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Meningioangiomatosis with meningioma: an uncommon
association of a rare entity-report of a case and review of the literature.
Deb
P, Gupta
A, Sharma
MC, Gaikwad
S, Singh
VP, Sarkar
C.
Department of Pathology, All India Institute of Medical Sciences (AIIMS),
Ansari Nagar, New Delhi, 110029, India, meharsharma@hotmail.com.
INTRODUCTION: Meningioangiomatosis (MA) is a rare lesion, probably of
malformative origin, consisting of meningovascular proliferation and
leptomeningeal calcification. Patients with MA usually present with seizures
or persistent headaches. Neurofibromatosis may be associated in a variable
proportion of patients, while in others it may be sporadic. Surgical
treatment is usually recommended, and is gratifying in most cases. Rarely,
MA has been described coexisting with meningiomas, arteriovenous
malformations, encephaloceles, oligodendrogliomas, meningeal
haemangiopericytomas and orbital erosion. Among these, meningiomatosis with
meningioma is the most frequent combination. CASE REPORT: We report a case
of MA with meningioma in an 18-month-old girl, who presented with recurrent
seizures. DISCUSSION: In these situations, it is extremely important for the
pathologist to be aware of this entity and to distinguish it from other
lesions, like cortical invasion by a meningioma, intraparenchymal meningioma
and intracerebral schwannoma, which it may mimic.
PMID: 16389566 [PubMed - in process]
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Management of child optic pathway gliomas: new
therapeutical option.
Suarez
JC, Viano
JC, Zunino
S, Herrera
EJ, Gomez
J, Tramunt
B, Marengo
I, Hiramatzu
E, Miras
M, Pena
M, Sonzini
Astudillo B.
Department of Neurosurgery, Allende Clinic and Municipal Child Hospital,
Cordoba, Argentina, totoralar@yahoo.com.
OBJECTIVE: To present our experience in the treatment of child optic pathway
gliomas in the last 25 years. MATERIAL AND METHODS: Seventeen children under
10 years of age have been analyzed and assessed from clinic, ophthalmologic,
endocrinologic, neurological, neuropathologic, and imaginologic points of
view. RESULTS: Predominance of female patients, 10 girls and 7 boys between
6 and 122 months old; mean age was 3 years and 8 months. The most frequent
symptoms have been ophthalmologic and visual alterations in all 17 patients,
endocrine alterations in 10, and neurological signs in 6. One of the
patients presented neurofibromatosis type 1 (NF1), another patient had Down
syndrome. Diagnosed using computed tomography or/and magnetic resonance
imaging, histological studies showed pilocytic astrocytomas in 13 cases and
a fibrillary astrocytoma grade II in 1 case. There were three patients
without histological diagnosis; one of them had NF1. The treatment consisted
of surgery, external beam radiotherapy, chemotherapy, and brachytherapy with
iodine 125, separately or combined. Five patients died; the causes were
secondary tumors in two children, tumor recurrence in one, sepsis secondary
to respiratory and urinary tract infections in the child with Down syndrome,
and finally, hydrocephaly due to hyperproteinorachia of tumor origin in one.
Average survival was 89 months. CONCLUSION: Chemotherapy and brachytherapy
are therapeutic methods to be considered, especially in children under 5.
Marsupialization of the residual cyst into the ventricular system postradio
or oncolytic treatment through endoscopic or stereotactic techniques is
useful in the treatment of endocranial hypertension and/or hypothalamic
compression in these patients.
PMID: 16389565 [PubMed - as supplied by publisher]
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The Geneva and Lausanne (French-speaking Switzerland)
experience: in favor of the transsphenoidal approach when feasible.
Rilliet
B, Vernet
O, Pica
A.
Service de Neurochirurgie, Hopitaux Universitaires de Geneve, rue
Micheli-du-Crest 24, 1205, Geneva, Switzerland. benedict.rilliet@hcuge.ch
BACKGROUND: The authors present their current attitude towards management of
craniopharyngiomas in children. Radical surgery cannot be performed when one
is not sure about its potential danger to the visual pathways and the
hypothalamus. METHODS: Most of the surgeries that have been performed in our
institution via an intracranial approach were incomplete and followed by
radiotherapy, in the last 10 years with stereotactic conformational
radiotherapy. DISCUSSION: Considering our past and present experience
concerning the transphenoidal approach for treatment of craniopharyngiomas,
we make a plea for the consideration of this approach in children whenever
feasible (around 25% of the cases in children older than 5 years).
Craniopharyngiomas that can be removed by this approach represent a milder
form of the disease and the results concerning the visual, hypothalamic
functions and quality of life are significantly better than that obtained
via an intracranial approach. When the craniopharyngioma cannot be removed
by this approach because of tight hypothalamic adherences, the technique of
cystosphenoidostomy with a custom-made shunt plus adjuvant stereotactic
conformational radiotherapy is an alternative for its total removal.
Publication Types:
PMID: 15959735 [PubMed - indexed for MEDLINE]
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Combination chemotherapy with 13-cis-retinoic acid and
celecoxib in the treatment of glioblastoma multiforme.
Levin
VA, Giglio
P, Puduvalli
VK, Jochec
J, Groves
MD, Yung
WK, Hess
K.
Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer
Center, Houston, Texas, USA.
In a phase II clinical trial, we sought to determine if combining celecoxib
with 13-cis-retinoic acid (13-cRA, Accutanetrade mark) was efficacious in
the treatment of recurrent (progressive) glioblastoma multiforme (GBM). In
parallel, we also sought to determine to what extent the outcomes from this
clinical trial correlated with the findings from studies utilizing two
murine intracerebral GBM models, U87MG and U251HF, to determine the
predictive value of these murine models. In the clinical trial, 25 patients
were studied at recurrence. Stable disease, which occurred in 44% of the
patients, was the best response. The median progression-free survival (PFS)
was 8 weeks, with a PFS at 6 months of only 19%. For the patients with
stable disease, the median PFS was 24 weeks. The toxicity profile was
unremarkable. The modest effect on PFS seen in this study agreed with the
recent findings of another study, which showed a 19% PFS at 6 months in
patients treated with 13-cRA alone. Thus, the combination of 13-cRA with
celecoxib is not more effective than 13-cRA in the treatment of progressive
GBM. In the murine model study, we found that long-term dosing with 13-cRA
or celecoxib alone or in combination did not increase survival in animals
with U87MG tumors but modestly increased survival in animals with U251HF
tumors. There was no evidence of synergism between the two drugs. From this,
we concluded that the animal studies generally predicted that the two agents
would have only a modest effect alone and no additive effect when given in
combination to patients.
PMID: 16391896 [PubMed - as supplied by publisher]
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Dosimetric Model for Locoregional Treatments of Brain
Tumors with 90Y-Conjugates: Clinical Application with 90Y-DOTATOC.
Ferrari
M, Cremonesi
M, Bartolomei
M, Bodei
L, Chinol
M, Fiorenza
M, Tosi
G, Paganelli
G.
Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy;
and 2Medical Physics, European Institute of Oncology, Milan, Italy.
Locoregional (LR) administration of (90)Y-conjugates after surgical
debulking is a promising therapeutic option of gliomas. Dosimetry is highly
recommended, as patient-specific parameters influence the absorbed dose to
target and normal tissues. After tumor resection, the absorbed dose must be
carefully evaluated in the rim of tissue surrounding the resected area. The
aim of this study was to calculate and provide the S values, according to
the MIRD concept, for dosimetry of LR brain treatments with several
(90)Y-labeled compounds. The S values thus obtained have been clinically
applied in 12 patients treated with (90)Y-labeled
[DOTA(0),d-Phe(1),Tyr(3)]octreotide ((90)Y-DOTATOC). METHODS: An
anthropomorphic model for Monte Carlo simulations was developed to evaluate
absorbed doses in brain-adjacent tissue (BAT) and in normal brain. To adapt
the model to single patients, S values were evaluated taking into account
(i) different surgical resection cavity (SRC) volumes, (ii) different
percentages of conjugate binding to the cavity wall, and (iii) different
depths of percolation of the conjugate trough the cavity wall. BAT was
divided into 1-mm-thick consecutive adjacent shells to evaluate the dose
distribution around the cavity. Corresponding S values were obtained to
allow dosimetric evaluation in brain LR therapy with (90)Y-conjugates. In
the clinical treatments, 0.4-1.1 GBq of (90)Y-DOTATOC were injected into the
SRC via an appropriate catheter. The activity in the SRC was assumed to be
the difference between the total injected activity and the activity in the
blood plus the activity cumulatively eliminated with the urine. RESULTS:
Assuming no diffusion, with a mean residence time in SRC of 60 +/- 8 h,
absorbed doses to shell II were 0.25 and 0.03 Gy/MBq for SRC volumes of 7.2
and 65.4 mL, respectively. Assuming a slight diffusion of 1 mm with a 7.2-mL
SRC, absorbed dose to shells I, II, and VI were consistently different:
5.32, 2.53, and 0.12 Gy/MBq, respectively. Mean doses to normal brain, red
marrow, bladder wall, and total body were 0.015, 0.03, 1.22, and 0.006
MGy/MBq. CONCLUSION: The model proved to be suitable for the dosimetry of
several LR therapies with (90)Y-conjugates. According to our results, LR
treatment with (90)Y-DOTATOC can safely deliver very high doses to target
tissue, sparing normal organs including brain.
PMID: 16391194 [PubMed - in process]
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| 6: Neurology.
2005 Jul 26;65(2):339; author reply 339. |
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Comment on:
Auditory agnosia caused by a tectal germinoma.
Simon
EN.
Publication Types:
PMID: 16043823 [PubMed - indexed for MEDLINE]
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Clinical features of status epilepticus in patients with
HIV infection.
Lee
KC, Garcia
PA, Alldredge
BK.
School of Pharmacy, Loma Linda University, 11262 Campus Street, West Hall
1333, Loma Linda, CA 92350, USA. kclee@rx.llu.edu
The authors reviewed the records of 42 patients with HIV infection and
status epilepticus (SE). Brain tumor and infection were the most common
etiologies. The median duration of SE was 2.0 +/- 10 hours. Most patients
(37 [88%]) responded to IV benzodiazepine or phenytoin treatment.
Nevertheless, 12 (29%) patients died and 15 (36%) developed new neurologic
deficits. In patients with HIV infection, aggressive management of seizures
may limit the risk of SE.
PMID: 16043809 [PubMed - indexed for MEDLINE]
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Volume 5, Number 2 - 7 January 2006