| 1: AJNR Am J Neuroradiol. 2004 Aug;25(7):1294-6. |
|
Thoracic intradural extramedullary capillary
hemangioma.
Abdullah DC, Raghuram K, Phillips CD, Jane JA Jr, Miller B.
Division of Neuroradiology, University of Virginia Health System,
Charlottesville, VA, USA.
We report a case of a thoracic intradural extramedullary capillary
hemangioma. The MR imaging appearance was nonspecific for this lesion, and
it could not be distinguished from more common spinal intradural
extramedullary lesions. The presence of subtly enlarged abnormal vessels on
contrast MR images should, however, lead one to consider a vascular mass and
order preoperative spinal arteriography.
Publication Types:
PMID: 15313728 [PubMed - indexed for MEDLINE]
| 2: AJNR Am
J Neuroradiol. 2004 Aug;25(7):1283-5. |
|
-
Pre- and postnatal MR imaging of hypothalamic hamartomas
associated with arachnoid cysts.
Booth TN, Timmons C, Shapiro K, Rollins NK.
Department of Radiology, Children's Medical Center of Dallas and University
of Texas Southwestern Medical Center, Dallas, TX, USA.
We describe two cases of hypothalamic hamartoma associated with arachnoid
cysts. One case was initially documented on prenatal MR images. Because of
the rarity of the association and resultant distortion in regional anatomy,
the solid component of the mass may be overlooked. This would certainly be
true when using lower-resolution diagnostic studies such as fetal MR
imaging. The lesion could also be confused with a cystic tumor such as
pilocytic astrocytoma. Thorough evaluation is required in patients with
precocious puberty, gelastic seizures, and the presence of a suprasellar
arachnoid cyst.
Publication Types:
PMID: 15313725 [PubMed - indexed for MEDLINE]
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| 3: AJNR Am
J Neuroradiol. 2004 Aug;25(7):1223-4. |
|
-
Leptomeningeal metastasis from malignant pleural
mesothelioma.
Petrovic BD, Kozic DB, Semnic RR, Prvulovic M, Djilas-Ivanovic D, Sener
RN, Klem I.
Department of Diagnostic Imaging, Institute of Oncology, Sremska Kamenica,
Serbia and Montenegro.
Leptomeningeal metastasis from malignant mesothelioma is very rare; to our
knowledge, only one imaging report exists in the literature. We present the
case of widespread leptomeningeal lesions secondary to a malignant
mesothelioma in a 61-year-old woman.
Publication Types:
PMID: 15313714 [PubMed - indexed for MEDLINE]
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| 4: AJNR Am
J Neuroradiol. 2004 Aug;25(7):1218-22. |
|
-
Histologic characteristics of normal perivascular spaces
along the optic tract: new pathogenetic mechanism for edema in tumors in the
pituitary region.
Saeki N, Nagai Y, Matsuura I, Uchino Y, Kubota M, Murai H, Ishikura H,
Ikehira H, Yamaura A.
Department of Neurologic Surgery, Chiba University Graduate School of
Medicine, Japan.
BACKGROUND AND PURPOSE: Perivascular (PV) spaces are known to distend and
cause edema along the optic tract (OT) in pituitary-region tumors.
Interstitial fluid may be retained in PV spaces when tumors block their
drainage outlets to subarachnoid spaces. However, these spaces and their
outlets have not been anatomically elucidated. Our purpose was to evaluate
how often large PV spaces are present along the OT and demonstrate their
superficial communication points to adjacent subarachnoid spaces. METHODS:
We examined serial histologic sections of 10 hemispheric blocks obtained
from cadavers without cerebral abnormality. RESULTS: Large PV spaces,
0.5-1.5 mm in maximum height, were always present along the middle portion
of the OT. Perforation points of the largest spaces were noted at the medial
sulcus of the OT in seven hemispheres and through the OT in three.
CONCLUSION: Large PV spaces are present along the middle portion of the OT.
Their communication point to adjacent subarachnoid spaces was histologically
demonstrated. The locations and variations of the outlet of large PV spaces
explain the clinical features of edemas; these findings anatomically support
the hypothesis that blockage of the outlets to subarachnoid spaces may play
a role in distending the PV spaces and in causing edema in pituitary-region
tumors. Only MR imaging has revealed this change; further pathologic
investigations are awaited.
PMID: 15313713 [PubMed - indexed for MEDLINE]
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| 5: AJNR Am
J Neuroradiol. 2004 Aug;25(7):1181-8. |
|
-
Delineation of lateral tentorial sinus with
contrast-enhanced MR imaging and its surgical implications.
Miabi Z, Midia R, Rohrer SE, Hoeffner EG, Vandorpe R, Berk CM, Midia M.
Department of Radiology, Tabriz University, Tabriz, Iran.
BACKGROUND AND PURPOSE: The lateral tentorial sinus (LTS) has not been well
described in the imaging literature. The aim of this study was to
investigate the value of MR imaging in assessing the LTS, which may provide
guidance for preoperative planning. METHODS: Fifty-five adult patients
underwent MR imaging of the brain. Four neuroradiologists evaluated the
studies for delineation of the LTS and its branches. Presence of arachnoid
granulation and dominance of the venous drainage also were reported.
RESULTS: An LTS was detected in 104 of 110 lobes. The LTS in each lobe was
classified as type I (candelabra) in 30 (28.8%), type II (independent veins)
in 22 (21.1%), and type III (venous lakes) in 37 (35.5%); in 15 (14.4%) of
the lobes, the LTS was indeterminate. LTS branches were inconsistently
detected, with the exception of the vein of Labbe (VL). Five of eight
branches were seen in approximately half of the cases. The VL was identified
in 94 (85.4%) lobes. Among these, 53 (56.4%) were draining into the LTS and
22 (23.4%) into the transverse sinus; in 19 (20.2%) cases, the terminal
portion was not visualized. The right transverse sinus was dominant in 19
(34.5%) patients and the left in 18 (32.7%); codomination was present in 18
(32.7%) cases. At least one arachnoid granulation was seen in the transverse
sinus in 27 (49.1%) patients. CONCLUSION: In many instances, the LTS and VL
drainage patterns were well delineated on routine MR images. For selected
cases, this information may be crucial during lateral skull base surgery to
avoid venous infarct.
Publication Types:
PMID: 15313706 [PubMed - indexed for MEDLINE]
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| 6: AJNR Am
J Neuroradiol. 2004 Aug;25(7):1127-8. |
|
Comment on:
Synergy of a combined near-infrared spectroscopy and
blood oxygenation level-dependent functional activation study.
McGowan JC, Wallace SK.
Publication Types:
PMID: 15313694 [PubMed - indexed for MEDLINE]
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| 7: Br J
Cancer. 2004 Aug 16;91(4):639-43. |
|
-
Incidence of cerebral metastases in patients treated with
trastuzumab for metastatic breast cancer.
Clayton AJ, Danson S, Jolly S, Ryder WD, Burt PA, Stewart AL, Wilkinson
PM, Welch RS, Magee B, Wilson G, Howell A, Wardley AM.
Department of Medical Oncology, Christie Hospital NHS Trust, Wilmslow Road,
Withington, Manchester M20 4BX, UK.
Trastuzumab is an effective treatment for patients with metastatic breast
cancer (MBC) that overexpresses HER-2. A high incidence of brain metastases
(BM) has been noted in patients receiving trastuzumab. A retrospective chart
review was conducted of 100 patients commencing trastuzumab for metastatic
breast cancer from July 1999 to December 2002, at the Christie Hospital.
Seven patients were excluded; five patients developed central nervous system
metastases prior to starting trastuzumab, and inadequate data were available
for two. Out of the remaining 93 patients, 23 (25%) have developed BM to
date. In all, 46 patients have died, and of these 18 (39%) have been
diagnosed with BM prior to death. Of the 23 patients developing BM, 18 (78%)
were hormone receptor negative and 18 (78%) had visceral disease. Univariate
analysis showed a significant association between the development of
cerebral disease and both hormone receptor status and the presence of
visceral disease. In conclusion, a high proportion of patients with MBC
treated with trastuzumab develop symptomatic cerebral metastases.
HER-2-positive breast cancer may have a predilection for the brain, or
trastuzumab therapy may change the disease pattern by prolonging survival.
New strategies to address this problem require investigation in this group
of patients.
PMID: 15266327 [PubMed - indexed for MEDLINE]
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| 8: Cancer
Res. 2004 Sep 15;64(18):6610-5. |
|
-
Excellent In vivo Bystander Activity of Fludarabine
Phosphate against Human Glioma Xenografts that Express the Escherichia coli
Purine Nucleoside Phosphorylase Gene.
Hong JS, Waud WR, Levasseur DN, Townes TM, Wen H, McPherson SA, Moore BA,
Bebok Z, Allan PW, Secrist JA 3rd, Parker WB, Sorscher EJ.
Departments of Cell Biology, Medicine, Biochemistry and Molecular Genetics,
and Center for Aids Research Core, University of Alabama at Birmingham,
Birmingham, Alabama.
Escherichia coli purine nucleoside phosphorylase (PNP) expressed in tumors
converts relatively nontoxic prodrugs into membrane-permeant cytotoxic
compounds with high bystander activity. In the present study, we examined
tumor regressions resulting from treatment with E. coli PNP and fludarabine
phosphate (F-araAMP), a clinically approved compound used in the treatment
of hematologic malignancies. We tested bystander killing with an adenoviral
construct expressing E. coli PNP and then more formally examined thresholds
for the bystander effect, using both MuLv and lentiviral vectoring. Because
of the importance of understanding the mechanism of bystander action and the
limits to this anticancer strategy, we also evaluated in vivo variables
related to the expression of E. coli PNP (level of E. coli PNP activity in
tumors, ectopic expression in liver, percentage of tumor cells transduced in
situ, and accumulation of active metabolites in tumors). Our results
indicate that F-araAMP confers excellent in vivo dose-dependent inhibition
of bystander tumor cells, including strong responses in subcutaneous human
glioma xenografts when 95 to 97.5% of the tumor mass is composed of
bystander cells. These findings define levels of E. coli PNP expression
necessary for antitumor activity with F-araAMP and demonstrate new potential
for a clinically approved compound in solid tumor therapy.
PMID: 15374975 [PubMed - in process]
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| 9: Cancer
Res. 2004 Sep 15;64(18):6503-6510. |
|
-
Gene Expression Profiling of Gliomas Strongly Predicts
Survival.
Freije WA, Castro-Vargas FE, Fang Z, Horvath S, Cloughesy T, Liau LM,
Mischel PS, Nelson SF.
Department of Human Genetics, Department of Obstetrics and Gynecology,
Department of Biostatistics, Department of Neurology, Henry E. Singleton
Brain Tumor Program, Department of Surgery, Division of Neurosurgery, and
Department of Pathology, David Geffen School of Medicine, University of
California at Los Angeles, Los Angeles, California.
In current clinical practice, histology-based grading of diffuse
infiltrative gliomas is the best predictor of patient survival time. Yet
histology provides little insight into the underlying biology of gliomas and
is limited in its ability to identify and guide new molecularly targeted
therapies. We have performed large-scale gene expression analysis using the
Affymetrix HG U133 oligonucleotide arrays on 85 diffuse infiltrating gliomas
of all histologic types to assess whether a gene expression-based,
histology-independent classifier is predictive of survival and to determine
whether gene expression signatures provide insight into the biology of
gliomas. We found that gene expression-based grouping of tumors is a more
powerful survival predictor than histologic grade or age. The poor prognosis
samples could be grouped into three different poor prognosis groups, each
with distinct molecular signatures. We further describe a list of 44 genes
whose expression patterns reliably classify gliomas into previously
unrecognized biological and prognostic groups: these genes are outstanding
candidates for use in histology-independent classification of high-grade
gliomas. The ability of the large scale and 44 gene set expression
signatures to group tumors into strong survival groups was validated with an
additional external and independent data set from another institution
composed of 50 additional gliomas. This demonstrates that large-scale gene
expression analysis and subset analysis of gliomas reveals unrecognized
heterogeneity of tumors and is efficient at selecting prognosis-related gene
expression differences which are able to be applied across institutions.
PMID: 15374961 [PubMed - as supplied by publisher]
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| 10: Cancer
Res. 2004 Sep 15;64(18):6381-6384. |
|
-
Transcriptional Targeting of Adenovirally Delivered Tumor
Necrosis Factor {alpha} by Temozolomide in Experimental Glioblastoma.
Yamini B, Yu X, Gillespie GY, Kufe DW, Weichselbaum RR.
Department of Surgery, Section of Neurosurgery and Department of Radiation
and Cellular Oncology, Pritzker School of Medicine, The University of
Chicago, Chicago, Illinois.
Temozolomide is an oral alkylating agent shown to have modest efficacy in
the treatment of glioblastoma multiforme. Tumor necrosis factor alpha
(TNF-alpha) is a polypeptide cytokine with synergistic antitumor activity in
combination therapy with alkylating agents. We investigated the combined use
of Ad.Egr-TNF, a replication-defective adenoviral vector encoding the cDNA
for TNF-alpha under the control of chemo-inducible elements of the egr1 gene
promoter, and intraperitoneal temozolomide in an intracranial human
malignant glioma model. In hind limb U87MG xenografts, temozolomide produced
a 6.4-fold greater induction of TNF-alpha after infection with Ad.Egr-TNF
compared with Ad.Egr-TNF alone at 96 hours (P < 0.02). TNF-alpha and
temozolomide combination leads to a synergistic decrease in U87 cell
viability at 72 hours compared with either treatment alone (P < 0.001).
Median survival for animals treated with Ad.Egr-TNF alone, temozolomide
alone, and Ad.Egr-TNF/temozolomide was 21, 28, and 74 days, respectively (P
< 0.001 by log-rank). Flow cytometric assessment of apoptosis revealed a
synergistic increase in U87 cell apoptosis in vitro at 72 hours (P <
0.05), and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick
end-labeling (TUNEL) evaluation of tumor sections revealed significantly
increased TUNEL-positive cells after combination treatment compared with
either treatment alone (P < 0.05). In conclusion, combination treatment
with transcriptionally activated intratumoral TNF-alpha and systemic
temozolomide significantly prolongs survival in an experimental glioblastoma
multiforme model.
PMID: 15374943 [PubMed - as supplied by publisher]
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| 11: J
Neurol Neurosurg Psychiatry. 2004 Sep;75 Suppl 3:iii47-52. |
|
-
Pituitary disease: presentation, diagnosis, and
management.
Levy A.
Henry Wellcome Labs for Integrative Neuroscience and Endocrinology,
University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol BS1
3NY, UK. a.levy@bris.ac.uk
Publication Types:
PMID: 15316045 [PubMed - indexed for MEDLINE]
-
| 12: J
Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1343-5. |
|
-
Optic chiasm enhancement associated with giant aneurysm
and yttrium treated pituitary adenoma.
Gabriel CM, Stevens JC, Bremner F, Brew S, Plant GT.
Department of Neurology, National Hospital for Neurology and Neurosurgery,
Queen Square, London, UK. carolyn.gabriel@St-Marys.nhs.uk
A patient with a history of pituitary tumour treated with yttrium 29 years
before presented with an asymmetrical chiasmal neuropathy. Magnetic
resonance imaging showed a partially thrombosed giant aneurysm of the right
internal carotid artery, with enhancement of the chiasm and right optic
tract adjacent to the aneurysm. It was thought that, in addition to the
effects of compression, a peri-aneurysmal inflammatory reaction had
developed, causing breakdown of the blood-brain barrier and consequent
inflammatory changes in the optic chiasm. High dose steroid treatment led to
significant improvement in vision within two weeks. Steroids may have a role
in the acute preservation of vision in similar cases, as well as in cases of
deterioration following coiling or embolisation of aneurysms where
thrombosis within the aneurysm has been induced.
PMID: 15314130 [PubMed - indexed for MEDLINE]
-
| 13: J
Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1340-2. |
|
-
Brain stem stroke associated with epidermoid tumours:
report of two cases.
Yilmazlar S, Kocaeli H, Cordan T.
Department of Neurosurgery, Uludag University, School of Medicine, Gorukle,
16059 Bursa, Turkey. selsus@uludag.edu.tr
Two cases of cerebello-pontine angle epidermoid tumour presented with the
clinical findings of brain stem stroke. Preoperative imaging showed
stretching of branches of the basilar artery. Brain stem stroke as a
presenting feature of cerebello-pontine angle epidermoid tumour has not been
reported before.
Publication Types:
PMID: 15314129 [PubMed - indexed for MEDLINE]
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| 14: J
Neurol Neurosurg Psychiatry. 2004 Sep;75(9):1309-13. |
|
-
Magnetoencephalography (MEG) predicts focal
epileptogenicity in cavernomas.
Stefan H, Scheler G, Hummel C, Walter J, Romstock J, Buchfelder M,
Blumcke I.
Department of Neurology, Epilepsy and Neuro-Center, University of
Erlangen-Nurnberg, Germany. hermann.stefan@neuro.imed.uni-erlangen.de
OBJECTIVE: The aim of this study was to identify the irritative epileptic
zone in patients with cavernomas by means of magnetoencephalography (MEG).
METHOD: Among 82 patients operated for epilepsy, whose presurgical
evaluation had included MEG, histological assessment of the tissue removed
had confirmed cavernomas in eight. These eight patients had epilepsy since
18.6 (SD 12.7) years on average. The monitoring lasted about 2.1 (SD 1.3)
hours and a median 20.9 (SD 14.3) spikes per hour were recorded. Spontaneous
brain activity was recorded by means of a 74 channel dual unit MEG system
(Magnes II, 4-D Neuroimaging) with simultaneous EEG recording (31 scalp
electrodes). Spike analysis was performed using different source (moving
dipole, current density reconstruction) and head models (spherical shells,
BEM). Co-registration of neurophysiological and imaging data (MRI) was based
upon anatomical landmarks. RESULTS: In 6/8 patients co-localisation from the
cavernoma and epileptic zone was found. In two patients the focus was
localised in the parieto-occipital lobe, in three patients in the frontal
lobe and in three patients in the temporal lobe. In one case of temporal and
one case of frontal lobe focus localisation there was no spatial
relationship to the cavernoma. CONCLUSION: In cases of focal seizures due to
a single cavernoma, MEG may precisely delineate the epileptogenic tissue
bordering the lesion. In patients with multiple cavernomas or dual
pathology, MSI may reveal the complexity of the case, and contribute to the
decision about further invasive diagnostics and more sophisticated
therapeutic measures. MEG is a promising method for prediction of the
epileptic zone in cavernoma related epilepsies, and thus it can contribute
to decision making about and planning of epilepsy surgery.
Publication Types:
PMID: 15314122 [PubMed - indexed for MEDLINE]
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| 15: J
Neurosurg. 2004 Sep;101(3):536-40. |
|
Endotracheal tube electrodes to map and monitor
activities of the vagus nerve intraoperatively. Technical note.
Mikuni N, Satow T, Taki J, Nishida N, Enatsu R, Hashimoto N.
Department of Neurosurgery, Kyoto University Graduate School of Medicine,
Kyoto, Japan. mikunin@kuhp.kyoto-u.ac.jp
Difficulty swallowing due to damage of the vagus nerve is one of the most
devastating complications of surgery in and around the medulla oblongata;
therefore, intraoperative anatomical and functional evaluation of this nerve
is crucial. The authors applied endotracheal tube surface electrodes to
record electromyography (EMG) activity from vocal cords innervated by the
vagus nerve. The vagal nucleus or rootlet was electrically stimulated during
surgery and vocalis muscle EMG activities were displayed by auditory and
visual signals. This technique was used successfully to identify the vagus
motor nerve and evaluate its integrity during surgery. The advantages of
this method compared with the use of needle electrodes include safe simple
electrode placement and stable recording during surgery. In cases involving
a pontine cavernoma pressing the nucleus or a jugular foramen tumor
encircling the rootlet, this method would be particularly valuable.
Additional studies with a larger number of patients are needed to estimate
the significance of this method as a means of functional monitoring to
predict clinical function.
PMID: 15352615 [PubMed - indexed for MEDLINE]
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| 16: J
Neurosurg. 2004 Sep;101(3):528-31. |
|
Transition from meningeal melanocytoma to primary
cerebral melanoma. Case report.
Roser F, Nakamura M, Brandis A, Hans V, Vorkapic P, Samii M.
Department of Neurosurgery, Klinikum Hannover Nordstadt, Germany.
f.roser@gmx.de
The authors describe the first case of an intracranial transition of a
melanocytoma into a primary malignant melanoma within a short time. A
37-year-old woman presented with progressive brainstem syndrome due to a
tumor, originally diagnosed and treated 12 years earlier, that extended from
the petroclival area to the anterior craniocervical junction. The
histological workup following subtotal tumor resection of the initial tumor
had revealed the typical features of a fibrous melanocytic meningioma
without increased proliferation. Ten years after the patient had completed
treatment for the melanocytic meningioma, control neuroimaging demonstrated
growth of the residual tumor with compression of the brainstem. Another
neurosurgical intervention revealed a dark tumor of hard consistency. At
this time immunohistochemical examinations demonstrated melanocytic features
(expression of vimentin, S100 protein, and melan A) of the lesion with
focally increased proliferation (5% of Ki-67-positive cells) but no higher
mitotic activity. Clinical signs of deterioration along with
imaging-confirmed tumor progression precipitated another operation within 7
months. A neuropathological examination revealed epithelial and anaplastic
changes and indicated that the MIB-1 indices were greater than 25%.
Pleomorphic changes and a focal high mitotic activity led to the diagnosis
of a primary cerebral malignant melanoma. The patient's later clinical
course consisted of a rapid diffuse meningeal spread of the lesion
throughout the entire brain and spine. Despite whole-brain and stereotactic
radiation therapy as well as chemotherapy, the patient died 4 months after
the last neuropathological diagnosis. Although grossly resembling a
meningioma, melanocytomas lack the former's histological and
immunohistochemical features. The biological behavior of a melanocytoma is
variable and recurrence may happen after subtotal resection, but
intracranial transition into a malignant melanoma has not been observed
previously.
Publication Types:
PMID: 15352613 [PubMed - indexed for MEDLINE]
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| 17: J
Neurosurg. 2004 Sep;101(3):476-83. |
|
Combined use of 18F-fluorodeoxyglucose and 11C-methionine
in 45 positron emission tomography-guided stereotactic brain biopsies.
Pirotte B, Goldman S, Massager N, David P, Wikler D, Lipszyc M, Salmon I,
Brotchi J, Levivier M.
Department of Neurosurgery, PET/Biomedical Cyclotron Unit, Erasme Hospital,
Universite Libre de Bruxelles, Brussels, Belgium. bpirotte@ulb.ac.be
OBJECT: The aim of this study was to compare the contribution of the tracers
11C-methionine (Met) and 18F-fluorodeoxy-glucose (FDG) in positron emission
tomography (PET)-guided stereotactic brain biopsy. METHODS: Forty-five
patients underwent combined Met-PET and FDG-PET studies associated with
computerized tomography (CT)- or magnetic resonance (MR)-guided stereotactic
biopsy. Each patient presented with a lesion that was in proximity to the
cortical or subcortical gray matter. The Met-PET and FDG-PET scans were
analyzed to determine which tracer offers the best information to guide at
least one stereotactic biopsy trajectory. Histologically based diagnoses
were rendered in all patients (39 tumors, six nontumorous lesions) and
biopsies were performed in all tumors with the aid of PET guidance. When
tumor FDG uptake was higher than that in the gray matter (18 tumors), FDG
was used for target definition. When FDG uptake was absent or equivalent to
that in the gray matter (21 tumors), Met was used for target definition.
Parallel review of all histological and imaging data showed that all tumors
had an area of abnormal Met uptake and 33 had abnormal FDG uptake. All six
nontumorous lesions had no Met uptake and biopsies were performed using CT
or MR guidance only. All tumor trajectories had an area of abnormal Met
uptake; all nondiagnostic trajectories in tumors had no abnormal Met uptake.
CONCLUSIONS: When FDG shows limitations in target selection, Met is a good
alternative because of its high specificity in tumors. Moreover, in the
context of a single-tracer procedure and regardless of FDG uptake, Met is a
better choice for PET guidance in neurosurgical procedures.
PMID: 15352606 [PubMed - indexed for MEDLINE]
-
| 18: J
Neurosurg. 2004 Sep;101(3):458-66. |
|
Variability of intraoperative electrocortical stimulation
mapping parameters across and within individuals.
Pouratian N, Cannestra AF, Bookheimer SY, Martin NA, Toga AW.
Laboratory of Neuro Imaging and Brain Mapping Center, Department of
Neurology, USA.
OBJECT: Electrocortical stimulation mapping is regarded as the gold standard
of intraoperative mapping for predicting functional outcomes. Nevertheless,
methodologies across institutions are inconsistent. Although many vary and
maximize stimulation currents at each cortical site, some use a single
current level to map the entire exposed cortex. The former comes at the cost
of possibly inducing additional afterdischarge activity. The authors
retrospectively reviewed their eperience with intraoperative electrocortical
stimulation mapping to characterize variability of both mapping and
afterdischarge thresholds. METHODS: Seventeen patients satisfied the study
inclusion criteria. Significant variability in mapping thresholds was
identified within individuals and across the patient population. Moreover, a
statistically significant difference in mapping thresholds was demonstrated
between the frontal and parietal/temporal lobes (p = 0.007, one-way analysis
of variance). The authors report a surprisingly high incidence of
afterdischarge during mapping, wide variability in afterdischarge thresholds
within individuals and across the study population, and mapping thresholds
regularly exceeding afterdischarge thresholds in neighboring cortex.
Differences in afterdischarge thresholds across lobes only approached
significance (p = 0.086). CONCLUSIONS: To maximize identification of
eloquent cortices in some clinical situations, it may be advantageous to
maximize currents at each cortical site regardless of adjacent
afterdischarge threshold rather than to map the entire exposed cortex at a
single current level. Moreover, the current findings highlight the need for
electrocorticography during electrocortical stimulation mapping, both to
identify when afterdischarges occur and to verify stimulation by recording
stimu lation artifacts. The advantages and limitations of maximizing
currents at each cortical site as well as mapping at a single current level
are discussed.
PMID: 15352604 [PubMed - indexed for MEDLINE]
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| 19: Neurosurgery.
2004 Aug;55(2):433. |
|
-
Solitary fibrous tumor of the spinal cord: case report
and review of the literature.
Kawamura M, Izawa K, Hosono N, Hirano H.
Department of Orthopedic Surgery, Osaka Seamen's Insurance Hospital, Osaka,
Japan.
Publication Types:
PMID: 15314822 [PubMed - indexed for MEDLINE]
-
| 20: Neurosurgery.
2004 Aug;55(2):349-55; discussion 355-7. |
|
-
Diagnosis and management of pineocytomas.
Deshmukh VR, Smith KA, Rekate HL, Coons S, Spetzler RF.
Division of Neurological Surgery, Barrow Neurological Institute, St.
Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
OBJECTIVE: Pineocytomas are associated with the most favorable prognosis of
all pineal tumors. However, a subset of pineocytomas may have a predilection
for recurrence and therefore behave aggressively. PATIENTS AND METHODS:
Records of nine patients (five men, four women; mean age, 44 yr; range,
24-63 yr) with histologically diagnosed pineocytomas consecutively treated
between 1990 and 2003 were reviewed retrospectively to identify factors
predictive of aggressiveness. Eight patients presented with hydrocephalus
and four with tectal compression. Three patients underwent gross total
resection, and six underwent subtotal resection or biopsy. RESULTS: Three
local recurrences necessitated reoperation. One recurrence involved the obex
of the fourth ventricle. The mean time to recurrence was 3.5 years (range,
1-7 yr). There was no correlation between histological features and tumor
recurrence. Patients undergoing radiosurgery showed stable or attenuated
local disease (mean follow-up, 19.3 mo; range, 6-36 mo). Mean radiographic
follow-up was 34 months (range, 6 mo to 10 yr). Mean clinical follow-up was
36 months (range, 1 mo to 10 yr). CONCLUSION: A subset of pineocytomas
demonstrates the potential for symptomatic recurrence. We advocate an
attempt at gross total tumor resection for all symptomatic patients with
tectal plate compression, reserving radiosurgery for small, subtotally
resected, or recurrent lesions. Patients must be followed closely for
recurrence. Radiosurgery seems to be beneficial for local tumor control.
Further investigation is needed to identify histological markers for
pineocytomas that behave aggressively.
PMID: 15271241 [PubMed - indexed for MEDLINE]
-
| 21: Neurosurgery.
2004 Aug;55(2):340-7; discussion 347-8. |
|
-
Evidence for a clinically distinct new subtype of grade
II astrocytomas in patients with long-term epilepsy.
Schramm J, Luyken C, Urbach H, Fimmers R, Blumcke I.
Department of Neurosurgery, University of Bonn Medical Center, Bonn,
Germany. Johannes.Schramm@ukb.uni-bonn.de
OBJECTIVE: The authors tested the hypothesis that among Grade II
astrocytomas with a particularly long seizure history, a subgroup is hidden
with a different prognosis and possibly histological characteristics. To do
so, clinical and histological characteristics of two groups of World Health
Organization Grade II astrocytoma patients were analyzed: the long-term
epilepsy-associated tumor (LEAT) astrocytoma group, with a mean duration of
12.5 years of seizures (n = 19), and the ordinary astrocytomas (n = 87),
with a mean length of seizure history of 1.5 years (Non-LEAT). METHODS: All
astrocytomas operated on between 1988 and 1999 were collected and followed
up for 2 to 13 years (median, 7.0 yr). The 19 LEAT astrocytomas belonged to
a group of 207 long-term epilepsy-associated tumors from the epilepsy
surgery program. The 87 Non-LEAT cases were 60 so-called ordinary or diffuse
World Health Organization Grade II astrocytomas and 27 oligoastrocytomas
without long-term epilepsy operated on during the same time period. All
tumor cases have been reviewed and partly reclassified as a result of the
use of modern immunohistochemical techniques. Statistical analyses for
possible discriminating factors included chi(2) test, Fisher's exact test,
Kaplan-Meier curves, and multifactorial analysis. RESULTS: Histological
subtyping revealed a possible new isomorphic astrocytoma subtype in seven
patients. By use of Kaplan-Meier curves, this isomorphic subtype had 50%
fewer recurrences at 7.5 years and an estimated long-term survival of 80%.
LEAT astrocytomas differed from ordinary Non-LEAT astrocytomas in overall
length of history, younger age at first seizure, and higher percentage of
10-year survivors (80%). Temporal location did not influence outcome, and
the presence of epilepsy per se was also not a prognostic factor.
CONCLUSION: Differences between astrocytomas with a very long seizure
history and those with a very short seizure history do exist. Significant
factors for prognosis were age at surgery and presence of postoperative
tumor residue but not the presence of epilepsy per se. A new subtype of
astrocytomas, provisionally called isomorphic LEA astrocytoma, has
putatively been identified with significantly better survival and lower
recurrence rate. The negative prognostic factor of a gemistocytic
differentiation pattern in diffuse astrocytomas was confirmed.
PMID: 15271240 [PubMed - indexed for MEDLINE]
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| 22: Pediatr
Neurosurg. 2004 May-Jun;40(3):112-9. |
|
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Endocrinological outcome of different treatment options
in children with craniopharyngioma: a retrospective analysis of 66 cases.
Gonc EN, Yordam N, Ozon A, Alikasifoglu A, Kandemir N.
Division of Pediatric Endocrinology, Faculty of Medicine, Hacettepe
University, Ankara, Turkey.
Craniopharyngioma is one of the leading causes of hypothalamic-pituitary
dysfunction in childhood, caused either by the tumor itself or the
consequences of treatment. Tumor management in terms of recurrence rate,
quality of life and complications is still controversial. Sixty-six patients
with craniopharyngioma at pediatric age were reviewed for symptoms, signs,
types of treatment, recurrence rates, complications, and endocrinological
outcome. The majority of symptoms was related to the neurological system.
Complaints only affecting the endocrinological system were seen in 6% of
patients. The most frequent complaints were headache and vomiting (74.2%).
The main endocrinological complaints were polyuria and polydipsia (15%), and
lassitude (10.6%). Although short stature was a symptom in 9.1% of patients,
it was a finding in 39.7% of patients. Plain skull X-rays raised the
suspicion of intracranial tumor in more than 90% of children with
craniopharyngioma. Recurrence rates were independent of the extent of tumor
removal (total or subtotal). The frequency of endocrine dysfunction
increased significantly after treatment. The most frequent
hypothalamic-pituitary dysfunction was growth hormone deficiency (100%) and
gonadotropin deficiency (80%). Hypothyroidism was diagnosed in 74% of
patients. The frequency of hypothalamic-pituitary dysfunction was not
affected by the extent of tumor removal. Radiotherapy did not increase the
frequency of endocrine dysfunctions further. In conclusion, growth follow-up
in childhood seems to be an important indicator of craniopharyngioma in
early diagnosis. Radiotherapy and extent of tumor removal - either total or
subtotal - did not influence endocrine outcome. Copyright 2004 S. Karger AG,
Basel
PMID: 15367800 [PubMed - in process]
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Volume 3, Supplement 1 - 22
September 2004