[Brainlife] Newsletter, Vol.3, Suppl.5

top

BRAINLIFE NEWSLETTER

Volume 3, Supplement 5 - 5 October 2004	Volume 3 Archive

1: Cancer. 2004 Sep 15;101(6):1445-54.

Medullomyoblastoma: a radiographic and clinicopathologic analysis of six cases and review of the literature.

Helton KJ, Fouladi M, Boop FA, Perry A, Dalton J, Kun L, Fuller C.

Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. kathleen.helton@stjude.org

BACKGROUND: Medullomyoblastoma (MMB) is a rare cerebellar embryonal neoplasm that occurs almost exclusively in children. It is biphasic by microscopy, containing myoblastic and primitive neuroectodermal components. METHODS: The authors conducted a retrospective review of the radiographic and pathologic characteristics, treatment, and clinical outcomes of six children with MMB who were treated at St. Jude Children's Research Hospital (Memphis, TN) between 1984 and 2003. Fluorescence in situ hybridization (FISH) data were available for four children. A literature review also was conducted and focused on imaging and pathologic findings. RESULTS: The median age at diagnosis was 4.5 years (range, 0.83-7.5 years). Radiographically, all tumors were cerebellar and exhibited variable enhancement, and 50% of tumors had necrotic foci. Three tumors contained discrete, magnetic resonance imaging (MRI) T2-weighted-hypointense/computed tomography (CT)-hyperdense enhancing regions and separate hyperintense/hypodense nonenhancing regions, which correlated microscopically with geographic islands of primitive neuroectodermal and rhabdomyoblastic cells. Large cell/anaplastic (five tumors), nodular/desmoplastic (two tumors), and classic (two tumors) medulloblastoma histologies were encountered either alone (five tumors) or in combination with each other (two tumors). All 4 tumors that were tested exhibited alterations in chromosome 17 or c-myc amplification. All patients underwent macroscopic total resection and subsequently received chemotherapy and craniospinal (five patients) or local conformal (one patient) radiotherapy. At a median follow-up of 92 months (range, 23-187 months), 3 patients remain alive with no evidence of disease, 2 patients have died of disease, and 1 patient has died of secondary acute lymphocytic leukemia. CONCLUSIONS: The results of the current study demonstrated the frequent correlation of biphasic nodularity (as determined by MRI or CT) with discrete rhabdomyoblastic and primitive neuroectodermal islands (as revealed by microscopy) in MMB. These results also support the view that MMB and medulloblastoma may have common tumorigenic origins, given their similar histologic and molecular features. Copyright 2004 American Cancer Society.

Publication Types:

Review
Review, Academic

PMID: 15368333 [PubMed - indexed for MEDLINE]

2: Cancer. 2004 Sep 1;101(5):1028-35.: Prognostic impact of TP53 mutation status for adult patients with supratentorial World Health Organization Grade II astrocytoma or oligoastrocytoma: a long-term analysis.

Stander M, Peraud A, Leroch B, Kreth FW.

Department of Neurosurgery, Klinikum Grosshadern, Ludwig-Maximilians-Universitat, Munich, Germany.

BACKGROUND: The goal of the current study was to retrospectively assess the prognostic impact of TP53 mutation status and P53 expression/accumulation on long-term outcome for adult patients with supratentorial World Health Organization (WHO) Grade II astrocytoma or oligoastrocytoma. METHODS: The authors revisited a previously published short-term data set containing information on 159 consecutive patients who were treated between 1991 and 1998. Each patient was screened for TP53 mutations and P53 overexpression/accumulation. The reference point for all analyses was the date of surgical treatment, and the date of last follow-up examination was August 2002. Overall survival, progression-free survival, postrecurrence survival, and time to malignant transformation were estimated using the Kaplan-Meier method, and potential prognostic factors were evaluated using the multivariate proportional hazards model. RESULTS: The median follow-up duration for survivors was 80.4 months (standard deviation, 33.0 months). TP53 mutations, which were present in 49.1% of all tumors, occurred preferentially in gemistocytic tumors (P < 0.05). In addition, the TP53 status of the primary tumor was predictive of the TP53 status of the recurrent tumor in all cases of disease recurrence. The 5-year overall and progression-free survival rates were 77.5% and 43.2%, respectively, and the risk of malignant transformation at 5 years postsurgery was 32.7%. Unfavorable prognostic factors with respect to survival duration included older age (> or = 50 years; P < 0.002), gemistocytic subtype (P < 0.01), and positive TP53 mutation status (P < 0.05), all of which were also negatively associated with progression-free survival (P < 0.05, P < 0.001, and P < 0.003, respectively). In contrast, positive TP53 mutation status was the only significant predictor of a reduction in time to malignant transformation (P < 0.03). P53 overexpression/accumulation did not exhibit prognostic relevance in any of the multivariate models constructed in the current study. CONCLUSIONS: TP53 mutations are common early events in the pathogenesis of WHO Grade II astrocytoma or oligoastrocytoma. In the current study, positive TP53 mutation status (but not P53 overexpression/accumulation) was found to be an independent unfavorable predictor of survival, progression-free survival, and time to malignant transformation. The therapeutic implications of these findings have yet to be determined. Copyright 2004 American Cancer Society.

PMID: 15329912 [PubMed - indexed for MEDLINE]

3: Cancer Genet Cytogenet. 2004 Aug;153(1):32-8.: Cytogenetic and molecular cytogenetic analyses in diffuse astrocytomas.

Krupp W, Geiger K, Schober R, Siegert G, Froster UG.

Department of Neurosurgery, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany. wkrupp@medizin.uni-leipzig.de

Diffuse astrocytomas are highly variable tumors and show complex biologic behavior that is based on multi-step oncogenesis. We report cytogenetic and molecular cytogenetic investigations in 23 cases of diffuse astrocytomas. The results of conventional karyotyping, interphase fluorescence in situ hybridization (FISH), comparative genomic hybridization, multicolor FISH, and spectral karyotyping are reported. Various numerical and structural chromosomal aberrations were identified. Clustering of structural alterations in the short arm of chromosome 2 (2p) and the long arm of chromosome 7 (7q) were detected. Using spectral karyotyping, additional chromosome rearrangements not detectable by conventional methods were found. Some of these anomalies have not been previously described in diffuse astrocytomas. An independent validation of these discrepant findings is required.

PMID: 15325091 [PubMed - indexed for MEDLINE]

4: Cancer Res. 2004 Aug 15;64(16):5830-8.: Delivery of interferon-alpha transfected dendritic cells into central nervous system tumors enhances the antitumor efficacy of peripheral peptide-based vaccines.

Okada H, Tsugawa T, Sato H, Kuwashima N, Gambotto A, Okada K, Dusak JE, Fellows-Mayle WK, Papworth GD, Watkins SC, Chambers WH, Potter DM, Storkus WJ, Pollack IF.

Departments of Neurological Surgery, University of Pittsburgh School of Medicine, PA 15213, USA. okadah@msx.upmc.edu

We evaluated the effects, on immunity and survival, of injection of interferon (IFN)-alpha-transfected dendritic cells (DC-IFN-alpha) into intracranial tumors in mice immunized previously with syngeneic dendritic cells (DCs) pulsed either with ovalbumin-derived CTL or T helper epitopes. These immunizations protected animals from s.c. challenge with ovalbumin-expressing M05 melanoma (class I+ and class II-negative). Notably, antiovalbumin CTL responses were observed in animals vaccinated with an ovalbumin-derived T helper epitope but only after the mice were challenged with M05 cells. This cross-priming of CTL was dependent on both CD4+ and CD8+ T cells. Because we observed that s.c., but not intracranial, tumors were infiltrated with CD11c+ DCs, and because IFN-alpha promotes the activation and survival of both DCs and T cells, we evaluated the combinational antitumor effects of injecting adenoviral (Ad)-IFN-alpha-engineered DCs into intracranial M05 tumors in preimmunized mice. Delivery of DC-IFN-alpha prolonged survival. This was most notable for animals prevaccinated with both the CTL and T helper ovalbumin epitopes, with 60% (6 of 10) of mice (versus 0 of 10 of control animals) surviving for > 80 days after tumor challenge. DC-IFN-alpha appeared to persist longer than mock-transfected DCs within the intracranial tumor microenvironment, and DC-IFN-alpha-treated mice exhibited enhanced levels of ovalbumin-specific CTL in draining cervical lymph nodes. On the basis of these results, we believe that local expression of IFN-alpha by DCs within the intracranial tumor site may enhance the clinical efficacy of peripheral vaccine approaches for brain tumors.

PMID: 15313927 [PubMed - indexed for MEDLINE]

5: Childs Nerv Syst. 2004 Sep 28 [Epub ahead of print]: Immunotherapy for malignant gliomas: emphasis on strategies of active specific immunotherapy using autologous dendritic cells.

De Vleeschouwer S, Van Gool SW, Van Calenbergh F.

Department of Neurosurgery, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.

REVIEW. In this review, we discuss immunotherapy for malignant gliomas. EMPHASIS. The emphasis is on the novel strategy of active specific immunotherapy using dendritic cells as antigen-presenting cells, especially its theoretical concepts and advantages, specific requirements, critical issues, pre-clinical and early clinical experience. Dendritic cell vaccination is situated in the diversity of other immunotherapeutical approaches. FURTHER DISCUSSION. Future directions, challenges, and drawbacks will be discussed.

PMID: 15452731 [PubMed - as supplied by publisher]

6: Childs Nerv Syst. 2004 Sep 28 [Epub ahead of print]: Uncommon case of a cystic papillary meningioma in an adolescent.

Buschmann U, Gers B, Hildebrandt G.

Department of Neurosurgery, Kantonsspital St. Gallen (KSSG), 9007, St. Gallen, Switzerland.

INTRODUCTION. Meningiomas, especially papillary meningiomas, are rare tumours in childhood and adolescence. They are histologically classified as atypical. CASE REPORT. We present a 15-year-old girl with a cystic papillary meningioma extending from the infratentorial to the supratentorial region extracranially. After a two-stage gross total resection combined with fractionated radiotherapy of a small residual tumour in the infratemporal fossa, the clinical course was stable for at least 4 years. Then a new infratentorial cystic papillary meningioma with a histological change in tumour malignancy was recognised within only 1 year. DISCUSSION. Besides the rare histology of a cystic papillary meningioma in an adolescent, the case is remarkable due to the considerable extent of the tumour and the irregular course with rapid regrowth and change into malignancy after an initially stable and benign course. For a comparison, the current literature is reviewed and discussed with regard to sex and age distribution, histopathological features, clinical course and therapeutical options.

PMID: 15452729 [PubMed - as supplied by publisher]

7: Clin Neuropathol. 2004 Jul-Aug;23(4):158-66.

Metastatic low-grade inflammatory myofibroblastic tumor (IMT) in the central nervous system of a 29-year-old male patient.

Petridis AK, Hempelmann RG, Hugo HH, Eichmann T, Mehdorn HM.

Department of Neurosurgery, University of Kiel, Germany. opticdisc@aol.com

A case of myofibrosarcoma (IMT) of the brain and lung as well as the spinal cord is described. A 29-year-old male patient presented with fever (40 degrees C), malaise, vomitus, meningism and leukocytosis. Computer tomography identified a bleeding in the left frontal lobe. A bleeding angioma was suspected and an operation was performed. The histological examination could not reveal an exact diagnosis. Eight months after complete recovery from the first bleeding, the patient had a second intracranial temporo-occipital bleeding on the right side which has been removed operatively. A new lesion was seen in the left parietal white matter of the brain. A growing cavernoma was suspected and resection of the lesion was planned. Pre-operatively the patient suffered from hemoptysis and fever. The X-ray of the chest showed a pulmonary lesion in the left lower lobe. In the CT of the chest a large tumor in the left lower lobe of the lung and additionally a cystic structure in the mediastinum was seen. The histological examination of this tumor identified an inflammatory myofibroblastic tumor (IMT). The left parietal lesion has been resected after the thoracic operation. The brain lesions were estimated to be metastases of the IMT of the lung. In the further clinical history the patient developed a large spinal cord metastasis of the thoracic spine. The metastatic development of the tumor reported in this case is unusual. The current therapy of these tumors consists of complete tumor resection and further clinical controls. However, due to the localization and the extension of some lesions in the present case, the complete resection has not been possible. There is no proven role of chemotherapy and radiation therapy. The patient died due to the pulmonary deterioration.

Publication Types:

Case Reports

PMID: 15328880 [PubMed - indexed for MEDLINE]

8: Clin Neuropathol. 2004 Jul-Aug;23(4):154-7.

Cerebellar hemangioendothelioma.

Suzuki K, Oka K, Yatabe Y, Mori S, Hayano M, Hakozaki H, Nakazato Y.

Department of Neurosurgery, Mito Saiseikai General Hospital, Mito, Ibaraki, Japan.

We report a 26-year-old woman with cellular hemangioendothelioma that may be the third case diagnosed as cerebellar hemangioendothelioma. The tumor was composed of numerous vascular channels lined by endothelial cells and aggregates of large round endothelial cells. Transitional cells were also present. The large round cells were positive for CD34 and vimentin in their abundant cytoplasm that contained 1 or some red blood cells, revealing intracytoplasmic lumina. The patient remains free of disease over 5 years after tumor resection.

Publication Types:

Case Reports

PMID: 15328879 [PubMed - indexed for MEDLINE]

9: Clin Neuropathol. 2004 Jul-Aug;23(4):149-53.

Chondroid tumors arising from the meninges--report of 2 cases and review of the literature.

Bergmann M, Pinz W, Blasius S, Lentschig M, Ostertag H, Neubauer U.

Institute of Clinical Neuropathology, Klinikum Bremen-Ost, Bremen, Germany. Markus.Bergmann@Klinikum.Bremen.ost.de

Chondroid tumors are rare intracranial tumors usually arising from the base of the skull. We present 2 cases of intracranial cartilaginous tumors with unusual location. In case 1, a 19-year-old woman, a chondroma of the falx cerebri with extensive secondary ossification was diagnosed. In case 2, a 30-year-old woman, a low-grade chondrosarcoma was resected from the right frontal lobe. Both patients showed an uneventful clinical course without evidence of disease 4.5 and 6 years after total extirpation. Our cases show that chondromas and low-grade chondrosarcomas of the dura and meninges usually occur in young adults with a good prognosis after complete extirpation.

Publication Types:

Case Reports

PMID: 15328878 [PubMed - indexed for MEDLINE]

10: J Clin Oncol. 2004 Sep 27 [Epub ahead of print]: Antitumor Vaccination of Patients With Glioblastoma Multiforme: A Pilot Study to Assess Feasibility, Safety, and Clinical Benefit.

Steiner HH, Bonsanto MM, Beckhove P, Brysch M, Geletneky K, Ahmadi R, Schuele-Freyer R, Kremer P, Ranaie G, Matejic D, Bauer H, Kiessling M, Kunze S, Schirrmacher V, Herold-Mende C.

Departments of Neurosurgery, Head and Neck Surgery, Neuropathology, and Neuroanaesthetics, University of Heidelberg; and Division of Cellular Immunology, German Cancer Research Center, Heidelberg, Germany.

PURPOSE: Prognosis of patients with glioblastoma is poor. Therefore, in glioblastoma patients, we analyzed whether antitumor vaccination with a virus-modified autologous tumor cell vaccine is feasible and safe. Also, we determined the influence on progression-free survival and overall survival and on vaccination-induced antitumor reactivity. PATIENTS AND METHODS: In a nonrandomized study, 23 patients were vaccinated and compared with nonvaccinated controls (n = 87). Vaccine was prepared from patient's tumor cell cultures by infection of the cells with Newcastle Disease Virus, followed by gamma-irradiation, and applied up to eight times. Antitumor immune reactivity was determined in skin, blood, and relapsed tumor by delayed-type hypersensitivity skin reaction, ELISPOT assay, and immunohistochemistry, respectively. RESULTS: Establishment of tumor cell cultures was successful in approximately 90% of patients. After vaccination, we observed no severe side effects. The median progression-free survival of vaccinated patients was 40 weeks (v 26 weeks in controls; log-rank test, P =.024), and the median overall survival of vaccinated patients was 100 weeks (v 49 weeks in controls; log-rank test, P <.001). Forty-five percent of the controls survived 1 year, 11% survived 2 years, and there were no long-term survivors (>/= 3 years). Ninety-one percent of vaccinated patients survived 1 year, 39% survived 2 years, and 4% were long-term survivors. In the vaccinated group, immune monitoring revealed significant increases of delayed-type hypersensitivity reactivity, numbers of tumor-reactive memory T cells, and numbers of CD8(+) tumor-infiltrating T-lymphocytes in secondary tumors. CONCLUSION: Postoperative vaccination with virus-modified autologous tumor cells seems to be feasible and safe and to improve the prognosis of patients with glioblastomas. This could be substantiated by the observed antitumor immune response.

PMID: 15452186 [PubMed - as supplied by publisher]

11: J Clin Oncol. 2004 Sep 27 [Epub ahead of print]: Toward a Glioblastoma Vaccine: Promise and Potential Pitfalls.

Fine HA.

Neuro-Oncology Branch, National Cancer Institute, National Institutes of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD.

PMID: 15452184 [PubMed - as supplied by publisher]

http://www.jco.org/cgi/reprint/JCO.2004.06.927v1

12: J Neuropathol Exp Neurol. 2004 Sep;63(9):956-63.: Arachidonylethanolamide induces apoptosis of human glioma cells through vanilloid receptor-1.

Contassot E, Wilmotte R, Tenan M, Belkouch MC, Schnuriger V, de Tribolet N, Bourkhardt K, Dietrich PY.

Laboratory of Tumor Immunology, University Hospital, Geneva, Switzerland.

The anti-tumor properties of cannabinoids have recently been evidenced, mainly with delta9-tetrahydrocannabinol (THC). However, the clinical application of this drug is limited by possible undesirable side effects due to a broad expression of cannabinoid receptors (CB1 and CB2). An attractive field of research therefore is to identify molecules with more selective tumor targeting. This is particularly important for malignant gliomas, considering their poor prognosis and their location in the brain. Here we investigated whether the most potent endogenous cannabinoid, arachidonylethanolamide (AEA), could be a candidate. We observed that AEA induced apoptosis in long-term and recently established glioma cell lines via aberrantly expressed vanilloid receptor-1 (VR1). In contrast with their role in THC-mediated death, both CB1 and CB2 partially protected glioma against AEA-induced apoptosis. These data show that the selective targeting of VR1 by AEA or more stable analogues is an attractive research area for the treatment of glioma.

PMID: 15453094 [PubMed - in process]

13: Neurology. 2004 Sep 28;63(6):1133-4.: Natural history of conservatively treated meningiomas.

Herscovici Z, Rappaport Z, Sulkes J, Danaila L, Rubin G.

Department of Neurosurgery, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel. hzvika@zahav.net.il

PMID: 15452322 [PubMed - in process]

14: Neuroradiology. 2004 Sep 21 [Epub ahead of print]: Glucocorticoid treatment of brain tumor patients: changes of apparent diffusion coefficient values measured by MR diffusion imaging.

Minamikawa S, Kono K, Nakayama K, Yokote H, Tashiro T, Nishio A, Hara M, Inoue Y.

Department of Radiology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka-shi, 545-8585, Osaka, Japan.

Glucocorticoids (GCC) generally are administered to patients with brain tumors to relieve neurological symptoms by decreasing the water content in a peritumoral zone of edema. We hypothesized that diffusion imaging and apparent diffusion coefficient (ADC) values could detect subtle changes of water content in brain tumors and in peritumoral edema after GCC therapy. The study consisted of 13 patients with intra-axial brain tumor, and ADC was measured in the tumor, within peritumoral edema, and in normal white matter remote from the tumor before and after GCC therapy. ADC also was measured in normal white matter in four control patients with no intracranial disease who were treated with GCC for other indications. Conventional MR images showed no visually evident interval change in tumor size or the extent of peritumoral edema in any subject after GCC therapy, which nonetheless resulted in a decrease in mean ADC of 7.0% in tumors ( P<0.05), 1.8% in peritumoral edema ( P>0.05, not significant) and 5.8% in normal white matter ( P<0.05). In patients with no intracranial disease, GCC therapy decreased mean ADC in white matter by 5.4% ( P<0.05). ADC measurement can demonstrate subtle changes in the brain after GCC therapy that cannot be observed by conventional MR imaging. Measurement of ADC proved to be a sensitive means of assessing the effect of GCC therapy, even in the absence of visually discernible changes in conventional MR images.

PMID: 15448954 [PubMed - as supplied by publisher]

15: Neuroradiology. 2004 May;46(5):355-8. Epub 2004 Apr 21.

MR imaging and spectroscopy in Lhermitte-Duclos disease.

Nagaraja S, Powell T, Griffiths PD, Wilkinson ID.

Academic Unit of Radiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. s.nagaraja@shef.ac.uk

Lhermitte-Duclos disease is a rare abnormality occurring in the cerebellum with only 130 cases reported in the literature. There is debate as to whether this abnormality is a hamartoma, a malformation or a tumour. In this case report we discuss the spectroscopy findings from two patients presenting with this disease. The patients, one 40-year-old Caucasian woman with a 6-year history of headaches, unsteady gait and falls, deterioration in vision and another 28-year-old Caucasian man with a 1-year history of headaches and a previous history of a transient stroke, were found to have this lesion in the cerebellum. Proton spectroscopic data were obtained using a single-voxel PRESS technique (TE=135 ms, TR=1600 ms), from the region of the abnormality. The results were expressed as ratios under the three prominent resonances representing choline (Cho), creatine (Cr), and N-acetyl (NA) moieties. The metabolite ratios were compared to normative data. The two cases demonstrated reduced ratios in NA/Cho and NA/Cr in relation to the controls. The ratios of Cho/Cr appeared closer to the normal mean ratio. There were peaks attributable to lactate in both cases. The low NA/Cr and NA/Cho ratios could be due to the apparent lack of neuronal architecture and the presence of embryonic neural tissue, which does not express NA, indicating more favourably towards a 'benign' hamartoma rather than a tumour. Copyright 2004 Springer-Verlag

Publication Types:

Case Reports

PMID: 15103436 [PubMed - indexed for MEDLINE]

16: Neuroradiology. 2004 May;46(5):351-4. Epub 2004 Apr 16.

Diffusion-weighted MRI in Lhermitte-Duclos disease: report of two cases.

Moonis G, Ibrahim M, Melhem ER.

Department of Radiology, Neuroradiology Section, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. moonis@rad.upenn.edu

Lhermitte-Duclos disease is a rare benign lesion of uncertain pathogenesis characterized by distortion of the normal cerebellar laminar cytoarchitecture. There is a characteristic MR imaging appearance of a nonenhancing mass in the cerebellar hemisphere with a striated pattern. We report two cases of Lhermitte-Duclos disease and describe findings on diffusion-weighted MR imaging. Copyright 2004 Springer-Verlag

Publication Types:

Case Reports

PMID: 15088131 [PubMed - indexed for MEDLINE]

17: Neurosurgery. 2004 Oct;55(4):916-25.: Feasibility of Radiosurgery for Malignant Brain Tumors in Infants by Use of Image-guided Robotic Radiosurgery: Preliminary Report.

Giller CA, Berger BD, Gilio JP, Delp JL, Gall KP, Weprin B, Bowers D.

Department of Neurological Surgery, Baylor University Medical Center, Dallas, Texas.

OBJECTIVE: The benefits of radiation therapy are generally denied to infants with malignant brain tumors because of the risk of devastating cognitive decline. Efforts to limit this morbidity with radiosurgical techniques have not been feasible for infants because of the dual requirements of rigid head fixation and high precision. We report the radiosurgical treatment of five infants by use of a robotically controlled system without rigid head fixation. METHODS: Five infants with malignant brain tumors received radiosurgical treatment with a robotically driven linear accelerator. Immobilization was aided by general anesthesia, form-fitting head supports, face masks, and body molds. The average marginal dose was 17 +/- 2 Gy, and the average treatment volume was 18 +/- 22 ml. RESULTS: X-rays obtained during treatment revealed acceptable agreement with preoperative computed tomographic scans in all patients. In one patient, the lesion did not progress, but a distant recurrence occurred 15 months after radiosurgery and also was treated with radiosurgery. In another patient, tumor in the treated region did not progress, but recurrence elsewhere led to death 7 months after treatment. Tumor enlargement occurred in Patient 3 at 3 months posttreatment, leading to death 2 months later. Tumor size was smaller in the remaining two patients at 9 and 11 months after treatment. There has been no toxicity attributed to treatment. CONCLUSION: Radiosurgery with minimal toxicity can be delivered to infants by use of a robotically controlled system that does not require rigid fixation. A formal dose-escalation trial is under way to address dose and toxicity for infants more thoroughly.

PMID: 15458600 [PubMed - in process]

18: Neurosurgery. 2004 Oct;55(4):824-9.: Taurine detection by proton magnetic resonance spectroscopy in medulloblastoma: contribution to noninvasive differential diagnosis with cerebellar astrocytoma.

Moreno-Torres A, Martinez-Perez I, Baquero M, Campistol J, Capdevila A, Arus C, Pujol J.

"Centre Diagnostic Pedralbes," Barcelona, Spain.

OBJECTIVE: We sought to evaluate whether taurine detection in short-echo (20 ms) proton magnetic resonance spectroscopy contributes to the noninvasive differential diagnosis between medulloblastoma and cerebellar astrocytoma in children and young adults. These two types of tumor have very different prognoses and may be difficult to differentiate by neuroradiological or clinical means. METHODS: Single-voxel proton magnetic resonance spectra of tumors were acquired at 1.5 T in 14 patients with biopsy-proven primary cerebellar tumors (six medulloblastomas, seven astrocytomas, and one mixed astroependymoma) using short-echo time (20 ms) and long-echo time (135 ms). For taurine assignment, qualitative analysis was performed on short-echo time spectra and results were compared in vitro with spectra of model solutions. Perchloric acid extracts of postsurgical tumor biopsies were performed in two medulloblastoma cases. RESULTS: Taurine detection was demonstrated in all patients with medulloblastoma and in none of those with astrocytoma. We were unable to ascertain any relationship between taurine and metastatic spread within the medulloblastoma group. CONCLUSION: Medulloblastomas characteristically seem to show taurine detectable in vivo by short-echo proton magnetic resonance spectroscopy, which may help to discriminate medulloblastoma from cerebellar astrocytoma.

PMID: 15458590 [PubMed - in process]

19: Radiology. 2004 Sep;232(3):846-53. Epub 2004 Jul 23.: Percutaneous vertebroplasty for malignant compression fractures with epidural involvement.

Shimony JS, Gilula LA, Zeller AJ, Brown DB.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110, USA. shimonyj@mir.wustl.edu

PURPOSE: To evaluate safety and effectiveness of performance of percutaneous vertebroplasty (PVP) in patients with malignant compression fractures and involvement of the epidural space. MATERIALS AND METHODS: PVP was performed in 50 patients with metastatic disease or multiple myeloma between June 1998 and April 2002. Twenty-five women (mean age, 62.3 years; range, 38-85 years) and 25 men (mean age, 63.1 years; range, 37-92 years) were included. Cases were retrospectively reviewed. Patients who had undergone cross-sectional imaging were classified into three groups. First group had no epidural involvement; second group, mild epidural involvement without contact with spinal cord or nerve roots; third group, moderate involvement and contact with spinal cord or nerve roots. Procedural safety was evaluated with review of all post-PVP complications and their treatment. Effectiveness was evaluated with follow-up phone calls for assessment of change in pain level and activity after PVP. Follow-up calls were performed at 1 day; 2 weeks; 1, 3, and 6 months; and 1 and 2 years. Differences between groups were assessed with singly ordered Kruskal-Wallis test. RESULTS: Fourteen patients were classified in the first group, 18 in the second, and 18 in the third. There were no significant differences in pain or mobility outcomes among groups. At the last follow-up call, 41 (82%) of 50 patients reported improvement in pre-PVP pain. Six (12%) reported no change, and three (6%) reported increased pain. After PVP in 26 (52%) patients, there was a period of increased mobility; in 19 (38%), no improvement in mobility occurred; and in five (10%), decreased mobility was reported. Complications included acute increased pain or new areas of pain in seven (14%) patients. None of these required surgery; four were treated with nerve root block; two, with central epidural injection; and one, with overnight intravenous steroids. CONCLUSION: PVP can be performed safely and effectively with conscious sedation in patients with malignant compression fractures and epidural involvement. Copyright RSNA, 2004

PMID: 15273339 [PubMed - indexed for MEDLINE]

20: Surg Neurol. 2004 Oct;62(4):332-8.: Conventional posterior fossa approach for surgery on petroclival meningiomas: A report on an experience with 28 cases.

Goel A, Muzumdar D.

Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, India.

BACKGROUND: This is a report of our experience with 28 cases of select petroclival meningiomas operated by a posterior fossa route encompassing the lateral supracerebellar-infratentorial and retrosigmoid avenues. METHODS: Twenty-eight cases of petroclival meningiomas treated during the period 1991 to 2002 by conventional posterior cranial fossa route are analyzed. The average length of follow-up is 48 months. RESULTS: The maximum diameter of the tumors ranged from 1.8 to 6.8 cm (mean, 4.0 cm). Five tumors extended up to or beyond the contralateral petroclival junction. Basilar artery was at least partially encased in 9 cases. Gross total tumor resection was achieved in 21 cases and a partial tumor resection was achieved in the remaining 7 cases. Two patients died in the postoperative phase. CONCLUSIONS: Conventional posterior cranial fossa surgery can be suitable for a select group of petroclival meningioma. Apart from other advantages, it provides easy and quick exposure of the tumor without any petrous bone drilling. It also provides a direct and early exposure of the tumor-cranial nerve-brainstem interface facilitating the dissection. The lateral and inferior tumor extensions in relationship to the clivus can be more easily accessed. The site of attachment of the tumor to the dura overlying the posterior face of the petrous apex can be seen directly.

PMID: 15451280 [PubMed - in process]