA repair
enzyme O6-alkylguanine-DNA alkyltransferase depletion, contributing to
overcoming drug resistance. Although Phase III studies are forthcoming, no
data are available on the long-term toxicity of temozolomide, which, in this
series, incurred prolonged, cumulative lymphopenia, which leads to a high
incidence of infections.
PMID: 16476947 [PubMed - in process]
Clinical relevance of diffusion and perfusion magnetic
resonance imaging in assessing intra-axial brain tumors.
Minh VA, Cotton
Department of Radiology, Lyon University School of Medicine, Lyon, France,
Advanced magnetic resonance (MR) imaging techniques provide physiologic
information that complements the anatomic information available from
conventional MR imaging. We evaluated the roles of diffusion and perfusion
imaging for the assessment of grade and type of histologically proven
intraaxial brain tumors. A total of 28 patients with intraaxial brain tumors
underwent conventional MR imaging (T2- and T1-weighted sequences after
gadobenate dimeglumine injection), diffusion imaging and T2*-weighted
echo-planar perfusion imaging. Examinations were performed on 19 patients
during initial diagnosis and on nine patients during follow-up therapy.
Determinations of relative cerebral blood volume (rCBV) and apparent
diffusion coefficient (ADC) were performed in the solid parts of each tumor,
peritumoral region and contralateral white matter. For gliomas, rCBV values
were greater in high-grade than in low-grade tumors (3.87+/-1.94 versus
1.30+/-0.42) at the time of initial diagnosis. rCBV values were increased in
all recurrent tumors, except in one patient who presented with a combination
of recurrent glioblastoma and massive radionecrosis on histology. Low-grade
gliomas had low rCBV even in the presence of contrast medium enhancement.
Differentiation between high- and low-grade gliomas was not possible using
diffusion-weighted images and ADC values alone. In the peritumoral areas of
untreated high-grade gliomas and metastases, the mean rCBV values were
higher for high-grade gliomas (1.7+/-0.37) than for metastases (0.54+/-0.18)
while the mean ADC values were higher for metastases. The rCBV values of
four lymphomas were low and the signal intensity-time curves revealed a
significant increase in signal intensity after the first pass of gadobenate
dimeglumine. Diffusion and perfusion imaging, even with relatively short
imaging and data processing times, provide important information for lesion
PMID: 16470375 [PubMed - as supplied by publisher]
Stimulation Mapping via Implanted Grid Electrodes prior
to Surgery for Gliomas in Highly Eloquent Cortex.
Department of Neurosurgery, University of Bonn Medical Center, Bonn,
OBJECTIVE: To evaluate whether preoperative mapping of higher cortical
functions with subdural grid electrodes can help to maximize resection in
functional areas and avoid permanent injury. METHODS: A consecutive series
of 16 patients (female: n = 7, male: n = 9, mean age of 38 yr) with a
history of seizures and without focal deficit was reviewed, harboring
gliomas located in the dominant hemisphere adjacent to or in the F3 gyrus/Broca
area (n = 11), parietal/perisylvian area (n = 5) and additionally the pre-
or postcentral area (n = 15). All patients in this series were operated for
cytoreductive purposes only and not for treatment of intractable seizures.
To preoperatively define and intraoperatively tailor the extent of resection
all patients had a presurgical grid implantation for functional brain
mapping. RESULTS: No permanent morbidity/mortality was observed after grid
implantation and resective surgery. On postoperative MRI the resection was
complete (100%), nearly complete (>90%) in n = 9 and subtotal (60% to
<90%) in n = 5 cases. Twice, only biopsies were taken according to the
results of mapping. All patients with high-grade gliomas had adjuvant
treatment with radiation and chemotherapy. After a mean follow up of 20.4
months, no tumor relapse or growth was seen in all cases of resection.
CONCLUSION: Preoperative grid mapping is a safe and precise instrument to
evaluate language and/or associated left perisylvian functions in patients
with gliomas. It may be considered a valid alternative to awake craniotomy
to maximize safe resection.
PMID: 16479627 [PubMed - in process]
[Cerebral cavernomas. A review and update of aetiological,
clinical and therapeutic features]
[Article in Spanish]
Servicio de Neurocirugia, Hospital General Gregorio Maranon, Madrid, Spain.
INTRODUCTION: Cavernous angiomas are uncommon lesions, with a reported
incidence of 0.4 to 0.8%, presenting a controversial management especially
regarding their surgical treatment. AIM: To update cavernous angiomas
characteristics and management through a deep review of the literature
concerning their aetiology, epidemiology, history, signs and symptoms,
diagnosis, and surgical and radiosurgical treatment. DEVELOPMENT AND
CONCLUSIONS: Most important advances found in the recent literature include
the identification of the genetic basis responsible for the familial form of
cavernomatosis (CCM1, CCM2 and CCM3), the identification of the dynamic
pattern of these lesions based on their pathology and imaging features, the
deeper knowledge on their natural history depending on their supra/infratentorial
location, and the main indications for surgical treatment and radiosurgical
therapy suggested by the recent series.
PMID: 16355357 [PubMed - indexed for MEDLINE]
Helmetlike skull deformity with a large arachnoid cyst.
Department of Neurosurgery, Kangwon National University College of Medicine,
Chunchon 200-701, Korea.
BACKGROUND: It is not difficult to find localized skull ballooning or
macrocrania in patients with intracranial arachnoid cysts. However, there
have been no previous reports regarding large localized skull protuberant
deformities resembling a war helmet. The authors report with a review of
literature a case of an adult with helmetlike skull deformity resulting from
a large supratentorial arachnoid cyst. CASE DESCRIPTION: A 35-year-old man
presented with a large head deformity since his early childhood that had
been the result of gradual progression from infantile macrocrania. He also
had mental retardation, sixth cranial nerve palsy with recent aggravation of
headache, reduced activity, poor voiding control, and walking disturbance.
Magnetic resonance imaging of the head showed hydrocephalus with a large
supratentorial arachnoid cyst located in the bilateral parietooccipital area
compressing the hemisphere anteriorly, and the tentorium and cerebellum
inferiorly. Magnetic resonance venogram demonstrated low-lying short
transverse and lateral sinuses, and the superior sagittal sinus and falx
were displaced to the right side. Radioisotopic cisternogram showed
nonfilling of the isotope in the bilateral parietooccipital area.
Cerebrospinal fluid pressure measured by lumbar puncture was 17 cm H(2)O. We
tentatively diagnosed the condition as normopressure hydrocephalus with a
large supratentorial arachnoid cyst. His headache, reduced activity, poor
voiding control, and walking disturbance improved after a cystoperitoneal
shunt. CONCLUSIONS: This might suggest that large arachnoid cysts found in
childhood should be treated for prevention of skull deformity and late
aggravation of increased intracranial pressure.
PMID: 16378873 [PubMed - indexed for MEDLINE]
Intracranial metastatic parathyroid carcinoma: case
Department of Neurosurgery, Niigata Cancer Hospital, Kawagishi-chou 2-15-3,
Niigata 951, Japan. firstname.lastname@example.org
BACKGROUND: Although parathyroid carcinoma is not frequent, it is a slowly
progressive disease characterized by frequent recurrences. A review of the
literature revealed only 2 other cases of intracranial metastatic
parathyroid carcinoma. We present here the case of cerebral metastases from
parathyroid carcinoma that could be treated successfully. CASE DESCRIPTION:
This 61-year-old Japanese woman presented to our institute with a complaint
of right lower-extremity weakness after hemiconvulsion. She had undergone a
parathyroidectomy for parathyroid carcinoma 18 years earlier. Lung
metastasis was also detected 6 years earlier, and she has been dialyzed
twice a month after chemotherapy. Computed tomographic scans demonstrated 2
enhancing right frontal tumors. After resection of the intracranial
metastases, her right hemiparesis and secondary hyperparathyroidism
resolved. CONCLUSIONS: This case report supports aggressive surgical
management to eliminate all parathyroid hormone-secreting malignant tissue
and prevent metabolic complications.
PMID: 16378868 [PubMed - indexed for MEDLINE]
Water dissection technique of Toth for opening
neurosurgical cleavage planes.
Department of Neurosurgery, National Institute of Neurosurgery, MAV
Hospital, Budapest, Hungary.
BACKGROUND: The low-pressure water dissection technique of Toth, first
reported in 1987, is a method to cautiously open neurosurgical cleavage
planes such as the sylvian fissure or the interhemispheric space, and the
interfaces between extraparenchymal masses and the adjacent brain. The aim
of this technical report is to present our long-term experience with this
simple and elegant asset of microneurosurgery and to promote its widespread
use. METHOD: Water is injected under microscopic control by a hand-held
syringe with a blunt needle or by an irrigating balloon applying repeated
injections of physiological saline into the cleavage plane to open it.
FINDINGS AND CONCLUSION: The water dissection technique of Toth has been
extensively used in Budapest and Helsinki in thousands of microsurgical
cases, in removal of meningiomas and to open sylvian and interhemispheric
fissure. In our experience, there have been no noticeable complications, and
we recommend this technique for widespread use. It is a very inexpensive,
simple, and effective method not requiring any expensive or complicated
PMID: 16378851 [PubMed - indexed for MEDLINE]
Intracranial hemangiopericytomas: correlation of
topoisomerase IIalpha expression with biologic behavior.
Division of Neuropathology, Department of Neurological Sciences, Christian
Medical College and Hospital, Vellore 632004, India. email@example.com
BACKGROUND: Meningeal hemangiopericytomas are aggressive tumors that have a
high rate of recurrence despite gross total resection and radiation therapy.
Topoisomerase, a cell proliferation marker, is also a target of certain
chemotherapeutic agents, and its nuclear levels are speculated to predict
efficacy of targeted therapy. The aim of this study was to correlate the
topoisomerase IIalpha proliferation index (TPI) with biologic behavior in
intracranial hemangiopericytomas. METHODS: Clinical, radiological, and
management data in 27 patients with intracranial hemangiopericytoma admitted
between 1990 and 2003 were reviewed. Immunohistochemistry was performed on
all the tumors using a monoclonal antibody to topoisomerase IIalpha, and the
proliferation index was calculated. The effect of TPI on outcome was sought.
RESULTS: The male/female ratio was 15:12. The mean age at presentation was
31.33 years. A radical excision of tumor was done in 18, subtotal excision
in 2, partial excision in 4, and a biopsy in 3 patients. Tumor recurrence
was noted in 15 (55.6%) of the 27 patients (mean follow-up duration, 51.5
months). The time to recurrence ranged from 7 months to 8 years (mean, 49
months). The 5-year recurrence-free survival was 33.8% in patients with a
TPI of 5% or greater, and 72% in patients with a TPI of less than 5%. The
relative risk of recurrence was 2.9 times greater in patients with a TPI 5%
or greater as compared with those a TPI of less than 5%. CONCLUSION: Our
study suggests that cases with a radical excision, radiation therapy, or a
TPI index of less than 5% have a longer recurrence-free survival. A TPI of
5% or greater is a reliable predictor of recurrence.
PMID: 16378841 [PubMed - indexed for MEDLINE]