| 1: AJNR
Am J Neuroradiol. 2005 Jan;26(1):160-2. |
|
-
Secondary supratentorial primitive neuroectodermal tumor
following irradiation in a patient with low-grade astrocytoma.
Chen AY, Lee H, Hartman J, Greco C, Ryu JK, O'Donnell R, Boggan J.
Department of Radiation Oncology , University of California-Davis Medical
Center, Sacramento, CA 95817, USA.
We report a case of a supratentorial primitive neuroectodermal tumor (PNET)
that occurred 12 years after cranial irradiation for a grade II astrocytoma.
Neuroimaging was unable to distinguish between a recurrence of the original
neoplasm and the development of a new, distinct entity. Pathologic review
assisted by immunohistochemical staining, however, revealed a high-grade
PNET. Although rare, PNET needs to be included in the differential diagnoses
for previously irradiated patients, who develop recurrent brain tumors in
the presence of uncharacteristic imaging features.
Publication Types:
PMID: 15661719 [PubMed - indexed for MEDLINE]
-
| 2: AJNR
Am J Neuroradiol. 2005 Jan;26(1):156-9. |
|
-
De novo development of a lesion with the appearance of a
cavernous malformation adjacent to an existing developmental venous anomaly.
Campeau NG, Lane JI.
Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
A case is presented in which a complex multicystic hemosiderin-containing
lesion developed adjacent to a previously documented developmental venous
anomaly (venous angioma). This lesion had the characteristic MR imaging
appearance of a cavernous malformation. Follow-up MR imaging demonstrated a
decrease in both the size and complexity of this lesion, which suggests at
least a portion of the lesion was due to sequelae of hemorrhage. This case
further supports the association of a de novo, hemosiderin-containing lesion
in association with developmental venous anomaly. Implications of these
findings are that the commonly seen "cavernous malformations" in
association with developmental venous anomaly are acquired lesions, and not
congenital in origin. A review of the literature discussing the etiology of
cavernous malformations and their reported association with the
developmental venous anomaly is provided.
Publication Types:
PMID: 15661718 [PubMed - indexed for MEDLINE]
-
| 3: AJNR
Am J Neuroradiol. 2005 Jan;26(1):145-51. |
|
-
Evaluation of communication between intracranial
arachnoid cysts and cisterns with phase-contrast cine MR imaging.
Yildiz H, Erdogan C, Yalcin R, Yazici Z, Hakyemez B, Parlak M, Tuncel E.
Department of Radiology , University of Uludag, School of Medicine, Bursa,
Turkey.
BACKGROUND AND PURPOSE: The demonstration of communication between arachnoid
cysts (ACs) and the adjacent subarachnoid space is a prerequisite for their
proper management. CT cisternography (CTC) is the conventional method for
functional evaluation of ACs. The sensitivity of MR imaging to CSF flow has
been demonstrated, but reports of the clinical usefulness of MR CSF flow
techniques in this application are limited. The purpose of our study was to
prospectively evaluate the accuracy of MR CSF flow study as an alternative
to CTC in this setting. METHODS: MR CSF flow study with retrospective
ECG-gated 2D, fast low-angle shot, phase-contrast (PC), cine gradient-echo
sequence was performed in 39 patients with an intracranial AC. Results were
compared with intraoperative and CTC findings. RESULTS: PC cine MR imaging
results were compatible with operative or CTC findings in 36 (92.3%) of 39
patients. Twenty-four cysts were noncommunicating, and 15 were
communicating. Three cysts were evaluated as being noncommunicating on PC
cine MR imaging (false-negative) but demonstrated contrast enhancement on
CTC. No false-positive diagnoses occurred. All cysts regarded as being
communicating on PC cine MR imaging were also found to be communicating on
both confirmation methods. CONCLUSION: MR CSF flow imaging with a PC cine
sequence can be incorporated in the imaging work-up of ACs. This is a
reliable alternative to invasive CTC for the functional evaluation of ACs.
PMID: 15661716 [PubMed - indexed for MEDLINE]
-
| 4: Arch
Pathol Lab Med. 2004 Dec;128(12):1448-50. |
|
-
Pathologic quiz case: infratentorial tumor in a
middle-aged woman. Oncocytic variant of choroid plexus papilloma.
Buccoliero AM, Bacci S, Mennonna P, Taddei GL.
Dipartimento di Patologia Umana e Oncologia, Universita degli Studi di
Firenze, viale G.B. Morgagni, 85, 50134 Firenze, Italy.
ambuccoliero@unifi.it
Publication Types:
PMID: 15578895 [PubMed - indexed for MEDLINE]
 
-
| 5: Int
J Cancer. 2005 May 24; [Epub ahead of print] |
|
-
Downregulation of laminin alpha4 chain expression
inhibits glioma invasion in vitro and in vivo.
Nagato S, Nakagawa K, Harada H, Kohno S, Fujiwara H, Sekiguchi K, Ohue S,
Iwata S, Ohnishi T.
Department of Neurosurgery, Ehime University School of Medicine, Ehime,
Japan.
The laminin family is a structural constituent of the extracellular matrix
that plays an essential role in promoting the motility of infiltrative tumor
cells. We investigated the role of laminin alpha4 chain, a subset of
laminin-8, -9 and -14, in the motile and invasive activities of human glioma
cells. All malignant glioma cell lines examined expressed more mRNA for the
laminin alpha4 and beta1 chains than for the beta2 chain, indicating that
these cells predominantly express the laminin-8 isoform. Introducing an
antisense oligonucleotide for laminin alpha4 chain (AS-Ln-alpha4) into the
glioma cells resulted in downregulation of laminin alpha4 expression.
AS-Ln-alpha4 also significantly suppressed glioma cell adhesion and
migration. Furthermore, invasiveness was significantly reduced in cells
transfected with AS-Ln-alpha4 compared to those transfected with the sense
oligonucleotide (S-Ln-alpha4). Indeed, when glioma spheroids were implanted
into rat brain slices, AS-Ln-alpha4-transfected cells failed to invade
surrounding normal brain tissues. In addition, intracerebral injection of
glioma cells transfected with AS-Ln-alpha4 into nude mice resulted in the
formation of a noninvasive tumor, whereas injection of cells transfected
with S-Ln-alpha4 resulted in diffuse invasion of brain tissue. These results
suggest that mainly laminin-8 is essential for the invasive activity of
human glioma cells; thus, a novel therapeutic strategy could target this
molecule to treat patients with malignant glioma. (c) 2005 Wiley-Liss, Inc.
PMID: 15915502 [PubMed - as supplied by publisher]
-
| 6: Int
J Cancer. 2005 May 23; [Epub ahead of print] |
|
-
Inter-alu PCR detects high frequency of genetic
alterations in glioma cells exposed to sub-lethal cisplatin.
Srivastava T, Seth A, Datta K, Chosdol K, Chattopadhyay P, Sinha S.
Department of Biochemistry, All India Institute of Medical Sciences, New
Delhi, India.
Increased genomic instability contributes to higher frequency of secondary
drug resistance and neoplastic progression in tumors as well as in cells
exposed to sub-lethal concentrations of chemotherapeutic agents. We have
used PCR based DNA fingerprinting techniques of randomly amplified
polymorphic DNA (RAPD) and inter-alu PCR to study this phenomenon in the
tumor genome. The choice of the primer, either random (for RAPD) or specific
(inter-alu PCR) can determine the nature of alterations being assessed. We
have compared the inter-alu PCR and RAPD profiles of U87MG glioblastoma
cells exposed to sequentially increasing low doses of cisplatin for 24
passages to that of untreated controls. Inter-alu PCR, with 2 primers,
demonstrated a number of alterations in the treated cells, in the form of
loss / gain and changes in the intensity of bands. No changes were observed
by RAPD analysis with 5 primers, however, indicating a preferential increase
in the alu mediated recombination frequency in the treated cells (p = 1.866
x 10(-4)). The number of changes observed with respect to the corresponding
leucocyte DNA in the inter-alu PCR profile of 26 primary tumors (Grade II =
13; Grade IV = 13), resected before chemotherapy, for the 2 inter-alu
primers was very small. We present a novel application of the inter-alu PCR
in detecting alterations in long term cultured cells at low dose exposure to
a chemotherapeutic agent. Our results suggest that alu mediated
recombination may be important in cells exposed to sub-lethal doses of
cisplatin but not in the genesis of primary glioma. (c) 2005 Wiley-Liss,
Inc.
PMID: 15912534 [PubMed - as supplied by publisher]
-
| 7: Int
J Cancer. 2005 May 19; [Epub ahead of print] |
|
-
Autoantibodies against GLEA2 and PHF3 in glioblastoma:
Tumor-associated autoantibodies correlated with prolonged survival.
Pallasch CP, Struss AK, Munnia A, Konig J, Steudel WI, Fischer U, Meese
E.
Institute for Human Genetics, University Hospital of Saarland, Homburg/Saar,
Germany.
Using serological identification of recombinantly expressed tumor antigens
(SEREX), we identified several autoantibodies against glioma-expressed
antigens including GLEA1, GLEA2 and PHD-finger protein3 (PHF3). Analysing
sera of 62 glioblastoma patients, we found an antibody response against
GLEA1 in 15 sera (24.2%), against GLEA2 in 30 sera (48.4%) and against PHF3
in 35 sera (56.5%). Relating patient survival to the occurrence of
autoantibodies against either GLEA1, GLEA2 or PHF3, we found a significant
prolonged survival for glioblastoma patients positive for autoantibodies
against GLEA2 (p = 0.0115) and PHF3 (p = 0.0031), respectively. The median
survival of patients with GLEA2 antibodies was increased to 17.4 months and
for patients with PHF3 antibodies to 14.7 months, as compared to 7.2 months
for patients without GLEA2 or PHF3 antibodies. There was no significant
correlation between patient survival and GLEA1-autoantibodies (p = 0.1611).
Herein we present autoantibodies that are: (i) most frequent in glioblastoma
patients; (ii) specific for glioblastoma-associated antigens; and (iii)
significantly correlated with prolonged survival in patients with
glioblastoma. (c) 2005 Wiley-Liss, Inc.
PMID: 15906353 [PubMed - as supplied by publisher]
-
| 8: Int
J Radiat Oncol Biol Phys. 2005 May 20; [Epub ahead of print] |
|
-
Prophylactic cranial irradiation for preventing brain
metastases in patients undergoing radical treatment for non-small-cell lung
cancer: A cochrane review.
Lester JF, Macbeth FR, Coles B.
Department of Oncology, Velindre Hospital, Whitchurch, Cardiff, Wales,
United Kingdom.
PURPOSE: To investigate whether prophylactic cranial irradiation (PCI) has a
role in the management of patients with non-small-cell lung cancer (NSCLC)
treated with curative intent. METHODS AND MATERIALS: A search strategy was
designed to identify randomized controlled trials (RCTs) comparing PCI with
no PCI in NSCLC patients treated with curative intent. The electronic
databases MEDLINE, EMBASE, LILACS, and Cancerlit were searched, along with
relevant journals, books, and review articles to identify potentially
eligible trials. Four RCTs were identified and reviewed. A total of 951
patients were randomized in these RCTs, of whom 833 were evaluable and
reported. Forty-two patients with small-cell lung cancer were excluded,
leaving 791 patients in total. Because of the small patient numbers and
trial heterogeneity, no meta-analysis was attempted. RESULTS: Prophylactic
cranial irradiation did significantly reduce the incidence of brain
metastases in three trials. No trial reported a survival advantage with PCI
over observation. Toxicity data were poorly collected and no quality of life
assessments were carried out in any trial. CONCLUSION: Prophylactic cranial
irradiation may reduce the incidence of brain metastases, but there is no
evidence of a survival benefit. It was not possible to evaluate whether any
radiotherapy regimen is superior, and the effect of PCI on quality of life
is not known. There is insufficient evidence to support the use of PCI in
clinical practice. Where possible, patients should be offered entry into a
clinical trial.
PMID: 15913909 [PubMed - as supplied by publisher]
-
| 9: J Neurochem.
2005 Apr;93(2):321-9. |
|
-
Differential phosphodiesterase expression and cytosolic
Ca2+ in human CNS tumour cells and in non-malignant and malignant cells of
rat origin.
Vatter S, Pahlke G, Deitmer JW, Eisenbrand G.
Department of Chemistry, Division of Food Chemistry and Environmental
Toxicology, University of Kaiserslautern, Kaiserslautern, Germany.
A promising attempt in the field of tumour therapy is the modulation of
intracellular, proliferation-associated signalling pathways. The role of
cyclic nucleotide phosphodiesterases (PDEs), key enzymes in cAMP/cGMP signal
transduction, was investigated in two human CNS tumour cell lines as well as
in the rat glioblastoma cell line C6 in comparison with rat cerebellar
astrocytes with the emphasis on target evaluation. We found differential PDE
expression patterns in human CNS tumour cell lines as well as in CNS cells
of rat origin. In human glioblastoma cells, intracellular cAMP and Ca(2+)
levels correlated well with the PDE expression pattern. There were, however,
marked differences in PDE expression and Ca(2+) kinetics between the human
glioblastoma cell lines. In contrast to human epithelial tumour cells, shown
earlier by us to express significantly enhanced cAMP-specific PDE activity,
this was not the case in rat glioblastoma cells compared with non-malignant
rat astrocytes. Despite different levels of PDE1 and PDE4 expression and
activity, cyclic nucleotide and Ca(2+) levels in non-malignant and malignant
rat CNS cells were similar. These in vitro data do not support the concept
of PDE1C representing a target exploitable for drug treatment of malignant
CNS tumours.
PMID: 15816855 [PubMed - indexed for MEDLINE]
-
| 10: J
Neuropathol Exp Neurol. 2005 Apr;64(4):341-9. |
|
Lhermitte-Duclos disease: a report of 31 cases with
immunohistochemical analysis of the PTEN/AKT/mTOR pathway.
Abel TW, Baker SJ, Fraser MM, Tihan T, Nelson JS, Yachnis AT, Bouffard
JP, Mena H, Burger PC, Eberhart CG.
Department of Pathology, Division of Neuropathology, Johns Hopkins
University, Baltimore, Maryland 21287, USA. tabel1@jhmi.edu
Lhermitte-Duclos disease (LDD) is a rare cerebellar tumor associated with
Cowden disease (CD) and germline mutations in the PTEN gene. To further
define these relationships, we reviewed clinical and pathologic findings in
31 LDD cases and analyzed the status of the PTEN pathway in 11 of them. We
hypothesized that the granule cell hypertrophy in LDD is secondary to
activation of mammalian target of rapamycin (mTOR), a downstream effector in
the PTEN/AKT pathway and a major regulator of cell growth.
Histopathologically, in addition to the classical findings of LDD, we
observed prominent vascular proliferation and vacuolization of the white
matter in many of the lesions. Four patients met diagnostic criteria for CD,
and many of the remaining patients had some clinical features of CD.
Immunohistochemical analysis showed high levels of phospho-AKT and
phospho-S6 in the large ganglionic cells forming the lesions, indicating
activation of the PTEN/AKT/mTOR pathway and suggesting a central role for
mTOR in the pathogenesis of LDD. These data support recommendations for
genetic testing and screening for CD in patients with LDD and suggest a
novel therapy for LDD through pharmacologic inhibition of mTOR.
Publication Types:
- Review
- Review of Reported Cases
PMID: 15835270 [PubMed - indexed for MEDLINE]
-
| 11: J Neurosurg.
2005 Apr;102(3 Suppl):322-5. |
|
Pineal region giant cell astrocytoma associated with
tuberous sclerosis: case report.
Dashti SR, Robinson S, Rodgers M, Cohen AR.
Division of Pediatric Neurosurgery, Rainbow Babies and Childrens Hospital,
Cleveland, Ohio 44106-5036, USA.
Tuberous sclerosis complex is a genetic disorder characterized by the
development of hamartomas in multiple organs including the brain, skin, eye,
kidney, and heart. Neurological features include seizures and mental
retardation. Cortical tubers and subependymal nodules are the characteristic
intracranial lesions of tuberous sclerosis. Subependymal giant cell
astrocytomas, typically located adjacent to the foramen of Monro, can
enlarge and cause symptomatic ventricular obstruction. The authors describe
the case of a 3-year-old boy with a history of tuberous sclerosis and
retinal lesions who presented with an enlarging enhancing pineal region
mass. Via an infratentorial supracerebellar approach, the mass was removed
using both the operative microscope and a rigid neuroendoscope. Pathological
examination showed a giant cell astrocytoma. To the authors' knowledge, this
is the first reported case of tuberous sclerosis associated with a giant
cell astrocytoma of the pineal region. Diagnostic considerations are
discussed.
Publication Types:
PMID: 15881760 [PubMed - indexed for MEDLINE]
-
| 12: J Neurosurg.
2005 Apr;102(3 Suppl):314-7. |
|
Expansion of arachnoid cysts in children: report of two
cases and review of the literature.
Rao G, Anderson RC, Feldstein NA, Brockmeyer DL.
Department of Neurosurgery, Division of Pediatric Neurosurgery, University
of Utah, Salt Lake City, Utah 84132, USA.
Arachnoid cysts are intracranial, space-occupying lesions that typically
remain stable in size on serial imaging. The authors describe two cases of
rapidly enlarging arachnoid cysts, including one located in the anterior
fossa. In the first case a 7-month-old boy presented with increasing head
circumference and a rapidly enlarging arachnoid cyst in the left middle
fossa, which had been documented by serial imaging over the preceding 6
months. In the second case a 4-year-old girl presented with an arachnoid
cyst compressing the right frontal lobe. The cyst had not been present on
imaging studies performed during the perinatal period. In both cases, a
craniotomy for open fenestration of the cyst was performed with successful
resolution of the mass effect. Rare cases of expansion of arachnoid cysts
have been reported in the literature. In this article the authors report the
dramatic enlargement of two arachnoid cysts, including the first description
of enlargement of an arachnoid cyst located in the anterior fossa.
Publication Types:
PMID: 15881758 [PubMed - indexed for MEDLINE]
-
| 13: J Neurosurg.
2005 Apr;102(3 Suppl):299-302. |
|
Multicentric atypical teratoid/rhabdoid tumors occurring
in the eye and fourth ventricle of an infant: case report.
Fujita M, Sato M, Nakamura M, Kudo K, Nagasaka T, Mizuno M, Amano E,
Okamoto Y, Hotta Y, Hatano H, Nakahara N, Wakabayashi T, Yoshida J.
Department of Ophthalmology, Hamamatsu University School of Medicine,
Hamamatsu, Japan.
Atypical teratoid/rhabdoid tumors (AT/RTs) are aggressive malignant tumors
found in infants and young children. The tumor is characterized by the
presence of a rhabdoid cell component in all cases, but the histological
origin is still unclear. Recently, germline mutation of the hSNF5/INI1 gene
has been reported in association with AT/RTs. The authors report a rare case
of an intraocular AT/RT followed by a fourth ventricular tumor. The results
of immunohistochemical studies of the surgical specimens revealed the
presence of an AT/RT and from this finding the neural origin was inferred. A
novel missense mutation of the hSNF5/INI1 gene was demonstrated by DNA
analysis. High-dose chemotherapy with stem cell rescue was effective in
treating this patient. The immunohistochemical relationship between rhabdoid
cells and the neurogenic zone, which has not been described in AT/RTs, is of
great interest in view of the nature of rhabdoid cells.
Publication Types:
PMID: 15881754 [PubMed - indexed for MEDLINE]
-
| 14: J Neurosurg.
2005 Apr;102(3 Suppl):288-93. |
|
Seizure outcome of lesionectomy in glioneuronal tumors
associated with epilepsy in children.
Giulioni M, Galassi E, Zucchelli M, Volpi L.
Department of Neurosciences, Bellaria Hospital, Bologna, Italy.
giulioni.m@tiscali.it
OBJECT: Glioneuronal tumors (ganglioglioma, dysembryoplastic neuroepithelial
tumors [DNTs]) are commonly associated with partial seizures. The optimal
surgical treatment of such tumors, however, has not been fully established;
it is still unclear whether lesionectomy itself can be used to control
seizures or if epileptogenic areas adjacent to the tumor should also be
removed. To address this uncertainty, the authors analyzed seizure outcome
in a series of children with epileptogenic glioneuronal tumors that had been
treated only by lesionectomy. METHODS: The authors retrospectively reviewed
15 children surgically treated for glioneuronal tumors associated with
epilepsy. Patients ranged in age from 3 to 18 years (mean 12.6 years); there
were 12 boys and three girls. The interval between onset of seizures and
surgery ranged from 0.5 to 16 years (mean 6.1 years). Ten patients (66.6%)
suffered complex partial seizures and five (33.3%) simple partial seizures.
Seizure frequency varied from several per day to one per month. Nine tumors
(60%) were temporal and six extratemporal; in all patients resection was
limited to the tumor. The follow-up duration ranged from 1 to 11 years (mean
5.6 years). Gross-total removal was achieved in 13 patients and subtotal in
two. The histological diagnosis was ganglioglioma in 11 cases and DNT in
four. At last follow up 13 patients (86.6%) were Engel Class I, one was
Engel Class II, and one was Engel Class III. CONCLUSIONS: The results of
this study indicate that lesionectomy may provide good long-term seizure
control in the majority of children with epileptogenic glioneuronal tumors.
PMID: 15881752 [PubMed - indexed for MEDLINE]
-
| 15: J Neurosurg.
2005 Apr;102(3 Suppl):280-7. |
|
Surgical management of temporal lobe tumor-related
epilepsy in children.
Cataltepe O, Turanli G, Yalnizoglu D, Topcu M, Akalan N.
Departments of Neurosurgery and Pediatric Neurology, Hacettepe University
Medical School, Ankara, Turkey. catalteo@um.mhc.org
OBJECT: Slow-growing, low-grade temporal lobe tumors are one of the most
common causes of epilepsy in children. Although there are numerous
consistent features in this patient group, consensus about the management
and surgical approach is lacking. In this study the authors review the
clinical, pathological, and radiological features as well as outcome data
obtained in 29 pediatric patients with temporal lobe tumor-related epilepsy
and discuss the surgical treatment strategies. METHODS: In patients who
presented with intractable seizures secondary to mass lesions and underwent
comprehensive epilepsy workup, the tumor was resected and the diagnosis
confirmed by pathological examination. A minimum follow-up period of 16
months was required. Medical records were reviewed for details of seizure
type and duration, electrophysiological data, imaging studies, operative
notes, pathological examination reports, and follow-up data. The surgical
approach was as follows. The lesionectomy with/without cortical resection
was performed in all cases of lateral temporal tumors. Lesionectomy was
performed with/without cortical resection in cases of basal temporal tumors
if the mesial structures were radiologically normal. Mesial temporal tumors
were excised, as were the remaining mesial temporal structures in the
nondominant hemisphere; however, if the tumor was in the dominant
hemisphere, lesionectomy was performed only if the remaining mesial
structures were radiologically normal. Twenty-nine patients between 2 and 18
years of age were identified. Most tumors were located in the mesial
temporal lobe. All patients underwent resection of the tumor with or without
mesial and cortical structures. The most common pathological entity was
dysembryoplastic neuroepithelial tumor. Sixty-nine percent of the patients
remained seizure free (Engel Class I) and 14% experienced significant
improvement (Engel Class II) after surgery. Outcome was better in the
patients who underwent gross-total tumor resection. CONCLUSIONS: Mesially
located low-grade neoplasms were the most frequently observed mass lesions
in children with temporal tumor-related epilepsy in this series. Resection
of the tumor with or without amygdalohippocampectomy provides a high rate of
seizure-free outcome. It is the author's opinion that temporal lobe tumors
should be managed based on the subgroups defined by their anatomical
locations. If the tumor is located in or in proximity to eloquent cortex, we
recommend functional magnetic resonance imaging and invasive monitoring
techniques to map the eloquent cortex and epileptogenic zone, thereby
tailoring the resection.
PMID: 15881751 [PubMed - indexed for MEDLINE]
-
| 16: J Neurosurg.
2005 Apr;102(4):745-52. |
|
Comment in:
Battling blood loss in neurosurgery: Harvey Cushing's
embrace of electrosurgery.
Voorhees JR, Cohen-Gadol AA, Laws ER, Spencer DD.
Department of Neurological Surgery, Yale University School of Medicine, New
Haven, Connecticut, USA.
For his pioneering spirit, definitive work, and unparalleled devotion to
conquering neurosurgery's toughest obstacles, Harvey Williams Cushing
inarguably has earned the title, "The Father of Neurosurgery." His
revolutionary incorporation of electrosurgical techniques in neurosurgery
was not exceptional, but part of a pattern of recognizing, embracing, and
establishing the use of medical technologies with great potential. Until
1910, Cushing had systematically reduced neurosurgery's primary
complications--infection and the effects of intracranial pressure--to
decrease mortality rates. Hemostasis had always been a concern of William
Halsted's surgical protege, but only after 1910 could Cushing primarily
focus on it. In fact, Cushing's crucial collaboration with William T. Bovie
and his electrosurgical apparatus conquered this major obstacle in 1926. The
nature of their collaboration--two experts in their respective fields who
were passionate about their work, working side by side in the operating
room--resulted in progress that surpassed all predecessors in the field.
Cushing never did learn the physics behind one of the most important
advances of his career. Nonetheless, he did know that by greatly reducing
blood loss, electrosurgery allowed him to operate in patients whose tumors
had been previously deemed inoperable and on the entire spectrum of
neurosurgical patients more safely.
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
- Cushing HW
- Halsted W
- Bovie WT
PMID: 15871521 [PubMed - indexed for MEDLINE]
-
| 17: J Neurosurg.
2005 Apr;102(4):730-2. |
|
Intracranial metastasis from a sacrococcygeal chordoma.
Case report.
Kamel MH, Lim C, Kelleher M, Aquilina K, Keohane C, Kaar G.
Department of Neurosurgery, Cork University Hospital, Beaumont Hospital,
Dublin, Republic of Ireland. mahmoudhamdy@yahoo.com
Chordoma is a locally invasive tumor of low metastatic potential. Only six
cases of chordoma that metastasized to the brain are found in the English
literature. Most of these lesions were clinically silent and all were
associated with extraneural metastases. The authors report a case of
symptomatic brain metastasis from a sacrococcygeal chordoma in the absence
of other metastases. The incidence, sites, and factors predictive of
chordoma metastasis are discussed.
Publication Types:
PMID: 15871518 [PubMed - indexed for MEDLINE]
-
| 18: J Neurosurg.
2005 Apr;102(4):678-91. |
|
Stereotactic radiosurgery for pituitary adenomas: an
intermediate review of its safety, efficacy, and role in the neurosurgical
treatment armamentarium.
Sheehan JP, Niranjan A, Sheehan JM, Jane JA Jr, Laws ER, Kondziolka D,
Flickinger J, Landolt AM, Loeffler JS, Lunsford LD.
Department of Neurological Surgery, University of Virginia Health System,
Charlottesville, Virginia 22908, USA. jps2f@virginia.edu
OBJECT: Pituitary adenomas are very common neoplasms, constituting between
10 and 20% of all primary brain tumors. Historically, the treatment
armamentarium for pituitary adenomas has included medical management,
microsurgery, and fractionated radiotherapy. More recently, radiosurgery has
emerged as a viable treatment option. The goal of this research was to
define more fully the efficacy, safety, and role of radiosurgery in the
treatment of pituitary adenomas. METHODS: Medical literature databases were
searched for articles pertaining to pituitary adenomas and stereotactic
radiosurgery. Each study was examined to determine the number of patients,
radiosurgical parameters (for example, maximal dose and tumor margin dose),
duration of follow-up review, tumor growth control rate, complications, and
rate of hormone normalization in the case of functioning adenomas. A total
of 35 peer-reviewed studies involving 1621 patients were examined.
Radiosurgery resulted in the control of tumor size in approximately 90% of
treated patients. The reported rates of hormone normalization for
functioning adenomas varied substantially. This was due in part to
widespread differences in endocrinological criteria used for the
postradiosurgical assessment. The risks of hypopituitarism,
radiation-induced neoplasia, and cerebral vasculopathy associated with
radiosurgery appeared lower than those for fractionated radiation therapy.
Nevertheless, further observation will be required to understand the true
probabilities. The incidence of other serious complications following
radiosurgery was quite low. CONCLUSIONS: Although microsurgery remains the
primary treatment modality in most cases, stereotactic radiosurgery offers
both safe and effective treatment for recurrent or residual pituitary
adenomas. In rare instances, radiosurgery may be the best initial treatment
for patients with pituitary adenomas. Further refinements in the
radiosurgical technique will likely lead to improved outcomes.
Publication Types:
PMID: 15871511 [PubMed - indexed for MEDLINE]
-
| 19: J Neurosurg.
2005 Apr;102(4):664-72. |
|
Combined use of tractography-integrated functional
neuronavigation and direct fiber stimulation.
Kamada K, Todo T, Masutani Y, Aoki S, Ino K, Takano T, Kirino T, Kawahara
N, Morita A.
Departments of Neurosurgery and Radiology, The University of Tokyo; and
Kobayashi Sofamor-Danek, Tokyo, Japan. kamady-k@umin.ac.jp
OBJECT: The aim of this study was better preoperative planning and direct
application to intraoperative procedures through accurate coregistration of
diffusion-tensor (DT) imaging-based tractography results and anatomical
three-dimensional magnetic resonance images and subsequent importation of
the combined images to a neuronavigation system (functional
neuronavigation). METHODS: Six patients with brain lesions adjacent to the
corticospinal tract (CST) were studied. During surgery, direct fiber
stimulation was used to evoke motor responses to confirm the accuracy of CST
depicted on functional neuronavigation. In three patients, stimulation of
the supposed CST elicited the expected motor evoked potentials. In the other
three, stimulation at the resection borders more than 1 cm away from the
supposed CST showed no motor response. All patients underwent appropriate
tumor resection with preservation of the CST. CONCLUSIONS: Integration of
the DT imaging-based tractography information into a traditional
neuronavigation system demonstrated spatial relationships between lesions
and the CST, allowing for the avoidance of tract injury during lesion
resection. Direct fiber stimulation was used for real-time reliable white
matter mapping, which served to adjust for any discrepancy between the
neuronavigation system data and potentially shifted positions of the brain
structures. The combination of these techniques enabled the authors to
identify accurate positions of the CST during surgery and to accomplish
optimal tumor resections.
Publication Types:
PMID: 15871509 [PubMed - indexed for MEDLINE]
-
| 20: J Neurosurg.
2005 Apr;102(4):658-63. |
|
High-resolution three-dimensional T2-weighted sequence
for neuronavigation: a new setup and clinical trial.
Gralla J, Guzman R, Brekenfeld C, Remonda L, Kiefer C.
Department of Neuroradiology, Inselspital, University of Bern, Switzerland.
jan.gralla@insel.ch
OBJECT: Conventional imaging for neuronavigation is performed using
high-resolution computerized tomography (CT) scanning or a T1-weighted
isovoxel magnetic resonance (MR) sequence. The extension of some lesions,
however, is depicted much better on T2-weighted MR images. A possible fusion
process used to match low-resolution T2-weighted MR image set with a
referenced CT or T1-weighted data set leads to poor resolution in the
three-dimensional (3D) reconstruction and decreases accuracy, which is
unacceptable for neuronavigation. The object of this work was to develop a
3D T2-weighted isovoxel sequence (3D turbo-spin echo [TSE]) for image-guided
neuronavigation of the whole brain and to evaluate its clinical application.
METHODS: The authors performed a phantom study and a clinical trial on a
newly developed T2-weighted isovoxel sequence, 3D TSE, for image-guided
neuronavigation using a common 1.5-tesla MR imager (Siemens Sonata
whole-body imager). The accuracy study and intraoperative image guidance
were performed with the aid of the pointer-based Medtronic Stealth Station
Treon. The 3D TSE data set was easily applied to the navigational setup and
demonstrated a high registration accuracy during the experimental trial and
during an initial prospective clinical trial in 25 patients. The sequence
displayed common disposable skin fiducial markers and provided convincing
delineation of lesions that appear hyperintense on T2-weighted images such
as low-grade gliomas and cavernomas in its clinical application.
CONCLUSIONS: Three-dimensional TSE imaging broadens the spectrum of
navigational and intraoperative data sets, especially for lesions that
appear hyperintense on T2-weighted images. The accuracy of its registration
is very reliable and it enables high-resolution reconstruction in any
orientation, maintaining the advantages of image-guided surgery.
Publication Types:
PMID: 15871508 [PubMed - indexed for MEDLINE]
-
| 21: J Neurosurg.
2005 Apr;102(4):629-36. |
|
Is gross-total resection sufficient treatment for
posterior fossa ependymomas?
Rogers L, Pueschel J, Spetzler R, Shapiro W, Coons S, Thomas T, Speiser
B.
GammaWest Radiation Therapy, Salt Lake City, Utah 84102, USA.
leland@gammawest.com
OBJECT: The goals of this study were to analyze outcomes in patients with
posterior fossa ependymomas, determine whether gross-total resection (GTR)
alone is appropriate treatment, and evaluate the role of radiation therapy.
METHODS: All patients with newly diagnosed intracranial ependymomas treated
at Barrow Neurological Institute between 1983 and 2002 were identified.
Those with supratentorial primary lesions, subependymomas, or neuraxis
dissemination were excluded. Forty-five patients met the criteria for the
study. Gross-total resection was accomplished in 32 patients (71%) and
subtotal resection (STR) in 13 (29%). Radiation therapy was given to 25
patients: 13 following GTR and 12 after STR. The radiation fields were
craniospinal followed by a posterior fossa boost in six patients and
posterior fossa or local only in the remaining patients. With a median
follow-up period of 66 months, the median duration of local control was 73.5
months with GTR alone, but has not yet been reached for patients with both
GTR and radiotherapy (p = 0.020). The median duration of local control
following STR and radiotherapy was 79.6 months. The 10-year actuarial local
control rate was 100% for patients who underwent GTR and radiotherapy, 50%
for those who underwent GTR alone, and 36% for those who underwent both STR
and radiotherapy, representing significant differences between the
GTR-plus-radiotherapy and GTR-alone cohorts (p = 0.018), and between the
GTR-plus-radiotherapy and the STR-plus-radiotherapy group (p = 0.003). There
was no significant difference in the 10-year actuarial local control rate
between the GTR-alone and STR-plus-radiotherapy cohorts (p = 0.370). The
10-year overall survival was numerically superior in patients who underwent
both GTR and radiotherapy: 83% compared with 67% in those who underwent GTR
alone and 43% in those who underwent both STR and radiotherapy. These
differences did not achieve statistical significance. Univariate analyses
revealed that radiotherapy, tumor grade, and extent of resection were
significant predictors of local control. CONCLUSIONS: Gross-total resection
should be the intent of surgery when it can be accomplished with an
acceptable degree of morbidity. Even after GTR has been confirmed with
postoperative imaging, however, adjuvant radiotherapy significantly improves
local control. The authors currently recommend the use of postoperative
radiotherapy, regardless of whether the resection is gross total or
subtotal.
PMID: 15871504 [PubMed - indexed for MEDLINE]
|
Volume 4, Number 23 - 31 May 2005