| 1: Br J Cancer. 2003 Apr 22;88(8):1191-8. |
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Reporting of prognostic markers: current problems and
development of guidelines for evidence-based practice in the future.
Riley RD, Abrams KR, Sutton AJ, Lambert PC, Jones DR, Heney D, Burchill
SA.
Department of Epidemiology and Public Health, University of Leicester,
Leicester, UK. rdr3@leicester.ac.uk
Prognostic markers help to stratify patients for treatment by identifying
patients with different risks of outcome (e.g. recurrence of disease), and
are important tools in the management of cancer and many other diseases.
Systematic review and meta-analytical approaches to identifying the most
valuable prognostic markers are needed because (sometimes conflicting)
evidence relating to markers is often published across a number of studies.
To investigate the practicality of this approach, an empirical investigation
of a systematic review of tumour markers for neuroblastoma was performed;
260 studies of prognostic markers were identified, which considered 130
different markers. The reporting of these studies was often inadequate, in
terms of both statistical analysis and presentation, and there was
considerable heterogeneity for many important clinical/statistical factors.
These problems restricted both the extraction of data and the meta-analysis
of results from the primary studies, limiting feasibility of the
evidence-based approach.Guidelines for reporting the results of primary
prognostic marker studies in cancer, and other diseases, are given in order
to facilitate both the interpretation of individual studies and the
undertaking of systematic reviews, meta-analysis and, ultimately,
evidence-based practice. General availability of full individual patient
data is a necessary step forward and would overcome the majority of problems
encountered, including poorly reported summary statistics and variability in
cutoff level, outcome assessed and adjustment factors used. It would also
limit the problem of reporting bias, although publication bias will remain a
concern until studies are prospectively registered. Such changes in practice
would help important evidence-based reviews to be conducted in order to
establish the most appropriate prognostic markers for clinical use, which
should ultimately improve patient care.
PMID: 12698183 [PubMed - indexed for MEDLINE]
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| 2: Br J Neurosurg. 2004 Jun;18(3):310-3. |
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Primary midbrain germinoma.
Ben Amor S, Siddiqui K, Baessa S.
Department of Neurosciences, King Faisal Specialist Hospital & RC,
Jeddah, Kingdom of Saudi Arabia. benamor@healthgulf.com
Intracranial germinomas arising primarily in the midbrain are extremely rare
and only one case has been reported in the literature. A 15-year-old boy
presented with headache, diplopia, unsteadiness and personality changes.
Brain MRI showed a heterogeneous lesion in the midbrain. The pineal body
region was free. The preoperative diagnosis included brain-stem glioma,
metastasis and lymphoma. Stereotactic biopsy was permitted in order to take
a specimen and the diagnosis of germinoma was established. The patient
responded well to chemotherapy and radiotherapy. Germinoma should be
included in the differential diagnosis of midbrain lesions. Preoperative
diagnosis is difficult and biopsy is still needed for such lesions.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15327241 [PubMed - indexed for MEDLINE]
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| 3: Br J Neurosurg. 2004 Jun;18(3):300-3. |
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Problematic differential diagnosis between cerebellar
liponeurocytoma and anaplastic oligodendroglioma.
Valery CA, Sakka LJ, Poirier J.
Services de Neurochirurgie, Hopital de la Pitie-Salpetriere, Paris, France.
charles.valery@psl.ap-hop-paris.fr
A cerebellar tumour, first diagnosed as an anaplastic oligodendroglioma,
received radiation therapy (45 Gy) following gross total resection. The
second histological study revealed a liponeurocytoma, a benign tumour not
requiring adjuvant therapy. This case emphasizes the importance of
considering this diagnosis to prevent unnecessary irradiation of such
rumours.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15327238 [PubMed - indexed for MEDLINE]
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| 4: Br J Neurosurg. 2004 Jun;18(3):284-9. |
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Primary cerebellar germinomas of the posterior fossa.
Maiuri F, Cappabianca P, Del Basso De Caro M, Esposito F, de Divitiis E.
Department of Neurological Sciences, Section of Neurosurgery, School of
Medicine, University Federico II, Naples, Italy. fcmaiuri@unina.it
Primary cerebellar germinomas, in the absence of germ-cell tumours outside
the nervous system or elsewhere in the cranial cavity and CSF pathways, are
exceptional; only two previous cases have been reported in the literature.
Two personal observations are described from our 20-year records of
intra-axial posterior fossa tumours. The patients were a 32-year-old man and
a 17-year-old woman with a clinical history of posterior fossa tumour,
studied by computed tomography. The first patient with slight cerebellar
signs had a small right hemispheric cerebellar tumour, and the other had a
left cerebellar mass with hydrocephalus and progressive intracranial
hypertension. Both were treated by tumour removal and irradiation to the
whole posterior fossa. The survival times were 58 and 49 months,
respectively. The diagnosis of primary cerebellar germinoma cannot be
suspected before pathological confirmation. The clinical, neuroradiological
and surgical findings are non-specific and quite similar to those of other
malignant cerebellar tumours, such as anaplastic gliomas or metastases.
Surgery and radiotherapy ensure adequate tumour control in the early stages;
cases of recurrence or disseminated disease may be treated by irradiation
and chemotherapy.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15327234 [PubMed - indexed for MEDLINE]
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| 5: Br J Neurosurg. 2004 Jun;18(3):280-4. |
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Cerebral aneurysm associated with an intracranial tumour:
staged endovascular and surgical treatment in two cases.
Javadpour M, Khan AD, Jenkinson MD, Foy PM, Nahser HC.
Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery,
Liverpool, UK.
Two cases are reported in which an anterior communicating artery aneurysm
was associated with an intracranial tumour. The tumour was a suprasellar
meningioma in one case and an optic chiasm/hypothalamic astrocytoma in the
other. In both cases, the aneurysm was successfully embolized using
Guglielmi detachable coils. Subsequently craniotomy was performed with
complete excision of the meningioma and subtotal removal of the astrocytoma.
Endovascular techniques can be employed to make the surgical excision of an
intracranial tumour co-existing with an incidental aneurysm safer.
Publication Types:
PMID: 15327233 [PubMed - indexed for MEDLINE]
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| 6: Br J Neurosurg. 2004 Jun;18(3):250-2. |
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Extensive vertebral haemangioma with cord compression in
two patients: review of the literature.
Shah KC, Chacko AG.
Department of Neurological Sciences, Christian Medical College Hospital,
Vellore, India.
Two cases of extensive vertebral haemangioma with progressive neurological
deficits are described. Successful treatment was accomplished with
palliative surgical decompression after preoperative embolization in one
case and with postoperative radiotherapy in the other. Preoperative
embolization, palliative surgical decompression and postoperative
radiotherapy appear to provide satisfactory outcome in patients with
extensive haemangiomas.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15327226 [PubMed - indexed for MEDLINE]
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| 7: Cancer Res. 2004 Nov 15;64(22):8468-8473. |
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Reduced Immunoglobulin E and Allergy among Adults with
Glioma Compared with Controls.
Wiemels JL, Wiencke JK, Patoka J, Moghadassi M, Chew T, McMillan A, Miike
R, Barger G, Wrensch M.
Laboratory for Molecular Epidemiology, Department of Epidemiology and
Biostatistics, Department of Neurological Surgery, and Comprehensive Cancer
Center, University of California San Francisco, San Francisco, California.
We and others have reported previously that adults with glioma are 1.5- to
4-fold less likely than controls to report a variety of allergic conditions.
The consistent nature of this relationship calls for a biological
explanation so that preventative or therapeutic modalities can be explored.
We enrolled 403 newly diagnosed adult glioma cases in the San Francisco Bay
Area over a 3-year period using a population-based cancer registry and 402
age/gender/ethnicity frequency-matched controls identified via random digit
dialing. We assessed total, food-specific, and respiratory-specific IgE in
available case (n = 228) and control (n = 289) serum samples. IgE levels
were associated with gender, age, smoking status, and ethnicity among cases
and/or controls. Among the cases, IgE levels were not associated with
aspects of glioma therapy including radiation, chemotherapy, or tumor
resection. Total IgE levels were lower in cases than controls:
age/gender/ethnicity/education/smoking-adjusted odds ratio (OR) for elevated
versus normal total IgE was 0.37 [95% confidence interval (CI), 0.22-0.64].
For the food panel, OR was 0.12 (95% CI, 0.04-0.41). For the respiratory
panel, OR was 0.76 (95% CI, 0.52-1.1). Among respiratory allergies, late age
of onset (>12 years) but not IgE levels defined a group with strong
associations with risk (OR, 0.50; 95% CI, 0.33-0.75). These results
corroborate and strengthen our findings of an inverse association between
allergic reactions and glioma by showing a relationship with a biomarker for
allergy and cancer for the first time. Furthermore, the results indicate a
complex relationship between allergic disease and glioma risk that varies by
allergen and allergic pathology.
PMID: 15548720 [PubMed - as supplied by publisher]
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| 8: Cancer Res. 2004 Nov 15;64(22):8292-8298. |
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SHP-2-t Mitogen-Activated Protein Kinase Activation
Regulates EGFRvIII but not Wild-Type Epidermal Growth Factor Receptor
Phosphorylation and Glioblastoma Cell Survival.
Zhan Y, O'rourke DM.
Departments of Neurosurgery and Pathology and Laboratory Medicine,
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
In human glioblastomas, the most common mutation of epidermal growth factor
receptor (EGFR) is an in-frame deletion of an 801-bp sequence in the
extracellular domain of EGFR termed EGFRvIII. The EGFRvIII does not bind
ligand EGF but has constitutive tyrosine phosphorylation (pTyr) content and
kinase activity that result in enhanced transformation, reduced apoptosis,
and resistance to therapy. Here we report that the protein tyrosine
phosphatase SHP-2 modulates a mitogen-activated protein kinase (MAPK) kinase
(MEK)-mediated signaling pathway that regulates EGFRvIII pTyr and cell
survival in U87MG.EGFRvIII cells. Overexpression of the phosphatase-inactive
form of SHP-2 inhibited EGFRvIII pTyr by decreasing MAPK phosphorylation.
Consistent with this, we observed that the MEK inhibitor PD98059, but not
the phosphatidylinositol 3'-kinase inhibitor LY294002, inhibited EGFRvIII
pTyr. Furthermore, constitutive EGFRvIII pTyr content observed in U87MG,
LN229, and U373MG glioblastoma cells, but not in NR6.EGFRvIII fibroblasts,
correlated with elevated MAPK levels in these cells. Interestingly,
LY294002, but not PD98059, inhibited wild-type EGFR pTyr in response to EGF
treatment in U87MG parental cells and in wild-type EGFR-overexpressing U87MG
cells. Inhibition of EGFRvIII pTyr by PD98059 was not observed to be
phosphorylation site specific. However, LY294002 more specifically inhibited
wild-type EGFR pTyr at residues Tyr(992) and Tyr(1068) in the COOH terminus.
Treatment of U87MG.EGFRvIII cells with PD98059, but not LY294002, also
resulted in increased cell death in response to cisplatin. Collectively, a
distinct MEK-mediated pathway in human glioblastoma cells appears to
differentially modulate EGFRvIII and wild-type EGFR pTyr, and inhibition of
the MAPK pathway sensitizes EGFRvIII-containing human glioblastoma cells to
cisplatin-induced cell death.
PMID: 15548697 [PubMed - as supplied by publisher]
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| 9: Cancer Res. 2004 Nov 15;64(22):8271-8275. |
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Role of Synaptojanin 2 in Glioma Cell Migration and
Invasion.
Chuang YY, Tran NL, Rusk N, Nakada M, Berens ME, Symons M.
Center for Oncology and Cell Biology, Institute for Medical Research at
North Shore-LIJ, Manhasset, New York.
The small GTPase Rac1 is thought to play an important role in cell migration
and invasion. We have previously identified synaptojanin 2, a
phosphoinositide phosphatase, as an effector of Rac1. Here, we show that
small interfering RNA-mediated depletion of either Rac1 or synaptojanin 2
inhibits invasion of SNB19 and U87MG glioblastoma cells through Matrigel and
rat brain slices. Depletion of Rac1 or synaptojanin 2 also inhibits
migration of SNB19 and U87MG cells on glioma-derived extracellular matrix.
In addition, we found that depletion of Rac1 or synaptojanin 2 inhibits the
formation of lamellipodia and invadopodia, specialized membrane structures
that are thought to be involved in extracellular matrix degradation. These
results suggest that synaptojanin 2 contributes to the role of Rac1 in cell
invasion and migration by regulating the formation of invadopodia and
lamellipodia. This study also identifies synaptojanin 2 as a novel potential
target for therapeutic intervention in malignant tumors.
PMID: 15548694 [PubMed - as supplied by publisher]
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| 10: J Clin Oncol. 2004 Nov 15;22(22):4551-60. |
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White matter lesions detected by magnetic resonance
imaging after radiotherapy and high-dose chemotherapy in children with
medulloblastoma or primitive neuroectodermal tumor.
Fouladi M, Chintagumpala M, Laningham FH, Ashley D, Kellie SJ, Langston
JW, McCluggage CW, Woo S, Kocak M, Krull K, Kun LE, Mulhern RK, Gajjar A.
Department of Hematology-Oncology, St Jude Children's Research Hospital, 332
N Lauderdale, Memphis, TN 38105-2794; e-mail: maryam.fouladi@stjude.org.
PURPOSE White matter lesions (WMLs) have been described as a delayed effect
of cranial irradiation in children with brain tumors, or a transient
subacute effect characterized by an intralesional or perilesional reaction.
We report the occurrence of subacute WMLs detected by magnetic resonance
imaging (MRI) in children treated for medulloblastoma or primitive
neuroectodermal tumor (PNET) and document the associated clinical,
radiologic, and neurocognitive findings. PATIENTS AND METHODS Among 134
patients with medulloblastoma or supratentorial PNET treated prospectively
with risk-adjusted craniospinal irradiation and conformal boost to the tumor
bed, followed by four high-dose chemotherapy (HDC) cycles with stem-cell
rescue, 22 developed WMLs on T1-weighted imaging with and without contrast
and/or T2-weighted imaging on MRI. Patients had >/= 12 months of
follow-up. Neurocognitive assessments included intelligence quotient (IQ)
tests and tests of academic achievement. Results Twenty-two patients
developed WMLs at a median of 7.8 months after starting therapy (range, 1.9
to 13.0 months). Lesions were predominantly in the pons (n = 8) and
cerebellum (n = 6). Sixteen patients (73%) had WML resolution at a median of
6.2 months (range, 1.68 to 23.5 months) after onset; two patients developed
necrosis and atrophy. Three developed persistent neurologic deficits.
Cumulative incidence of WMLs at 1 year was 15% +/- 3%. Patients with WMLs
had a significant decline in estimated IQ (-2.5 per year; P = .03) and math
(-4.5 per year; P = .003) scores. CONCLUSION WMLs in medulloblastoma or PNET
patients treated with conformal radiotherapy and HDC are typically transient
and asymptomatic, and may mimic early tumor recurrence. A minority of
patients with WMLs develop permanent neurologic deficits and imaging
changes. Overall, the presence of WMLs is associated with greater
neurocognitive decline.
PMID: 15542806 [PubMed - in process]
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| 11: J Neurol Neurosurg Psychiatry. 2003 Jan;74(1):141. |
|
Comment on:
- J
Neurol Neurosurg Psychiatry. 2002 Feb;72(2):257-8.
Cerebral metastasis after primary renal cell carcinoma.
Heckl S, Braun K, Debus J, Kunze S.
Publication Types:
PMID: 12486293 [PubMed - indexed for MEDLINE]
 http://jnnp.bmjjournals.com/cgi/reprint/74/1/141
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| 12: J Neurosurg. 2004 Nov;101(5):858-60. |
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A carcinoid tumor mimicking an isolated intracranial
meningioma. Case report.
Deshaies EM, Adamo MA, Qian J, DiRisio DA.
Department of Surgery, Division of Neurosurgery, Albany Medical Center,
Albany, New York 12208, USA. deshaie@mail.amc.edu
This 79-year-old woman presented with progressively worsening dementia,
abulia, flat affect, urinary incontinence, and profuse watery diarrhea.
Results of computerized tomography and magnetic resonance studies indicated
an extraaxial, dural-based mass compressing the right frontal lobe and
consistent with a convexity meningioma. A right frontal craniotomy was
performed and the dural-based mass was resected. Histopathological features
on immunostaining of the lesion were consistent with a carcinoid tumor
(low-grade neuroendocrine carcinoma). Further evaluation revealed no primary
carcinoid tumor in the foregut from which they typically originate. The
authors concluded that this intracranial carcinoid tumor was the primary
lesion despite its unusual location and that it should be included in the
differential diagnosis of dural-based, extraaxial brain lesions.
PMID: 15540927 [PubMed - in process]
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| 13: J Neurosurg. 2004 Nov;101(5):826-31. |
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Invasive phenotype observed in
1,3-bis(2-chloroethyl)-1-nitrosourea-resistant sublines of 9L rat glioma
cells: a tumor model mimicking a recurrent malignant glioma.
Saito R, Bringas J, Mirek H, Berger MS, Bankiewicz KS.
Department of Neurological Surgery, Brain Tumor Research Center, University
of California, San Francisco, California 94103, USA.
OBJECT: Chemotherapy is suspected of having an effect on the generation of
phenotypical heterogeneity and the development of drug resistance in tumors.
Recurrent gliomas feature drug resistance as well as greater invasive growth
than original tumors. The authors investigated phenotypical changes in
invasion observed in 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU)-resistant
sublines of the 9L rat gliosarcoma. METHODS: Two established BCNU-resistant
sublines, derived from 9L gliosarcoma cells by treating these cells with
BCNU in vivo or in vitro, were used in the study. An in vitro examination
confirmed the resistance of the cells to BCNU treatment. The cells were
implanted into the striatum of Fisher 344 rats, and histological
examinations were performed to compare the growth patterns of the resultant
tumors. A new brain tumor model was established by implanting 9L-2 cells in
Fisher 344 rats. The 9L-2 and BTRC-19 cells displayed a distinct increase in
BCNU resistance compared with the 9L cells. Both BCNU-resistant sublines
developed a tumor mass with invasive margins, which is not the case with 9L
tumor models. The newly developed 9L-2 tumor model demonstrated 100% tumor
uptake with consistent growth patterns. CONCLUSIONS: Cells that acquire drug
resistance also demonstrated invasive growth. Because the 9L-2 and BTRC-19
cells were derived from 9L cells that had been treated with BCNU in vivo and
in vitro, this change in phenotype was likely caused by the drug treatment,
which may have implications for chemotherapy of gliomas. The tumor model
that developed from the 9L-2 cells can be used as a model of a recurrent
glioma, which features drug resistance and invasive growth.
PMID: 15540922 [PubMed - in process]
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| 14: J Neurosurg. 2004 Nov;101(5):779-86. |
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Volumetric thermal devascularization of large
meningiomas.
Kato A, Fujimoto Y, Taniguchi M, Hashimoto N, Hirayama A, Kinoshita M,
Baba T, Maruno M, Yoshimine T.
Department of Neurosurgery, Osaka University Medical School, Suita, Japan.
akato@nsurg.med.osaka-u.ac.jp
OBJECT: Controlling hemorrhage is crucial in the safe and efficient removal
of large meningiomas. Intravascular embolization is not always a
satisfactory means of accomplishing this goal because of the procedure's
hemostatic effect and risk of complications. The authors in this study used
a volumetric thermal ablation technique incorporating radiofrequency energy,
image guidance, and local temperature control to devascularize tumor tissue.
METHODS: Five patients with large meningiomas were treated. The target and
orientation of the radiofrequency thermal ablation (RFTA) were simulated
preoperatively to maximize devascularization of the lesion without thermal
injury to adjacent critical structures. Image fusion, three-dimensional
reconstruction, and image-guided methods provided for optimized trajectories
and targets for insertion of the RFTA needle. During ablation, local
temperatures of the tissue being cauterized were monitored continuously to
limit the ablated lesion to within the target volume. The effects of
devascularization and the softening of the tumor parenchyma facilitated
lesion removal. The intracranial ablated meningioma changed into necrotic
tissue and shrank within a few months. Histopathological examination of the
ablated lesion revealed sharply demarcated coagulation necrosis.
CONCLUSIONS: Volumetric thermal devascularization can be applied safely in
the treatment of large meningiomas to facilitate surgical manipulation of
the lesion as well as to reduce its size palliatively. The procedure's
usefulness should be studied further in a larger number of cases with
different tumor characteristics.
PMID: 15540916 [PubMed - in process]
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| 15: J Neurosurg. 2004 Oct;101(4):690-3. |
|
Cerebral venous angioma of the pons complicated by
nonhemorrhagic infarction. Case report.
Peltier J, Toussaint P, Desenclos C, Le Gars D, Deramond H.
Departments of Neurosurgery and Neuroradiology, University Hospital Center,
Amiens, France. jojo.peltier@caramail.com
The authors emphasize an unusual complication of venous angiomas in the
brain: venous infarction. The patient in this case is a 32-year-old man who
presented with a clinical history of headache followed by a worsening of his
neurological status. Neuroimaging studies demonstrated a brain infarct in
the posterior fossa, which was related to thrombosis of the draining vein of
a cerebral venous angioma. A conservative treatment approach without
anticoagulation therapy was followed and the patient completely recovered.
Nonhemorragic venous infarction caused by thrombosis of a venous angioma is
exceptional and only nine previous cases have been reported in the
literature.
Publication Types:
PMID: 15481728 [PubMed - indexed for MEDLINE]
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| 16: J Neurosurg. 2004 Oct;101(4):607-12. |
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Postoperative evaluation of microsurgical resection for
cavernous malformations of the brainstem.
Kikuta K, Nozaki K, Takahashi JA, Miyamoto S, Kikuchi H, Hashimoto N.
Department of Neurosurgery, Kyoto University Graduate School of Medicine,
Kyoto, Japan. kikuta@kuhp.kyoto-u.ac.jp
OBJECT: The aim of this study was to propose criteria to determine whether
complete resection of cavernous malformations in the brainstem had been
achieved. METHODS: The authors retrospectively analyzed data in 10 patients
harboring a single cavernous malformation who had presented with hemorrhagic
symptoms and had been followed up for longer than 2 years postsurgery. The
study population consisted of five male and five female patients ranging in
age from 13 to 57 years (mean 36.8 years). When preoperative magnetic
resonance (MR) images demonstrated the lesion as a homogeneous hyperintense
mass, the surgery was defined as complete or incomplete based on
intraoperative findings. When preoperative MR images revealed other
findings, complete resection was determined according to whether
postoperative MR imaging results demonstrated lesions distinct from the
peripheral hemosiderin rim. Among the 13 operations in this series, nine
resulted in complete resection and were associated with no postoperative
clinical relapse of hemorrhage, whereas four operations resulted in
incomplete resection and were correlated with postoperative recurrent
hemorrhage. The seven patients in whom the outcome of the initial operation
was complete demonstrated good neurological recovery in the long-term
follow-up period, whereas the three patients in whom the outcome of the
initial surgery was judged to be incomplete showed inadequate neurological
recovery due to recurrent hemorrhage. CONCLUSIONS: The criteria proposed in
this study to evaluate surgical treatment may be a reliable means of
predicting the recurrence of hemorrhage postoperatively.
PMID: 15481714 [PubMed - indexed for MEDLINE]
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| 17: J Neurosurg. 2004 Oct;101(4):590-3. |
|
Leksell Gamma Knife coordinate setting slippage: how
often, how much?
Foote RL, Pollock BE, Link MJ, Garces YI, Kline RW.
Division of Radiation Oncology and Department of Neurologic Surgery, Mayo
Clinic College of Medicine, Rochester, Minnesota 55905, USA. robert@mayo.edu
OBJECT: The aim of this study was to determine the incidence and magnitude
of coordinate setting slippage during gamma knife surgery (GKS). METHODS:
Thirty-six consecutive patients undergoing GKS with a Leksell unit between
June and December 2000 had their coordinates (right and left x-, y-, and
z-coordinates; 1548 coordinates; 258 isocenters) and gamma angles checked
after the delivery of treatment to each isocenter to determine whether the
coordinate settings had slipped and, if so, which settings and the magnitude
of the slippage. CONCLUSIONS: Coordinate setting slippage during GKS with a
Leksell unit does occur but is rare. The magnitude of such slippage is
typically within the error of the stereotactic system and coordinate
reading. The authors noted that coordinate setting slippage is significantly
correlated with patient weight.
PMID: 15481711 [PubMed - indexed for MEDLINE]
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| 18: J Neurosurg. 2004 Oct;101(4):577-84. |
|
Comment in:
- J
Neurosurg. 2004 Oct;101(4):571-2; discussion 572.
Surgery for Rathke cleft cysts: technical considerations
and outcomes.
Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD.
Departments of Neurosurgery and Radiology, Mount Sinai School of Medicine,
New York, New York 10029-6574, USA.
OBJECT: The aim of this study was to identify the optimal surgical goals and
techniques for managing symptomatic Rathke cleft cysts (RCCs). METHODS: The
authors conducted a retrospective study of 62 consecutive patients who had
undergone surgery for RCCs. Postoperative follow up was a mean of 28 months.
Fifty-six patients underwent transsphenoidal cyst decompression and biopsy
procedures, and six underwent cyst wall resection. Postoperatively, symptoms
improved in 91% of patients with headaches and 92% of patients with visual
deficits. Decompression and biopsy were associated with a 10% incidence of
new anterior pituitary hormone deficiencies and a 6% incidence of new
permanent diabetes insipidus; the incidence of new hormone deficiencies was
significantly higher in the few patients who had undergone cyst wall
resection. The incidence of relapse, defined as cyst regrowth with either
recurrent symptoms or chiasmal compression, was 16%. Resection of the cyst
wall was associated with a trend toward a decreased risk of relapse. Sellar
packing, sellar floor reconstruction, and irrigation with absolute ethanol
did not affect the likelihood of relapse. Squamous metaplasia and
inflammation increased the risk of relapse. Residual cyst demonstrated on
postoperative magnetic resonance imaging was associated with an increased
risk of subsequent asymptomatic cyst regrowth. Seven patients (11%)
underwent repeated operation with symptomatic improvement and minimal
morbidity; only one patient relapsed following a second surgery.
CONCLUSIONS: Decompression and biopsy procedures in the treatment of RCCs
lead to improvement in signs and symptoms, with low morbidity rates.
Repeated operations will be required in as many as 16% of patients but are
also associated with symptomatic improvement, low morbidity, and durable
remission. Decompression and biopsy may represent the optimal surgical
management of RCC.
PMID: 15481709 [PubMed - indexed for MEDLINE]
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| 19: J Neurosurg. 2004 Oct;101(4):571-2; discussion 572. |
|
Comment on:
- J
Neurosurg. 2004 Oct;101(4):577-84.
Rathke cleft cysts.
Laws ER, Kanter AS.
Publication Types:
PMID: 15481706 [PubMed - indexed for MEDLINE]
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| 20: Surg Neurol. 2004 Nov;62(5):393-9; discussion 399. |
|
Apoptosis, vascularity, and proliferation in primary
central nervous system lymphomas (PCNSL): a histopathological study.
Roser F, Saini M, Meliss R, Ostertag H, Samii M, Bellinzona M.
Center for Experimental Neuro-Oncology, Klinikum Hannover Nordstadt,
Hannover, Germany.
BACKGROUND: In the present study apoptosis, vascularity, and proliferation
were quantitatively analyzed with immunohistopathological techniques in
primary central nervous system lymphomas (PCNSL). Statistical analysis of
these parameters was performed to evaluate their possible relationship with
the unfavorable outcome of this tumor. METHODS: A series of 32 PCNSL
patients for a total of 33 tumors treated from 1984 to 2000 in the
Neurosurgical Department were reviewed, and their histologic specimens
examined for apoptosis, vascularity, and proliferation. RESULTS: Patients
were treated with either gross total/subtotal tumor removal or stereotactic
biopsy. Vascularity was studied by means of FVIII staining, proliferative
index with Ki-67 staining, and apoptosis with the TUNEL technique. Most
tumors could be classified as immunoblastic or centroblastic B-Cell NHL.
Mean Mib-1 Labeling Index was 35.34% (5-80), blood vessel density of 40.8
per 10 high power fields. Apoptotic cells were zero or less than 8 cells per
10 high power fields. CONCLUSION: No statistically significant correlation
between survival and histopathological parameters could be shown. However,
the apoptosis index was found to be negatively correlated with proliferative
index and may account for a more aggressive clinical course of PCNSL.
PMID: 15518841 [PubMed - indexed for MEDLINE]
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Volume 3, Supplement 15 - 23 November 2004