| 1: Ann
Neurol. 2005 Jan;57(1):136-9. |
|
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Capillary physiology and drug delivery in central nervous
system lymphomas.
Warnke PC, Timmer J, Ostertag CB, Kopitzki K.
Department of Neurological Science, University of Liverpool, Clinical
Sciences Centre for Research and Education, Lower Lane, Fazakerley,
Liverpool L9 7LJ, Merseyside, United Kingdom. warnke@liverpool.ac.uk
To evaluate whether the chemosensitivity of primary central nervous system
lymphomas to water-soluble drugs could result from improved drug delivery,
we quantitatively assessed pharmacokinetic factors in seven patients. The
capillary permeability surface product was found to be significantly
increased in central nervous system lymphomas compared with glioblastoma
multiforme, medulloblastomas, and metastases. Tumoral blood flow was
significantly greater than in normal white matter. Our results suggest
favorable pharmacokinetics to water- and lipid-soluble drugs in primary
central nervous system lymphomas.
PMID: 15622544 [PubMed - indexed for MEDLINE]
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| 2: Arch
Pathol Lab Med. 2004 Oct;128(10):1161-4. |
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Microdissection genotyping of mixed glial and primitive
neuroectodermal central nervous system neoplasm.
Mohan D, Rao GR, Swalsky PA, Bakker A, Martinez AJ, Finkelstein SD.
Department of Pathology, University of Pittsburgh Medical Center,
Pittsburgh, Pa, USA. Deepak.Mohan@cshs.org
A 22-year-old man with previous radiation treatment for childhood
astrocytoma underwent resection of a right parietooccipital lesion.
Histopathology revealed a malignant neoplasm with areas of astrocytic and
primitive neuroectodermal components. To resolve the relationship and
cellular origin, representative tissue was microdissected from several
targets, obtaining a balanced mixture of each element. Nonneoplastic brain
parenchyma was separately microdissected to determine polymorphic marker
informativeness and to serve as an internal negative control. Despite the
relatively small quantity of tissue removed for each microdissection target,
sufficient material was available for reliable, balanced, polymerase chain
reaction-format genotyping encompassing a panel of tumor suppressor genes
and genetic loci associated with these forms of neoplasia. The findings
revealed distinct discordant genotypic profiles for each of the neoplastic
components. The efficacy of the approach used for molecular analysis of this
complex neoplasm and the implication of the genotypic findings are
discussed.
Publication Types:
PMID: 15387704 [PubMed - indexed for MEDLINE]
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| 3: Cancer.
2005 Mar 15; [Epub ahead of print] |
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Medulloblastoma in the second decade of life: A specific
group with respect to toxicity and management.
Tabori U, Sung L, Hukin J, Laperriere N, Crooks B, Carret AS, Silva M,
Odame I, Mpofu C, Strother D, Wilson B, Samson Y, Bouffet E.
Pediatric Brain Tumor Program, The Hospital for Sick Children, Toronto,
Ontario, Canada.
BACKGROUND: Most reported data of chemoradiotherapy protocols for the
treatment of medulloblastoma describe children who were treated in the first
decade of life. To consider the feasibility of this approach in adolescents,
the authors studied their clinical course with specific emphasis on
toxicity, tolerability, and prognosis. METHODS: In this retrospective study,
the authors examined the toxicity profiles and outcomes of children age
10-20 years with medulloblastoma who were treated at centers throughout
Canada between 1986 and 2003. Detailed toxicity data from 2 chemotherapy
protocols were collected for teenagers and were compared with data from a
group of control patients age 5-10 years. RESULTS: In total, 72 teenagers
were analyzed. Grade >/= 2 ototoxicity and neurotoxicity occurred in 45%
and 71% of chemotherapy-treated patients, respectively. Grade 3-4
hematotoxicty occurred in 95% of patients. Toxicity resulted in delay of
treatment for 73% of patients and dose modification in 75% of patients,
including protocol discontinuation in 25% of patients. Weight loss > 10%
was encountered in 73% of patients and required intervention in 45% of
patients. Teenagers had significantly more hematotoxicity and neurotoxicity
compared with controls on both chemotherapeutic protocols. Ototoxicity was
similar in both age groups. Toxicity resulted in significantly more
treatment delays and dose modifications in teenager patients compared with
controls. The 5-year overall and event-free survival rates (+/- standard
deviation) were 78% +/- 6% and 70% +/- 6%, respectively. The mean time (+/-
standard deviation) to disease recurrence was 3.2 +/- 2.2 years.
CONCLUSIONS: The increased toxicity rate and high incidence of treatment
modifications in this study suggested that current pediatric protocols may
require modifications for teenagers with medulloblastoma. The results
highlighted several issues that should be addressed in future prospective
trials. Cancer 2005. (c) 2005 American Cancer Society.
PMID: 15770645 [PubMed - as supplied by publisher]
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| 4: Cancer
Res. 2005 Feb 1;65(3):787-96. |
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Suppression of melanotroph carcinogenesis leads to
accelerated progression of pituitary anterior lobe tumors and medullary
thyroid carcinomas in Rb+/- mice.
Zhou Z, Flesken-Nikitin A, Levine CG, Shmidt EN, Eng JP, Nikitina EY,
Spencer DM, Nikitin AY.
Department of Biomedical Sciences, Cornell University, Ithaca, NY
14853-6401, USA.
Mice with a single copy of the retinoblastoma gene (Rb(+/-)) develop a
syndrome of multiple neuroendocrine neoplasia. They usually succumb to
fast-growing, Rb-deficient melanotroph tumors of the pituitary intermediate
lobe, which are extremely rare in humans. Thus, full assessment of Rb role
in other, more relevant to human pathology, neoplasms is complicated. To
prevent melanotroph neoplasia while preserving spontaneous carcinogenesis in
other types of cells, we have prepared transgenic mice in which 770-bp
fragment of pro-opiomelanocortin promoter directs expression of the human RB
gene to melanotrophs (TgPOMC-RB). In three independent lines, transgenic
mice crossed to Rb(+/-) background are devoid of melanotroph tumors but
develop the usual spectrum of other neoplasms. Interestingly, abrogation of
melanotroph carcinogenesis results in accelerated progression of pituitary
anterior lobe tumors and medullary thyroid carcinomas. A combination of
immunologic tests, cell culture studies, and tumorigenicity assays indicates
that alpha-melanocyte-stimulating hormone, which is overproduced by
melanotroph tumors, attenuates neoplastic progression by decreasing cell
proliferation and inducing apoptosis. Taken together, we show that cell
lineage-specific complementation of Rb function can be successfully used for
refining available models of stochastic carcinogenesis and identify
alpha-melanocyte-stimulating hormone as a potential attenuating factor
during progression of neuroendocrine neoplasms.
PMID: 15705875 [PubMed - indexed for MEDLINE]
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| 5: J
Clin Oncol. 2005 Mar 20;23(9):2114-6. |
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Survival after brain metastases from breast cancer in the
trastuzumab era.
Kirsch DG, Ledezma CJ, Mathews CS, Bhan AK, Ancukiewicz M, Hochberg FH,
Loeffler JS.
PMID: 15774813 [PubMed - in process]
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| 6: J
Neurol Neurosurg Psychiatry. 2005 Apr;76(4):562-8. |
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Facets and determinants of quality of life in patients
with recurrent high grade glioma.
Giovagnoli AR, Silvani A, Colombo E, Boiardi A.
Department of Neurology and Neuropathology, Carlo Besta National
Neurological Institute, Via Celoria 11, 20133 Milan, Italy.
rgiovagnoli@istituto-besta.it.
OBJECTIVES: To assess patients with recurrent high grade brain glioma with
the aim of evaluating facets of quality of life (QOL) and their association
with mood, cognition, and physical performance. METHODS: Ninety four glioma
patients (four groups with different duration of glioma recurrence) were
compared with 24 patients with other chronic neurological diseases and 48
healthy subjects. The Functional Living Index-Cancer (FLIC) provided QOL
self evaluations, and standardised scales and neuropsychological tests
assessed physical performance, mood, and cognition. RESULTS: In glioma
patients, factor analysis of the FLIC items documented five domains:
Psychological well being, Role/sociability, Inner experience of disease,
Isolation/sharing, and Nausea. Higher FLIC total scores were related to
better cognition, physical performances, and mood, and lower grading; poorer
Psychological well being and worse Inner experience of disease to depressed
mood; minor Role/sociability to worse cognitive and physical performances
and higher grading; worse Nausea to longer disease duration. Compared with
healthy subjects, all glioma groups were cognitively impaired and more
anxious, and two groups with short duration of recurrence were also more
depressed. Patients with chronic neurological diseases showed worse mood and
cognitive abilities compared with healthy subjects, but performed attention
tests better than glioma patients. Glioma and chronic disease patients
showed similar FLIC scores and autonomy. CONCLUSIONS: These results show
that QOL of recurrent high grade glioma patients is multifaceted and
determined by multiple factors. Disease severity does not necessarily
eliminate the possibility of expressing personal feelings and opinions which
could provide criteria for clinical decision making and psychological
support.
PMID: 15774446 [PubMed - in process]
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| 7: J
Neurol Neurosurg Psychiatry. 2005 Apr;76(4):555-561. |
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Views of bereaved relatives about quality of survival
after radiotherapy for malignant cerebral glioma.
Davies E, Clarke C.
Thames Cancer Registry, Guy's, King's, and St Thomas's School of Medicine,
1st Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.
elizabethdavies@doctors.org.uk.
OBJECTIVE: To explore the views of bereaved relatives about quality of
survival after radiotherapy for malignant cerebral glioma. DESIGN:
Semistructured interviews with the bereaved relatives of 56 previously
studied patients with glioma. SETTING: Patients treated at six London
hospitals from 1990 to 1992 surviving between one and 46 months (median,
eight). SUBJECTS: Fifty six relatives (44 spouses, 12 others) seen four to
six months after bereavement and 20 again at 13 months. MAIN OUTCOME
MEASURES: Views about quality of life and satisfaction with radiotherapy.
RESULTS: Relatives described quality of life as "good or
acceptable" when patients carried on some normal activities or enjoyed
social relationships. They described restricted and dependent states,
constant deterioration, or loss of social interaction as giving "poor
or unacceptable" quality of life. Length of time lived in such states
also appeared important. Relatives' views of good or acceptable quality of
life were independently related to low initial cognitive or personality
change or low distress in the patient after diagnosis, and to their
subsequent survival free from physical disability for at least one month.
Satisfaction with radiotherapy was related to low initial distress, some
degree of surgical resection, and overall length of survival longer than six
months. CONCLUSIONS: Carefully exploring the views of bereaved relatives can
bring a useful perspective to difficult treatment decisions. Their values
support including disability and distress in quality of life measures, but
cast doubt on the QALY-type approach of using full years of survival or time
free from disability to judge whether treatments are worthwhile.
PMID: 15774445 [PubMed - as supplied by publisher]
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| 8: J
Neurol Neurosurg Psychiatry. 2005 Mar;76(3):415-9. |
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The time course of visual field recovery following
transphenoidal surgery for pituitary adenomas: predictive factors for a good
outcome.
Gnanalingham KK, Bhattacharjee S, Pennington R, Ng J, Mendoza N.
Brindhaven, II Deena Close, Queens Drive, London W3 0HR, UK.
kannagnana@doctors.org.uk
OBJECTIVE: To report the quantitative assessment of visual fields (VF) in
patients with pituitary macroadenomas, and the time course and predictive
factors for recovery of vision. METHODS: Retrospective study of 41 patients
with pituitary adenomas and visual disturbance. Patients underwent pre- and
postoperative VF assessment at one week, three to six months, one year, two
years, and five years using the Humphrey field analyser, which gives a
quantitative measure of VF in each quadrant. RESULTS: 36/41 patients (88%)
presented with a visual disturbance. Mean (SEM) duration of symptoms was 94
(50) weeks (range 0.5 to 1500); 12 (29%) had optic atrophy at presentation.
Impairment of VF was greatest in the upper temporal quadrant, followed by
the lower temporal. VF recovery was progressive and apparent even at the
five year follow up (p<0.001). Overall, VF returned to normal in 35% of
eyes, improved in 60%, and remained unchanged in 5%. Patients whose VF
returned to normal had a shorter duration of symptoms (16 (5) v 137 (56)
weeks; p<0.05), better preoperative visual acuity (p<0.05), and a
smaller degree of impairment in preoperative lateral quadrant VF (p<0.01)
than those whose VF only improved. On multivariate analysis, the only
predictive factor for VF recovery was the degree of impairment in VF
preoperatively. CONCLUSIONS: Transphenoidal surgery for pituitary
macroadenoma results in a progressive recovery of VF in 95% of patients. The
extent of the VF recovery is mainly dependent on the preoperative VF
deficit, which emphasises the need for early intervention in these patients.
PMID: 15716538 [PubMed - indexed for MEDLINE]
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| 9: J
Neurol Neurosurg Psychiatry. 2005 Mar;76(3):390-4. |
|
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Lower urinary tract function in patients with pituitary
adenoma compressing hypothalamus.
Yamamoto T, Sakakibara R, Uchiyama T, Liu Z, Ito T, Yamanishi T, Hattori
T.
Neurology Department, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba
260-8670, Japan.
BACKGROUND: The micturition reflex is under the tonic influence of
suprapontine structures including the anteromedial frontal cortex, basal
ganglia, and hypothalamus. However, there have been few reports about the
role of the hypothalamus on the lower urinary tract (LUT) function in
humans. OBJECTIVE: To investigate LUT function in patients with pituitary
adenomas. METHODS: Urodynamic studies were carried out in three patients
with LUT symptoms who had pituitary adenomas extending upwards to the
hypothalamus. RESULTS: All three male patients (age 28 to 62 years)
developed LUT symptoms (urinary urgency and frequency (3); urinary
incontinence (3); voiding difficulty and retention (2)) along with weight
loss, psychiatric symptoms, unsteady gait, and/or visual disturbances. One
had the syndrome of inappropriate secretion of antidiuretic hormone, but
none had diabetes insipidus. Two had resection of the tumour and subsequent
radiation therapy, but LUT dysfunction persisted. The third patient had
partial resection of the tumour to ameliorate hydrocephalus. Urodynamic
studies showed detrusor overactivity during the storage phase in all
patients; during the voiding phase there was underactive detrusor in two and
non-relaxing sphincter in one. CONCLUSIONS: Hypothalamic lesions can cause
severe LUT dysfunction in both the storage and voiding phases of
micturition. This may reflect the crucial role of the hypothalamus in
regulating micturition in humans.
Publication Types:
PMID: 15716534 [PubMed - indexed for MEDLINE]
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| 10: J
Neurosurg. 2005 Feb;102(2):402-3; author reply 403. |
|
Comment on:
Spectroscopy and navigation.
Chernov MF, Muragaki Y, Ochiai T, Maruyama T, Izawa M, Hayashi M, Ono Y,
Kubo O, Hori T.
Publication Types:
PMID: 15739576 [PubMed - indexed for MEDLINE]
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| 11: J
Neurosurg. 2005 Feb;102(2):386-8. |
|
Tension pneumoventricle after placement of a
ventriculoperitoneal shunt: a novel treatment strategy. Case report.
Perrin RG, Bernstein M.
Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario,
Canada.
A case of pneumoventricle following insertion of a ventriculoperitoneal
shunt for hydrocephalus is described. The pneumoventricle was associated
with significant morbidity, which improved with treatment. The authors
propose a rational treatment for this condition, which, as far as they know,
has not previously been described. They also discuss potential mechanisms
involved in the pathogenesis of pneumoventricle.
Publication Types:
PMID: 15739571 [PubMed - indexed for MEDLINE]
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| 12: J
Neurosurg. 2005 Feb;102(2):376-81. |
|
Multicentric pleomorphic xanthoastrocytoma in a patient
with neurofibromatosis type 1. Case report and review of the literature.
Saikali S, Le Strat A, Heckly A, Stock N, Scarabin JM, Hamlat A.
Department of Pathology, Centre Hospitalier Regional et Universitaire
Pontchaillou, Rennes, France.
The authors report an unusual case of multicentric pleomorphic
xanthoastrocytoma (PXA) in a 36-year-old woman with neurofibromatosis Type 1
(NF1). Both lesions were diagnosed as PXA but demonstrated different
neuroimaging features and very different outcomes. Although the occipital
lesion was cured surgically, the cerebellar tumor recurred three times and
underwent malignant transformation into an anaplastic oligodendroglioma. The
authors discuss the causes of PXA and suggest that it could originate from
common bipotential precursor cells with two phenotypes.
Publication Types:
PMID: 15739569 [PubMed - indexed for MEDLINE]
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| 13: J
Neurosurg. 2005 Feb;102(2):342-7. |
|
Biological activity of adult cavernous malformations: a
study of 56 patients.
Sure U, Freman S, Bozinov O, Benes L, Siegel AM, Bertalanffy H.
Department of Neurosurgery, Philipps University, Marburg, Germany.
sure@med.uni-marburg.de
OBJECT: Cerebral cavernous malformations (CCMs) have previously been
considered as congenital and biologically static malformations. On the other
hand, the potential for growth and de novo generation of CCMs have also been
reported. It is therefore important to study the proliferative and
neoangiogenetic capacity of these lesions. METHODS: The authors studied the
surgical specimens of 56 CCMs (23 deep and 33 superficial) obtained from
adult patients. The proliferative activity of the endothelium and the
neoangiogenetic capacity of these lesions were considered through
immunohistochemical anaylsis of proliferating cell nuclear antigen (PCNA),
MIB-1, Flk-1, vascular endothelial growth factor (VEGF), hypoxia-inducible
factor (HIF)-1alpha, and endoglin antibodies. Positive immunostaining of
endothelial cells occurred in 86% of patients for PCNA and in 38% of the
cases for MIB 1. The expression of Flk-1 was observed in the endothelium of
71% of the cases, for VEGF in 41%, for HIF-1 alpha in 48.1%, and for
endoglin in 63.6% of the cases. The correlation of immunohistochemical and
clinical data indicated that VEGF was expressed in significantly less
deep-seated lesions when compared with superficial CCMs. Neither the
expression of the proliferative markers nor the expression of the
angiogenetic antibodies correlated with patient age at surgery, sex, or the
number of recent prior hemorrhagic episodes in the patients. CONCLUSIONS:
The CCMs from adult patients are active lesions exhibiting endothelial
proliferation and neoangiogenesis. According to the data in this study,
neoangiogenesis is more prominent in superficial CCMs than in deep-seated
CCMs and is not associated with recent prior hemorrhages.
PMID: 15739564 [PubMed - indexed for MEDLINE]
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| 14: J
Neurosurg. 2005 Feb;102(2):336-41. |
|
Diffusion tensor analysis of peritumoral edema using
lambda chart analysis indicative of the heterogeneity of the microstructure
within edema.
Morita K, Matsuzawa H, Fujii Y, Tanaka R, Kwee IL, Nakada T.
Center for Integrated Human Brain Science, Department of Neurosurgery, Brain
Research Institute, University of Niigata, Japan.
OBJECT: Histopathological studies indicate that cerebral edema associated
with tumors (peritumoral edema) does not represent a single
pathophysiological or clinical entity. In this study the authors
investigated peritumoral edema by performing lambda chart analysis (LCA), a
noninvasive technique that can be used to make visible and analyze apparent
water diffusivity in tissues in vivo, and assessed the utility of LCA in
differentiating high-grade gliomas from nonglial tumors. METHODS: The water
diffusivity characteristics of peritumoral edema associated with four tumor
groups-12 high-grade gliomas, five low-grade gliomas, 11 metastatic tumors,
and 15 meningiomas-were assessed in 43 patients by performing magnetic
resonance imaging with the aid of a 3-tesla magnetic resonance imaging
system. In all tumor groups, peritumoral edema exhibited greater trace
values and reduced anisotropy compared with normal white matter. Edema
associated with high-grade gliomas had significantly higher trace values
than edema associated with the other three tumor groups, although the
anisotropic angles of those groups were comparable. CONCLUSIONS: Lambda
chart analysis identified two distinct types of peritumoral edema: edema
associated with high-grade gliomas and edema associated with low-grade
gliomas or nonglial tumors. The apparent water diffusivity was significantly
greater in high-grade gliomas, whereas the anisotropy in these lesions was
comparable to that of edema in other tumors. These findings indicated that
water movement in areas of edema, predominantly in the extracellular spaces,
was less restricted in high-grade gliomas, a phenomenon that likely
reflected the destruction of the extracellular matrix ultrastructure by
malignant cell infiltration and consequently greater water diffusion.
Although preliminary, this study indicates that LCA could be used as a
clinical tool for differentiating high-grade gliomas and for evaluating the
extent of cellular infiltration.
PMID: 15739563 [PubMed - indexed for MEDLINE]
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| 15: J
Neurosurg. 2005 Feb;102(2):302-10. |
|
Brain surface reformatted images for fast and easy
localization of perirolandic lesions.
Hattingen E, Good C, Weidauer S, Herminghaus S, Raab P, Marquardt G,
Raabe A, Seifert V, Zanella FE.
Institute of Neuroradiology, Department of Neurosurgery, Johann Wolfgang
Goethe University, Frankfurt am Main, Germany. elkejoerg@web.de
OBJECT: The goal of this study was to evaluate a novel form of brain surface
representation that allows simple, reliable mapping of the surface
neuroanatomy for the preoperative evaluation of the spatial relationship
between a focal lesion and the precentral gyrus. METHODS: High-resolution
three-dimensional (3D) magnetic resonance (MR) imaging data sets were
postprocessed using a curved multiplanar reformatting technique to create
brain surface reformatted (BSR) images. These BSR images were reconstructed
in less than 5 minutes and demonstrated the entire central sulcus with
adjacent surface structures in one view. Two experienced neuroradiologists
determined the localization of lesions near the central sulcus in 27
patients on standard MR images in three orthogonal planes and on BSR images.
In addition, these observers judged whether the lesions were easy or
difficult to localize on standard MR and BSR images, and whether diagnoses
based on these methods were certain or doubtful. Anatomical localization
based on BSR images was compared with that based on functional MR (fMR)
images or intraoperative mapping of motor function. The BSR images yielded a
perfect concordance with the fMR images and intraoperative mapping (Cohen
kappa 1.0) and optimal diagnostic accuracy in localizing perirolandic
lesions (both sensitivity and specificity were 100%). Localization was
judged to be easy for 48 of 54 diagnoses based on BSR images compared with
26 of 54 based on standard MR images. Diagnoses were assessed as certain for
52 cases based on BSR images and 34 cases based on standard MR images.
CONCLUSIONS: Brain surface reformatted imaging improves the diagnostic
accuracy of standard anatomical MR imaging for localizing superficial brain
lesions in relation to the precentral gyrus. The complementary use of this
technique with standard two-dimensional imaging is supported by the fast and
simple postprocessing technique and may provide useful information for
preoperative surgical planning.
PMID: 15739559 [PubMed - indexed for MEDLINE]
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| 16: J
Neurosurg. 2005 Feb;102(2):295-301. |
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Intraoperative power Doppler ultrasonography with a
contrast-enhancing agent for intracranial tumors.
Kanno H, Ozawa Y, Sakata K, Sato H, Tanabe Y, Shimizu N, Yamamoto I.
Department of Neurosurgery, Yokohama City University Graduate School of
Medicine, Yokohama, Japan. kanno@med.yokohama-cu.ac.jp
OBJECT: The goal of this study was to evaluate intraoperative power Doppler
ultrasonography when used with a contrast-enhancing agent for operations on
intracranial tumors. METHODS: Forty intracranial tumors were examined using
power Doppler ultrasonography with a galactose microparticle-based
ultrasonographic contrast-enhancing agent during operations on the brain.
The tumors included 37 intracranial neoplasms (14 gliomas, six meningiomas,
three hemangioblastomas, two malignant lymphomas, three other primary
neoplasms, nine metastatic tumors, and three nonneoplastic lesions). All
patients also underwent computerized tomography and magnetic resonance
imaging, and all but three of the patients underwent digital subtraction
(DS) angiography. Before injection of the ultrasonographic contrast agent,
intra- and peritumoral power Doppler flow signals were detected in 32 of the
intracranial tumors. After the injection, the signals were enhanced in blood
vessels around the tumors and in the tumor parenchyma in 36 tumors. The
duration of contrast enhancement continued for 70 to 365 seconds (mean 251.8
+/- 69 seconds) after the injection. Among the tumors, hemangioblastomas
displayed particularly strong contrast enhancement. In these intracranial
tumors, the echo signals obtained using contrast-enhanced power Doppler
ultrasonography correlated with DS angiographic staining. Power Doppler
ultrasonograms with the appropriate contrast agent provided better data on
the precise real-time position of the tumors and their relationship to
adjacent vessels than ultrasonograms obtained before the injection of the
contrast agent. CONCLUSIONS: Intraoperative power Doppler ultrasonography
performed using a contrast-enhancing agent can facilitate intraoperative
real-time navigation and assessment of the intratumoral vasculature and
peritumoral vessels, particularly for tumors having abundant vessels such as
hemangioblastomas.
PMID: 15739558 [PubMed - indexed for MEDLINE]
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| 17: J
Neurosurg. 2005 Feb;102(2):189-93. |
|
Surgical outcomes in 118 patients with Rathke cleft
cysts.
Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH.
Department of Neurosurgery, University of Southern California, Los Angeles,
California, USA.
OBJECT: Microscopic Rathke cleft cysts are a common incidental autopsy
finding, but some Rathke cleft cysts can become sufficiently large to cause
visual impairment, hypothalamic-pituitary dysfunction, and headaches. In
this study patients were evaluated pre- and postoperatively to ascertain the
clinical significance of surgical intervention on endocrine and visual
improvement. Factors correlated with cyst recurrence were also evaluated.
METHODS: A retrospective analysis was conducted in 160 patients with Rathke
cleft cysts who were treated between 1984 and 1995 and completed at least a
5-year follow-up period. Of these 160 patients, 118 initially exhibited
symptoms of visual impairment or endocrine dysfunction, became symptomatic
during the follow-up period, or were found to have cyst enlargement. These
118 patients underwent transsphenoidal surgery. Forty-two patients with
incidental lesions that demonstrated no growth on magnetic resonance (MR)
images were followed up without an operation. Complete resection, as
observed on MR images 3 months postoperatively, was obtained in 114 (97%) of
118 patients. Vision improved postoperatively in 57 (98%) of 58 patients.
Hypogonadism improved in 11 (18%) of 62 patients, growth hormone deficiency
resolved in 14 (18%) of 78 patients, and hypocortisolemia resolved in one
(14%) of seven patients. Twenty-two patients (19%) began to exhibit symptoms
of diabetes insipidus, which had not been present preoperatively. The total
5-year recurrence rate was 18% (21 of 118 patients), with 12 patients
requiring a repeated operation. Surgical and pathological factors that were
found to be statistically associated with recurrence were the use of a fat
and/or fascial graft for closure (p < 0.01) and the presence of squamous
metaplasia in the cyst wall (p < 0.01). The extent of resection of the
cyst wall was not associated with an increased rate of recurrence. In 42
(69%) of 61 patients the incidental cysts did not progress on imaging
studies or clinically. CONCLUSIONS: This is the largest series of patients
with symptomatic Rathke cleft cysts who received operative intervention and
participated in the longest postoperative follow up reported in the
literature. The high recurrence rate (18%) supports the theory that a
relationship exists between a symptomatic Rathke cleft cyst and
craniopharyngioma. Improvements in visual and endocrine dysfunction can be
expected after surgical decompression of the optic apparatus and the
hypothalamic-pituitary axis.
PMID: 15739543 [PubMed - indexed for MEDLINE]
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Volume 4, Number 14 - 22 March 2005