| 1: Cancer. 2006 Jun
15;106(12):2672-81. |
|
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Cerebral metastases pathology after radiosurgery: a
multicenter study.
Szeifert GT, Atteberry DS, Kondziolka D, Levivier M,
Lunsford LD.
National Institute of Neurosurgery and Department of Neurological Surgery,
Semmelweis University, Budapest, Hungary.
BACKGROUND: To the authors' knowledge, comprehensive human pathologic
investigations that explore fundamental radiosurgical effects on metastatic
brain tumors are sparse in the literature. The objective of this study was
to analyze histopathologic findings in a set of clinically recurrent
cerebral metastases after patients underwent stereotactic radiosurgery
(SRS). METHODS: In a series of 7500 patients who underwent radiosurgery,
2020 patients (27%) harbored cerebral metastases. Eighteen of 2020 patients
(0.9%) underwent subsequent craniotomy for tumor removal anywhere from 1
month to 59 months after they received high-dose irradiation. Histologic and
immunohistochemical investigations were performed on the surgically resected
tissue specimens. These specimens were within the radiosurgical treatment
volume of the metastatic tumor. RESULTS: Light microscopy revealed 3 basic
categories of histologic responses: acute-type, subacute-type, and
chronic-type tissue reactions. A moderate-to-intense inflammatory cell
reaction was seen in the tissue responses of well controlled neoplasms
(i.e., in patients who had neoplasms that required craniotomy for recurrent
disease > 5 months after SRS), whereas the inflammatory reaction was
missing or sparse in poorly controlled neoplasms (patients who required
craniotomy for recurrent disease < 5 months after SRS). This reaction was
seen within the irradiated tumor volume and not in the peritumoral area nor
in areas remote from the radiosurgical treatment volume. Immunohistochemical
characterization demonstrated the presence of prominent CD68-positive
macrophage and CD3-positive T-lymphocyte populations. A progressively severe
vasculopathy also was observed with increasing time after radiosurgery.
CONCLUSIONS: Although causality has not been established, a brisk
inflammatory response and more severe vasculopathy were observed in lesions
in which recurrences were more delayed. Copyright 2006 American Cancer
Society.
Publication Types:
PMID: 16700040 [PubMed - indexed for MEDLINE]3
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| 2: Cancer. 2006 Jun
15;106(12):2540-6. |
|
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Central nervous system recurrence in adult patients with
acute lymphoblastic leukemia: frequency and prognosis in 467 patients
without cranial irradiation for prophylaxis.
Sancho JM, Ribera JM, Oriol A, Hernandez-Rivas JM,
Rivas C, Bethencourt C, Parody R, Deben G, Bello
JL, Feliu E; Programa para el Estudio y Tratamiento de
Hemopatias Malignas Group.
Clinical Hematology Department. Institut Catala d'Oncologia-Hospital Germans
Trias i Pujol, Badalona, Universidad Autonoma de Barcelona, Barcelona,
Spain.
Recurrence of acute lymphoblastic leukemia (ALL) in the central nervous
system (CNS) confers a poor prognosis, although to the authors' knowledge,
only a few studies have analyzed this issue in adults. For the current
study, the authors analyzed the frequency, predictive factors, and prognosis
of CNS involvement and recurrence in adult patients with ALL who did not
receive cranial irradiation for CNS prophylaxis. Four hundred sixty-seven
adult patients (age > or = 15 years) with ALL were treated on 4
protocols: ALL-89 (standard-risk and high-risk ALL; n = 108 patients),
ALL-93 (high-risk ALL; n = 222 patients), ALL-96 (standard-risk ALL; n = 84
patients), and ALL3-97 (Burkitt leukemia; n = 53 patients). CNS prophylaxis
consisted of intrathecal methotrexate, cytarabine, and hydrocortisone
together with high-dose systemic methotrexate and cytarabine. The mean age
(+/- standard deviation) was 33 years (+/- 16 years), and 272 patients were
males. ALL subtypes included an early pre-B phenotype (15%), a common
phenotype (45%), a pre-B phenotype (5%), a mature B phenotype (11%), and a T
phenotype (24%). CNS involvement at diagnosis was observed in 18 patients
(3.9%). Of 159 recurrences, 22 occurred (5.8%) in the CNS (14 isolated and 8
combined). A lactate dehydrogenase level > 1000 U/L was the only factor
associated with the risk of CNS recurrence. A complete remission was
attained in 7 of 22 patients (32%). The median overall survival after
recurrence was 0.7 years for patients with isolated CNS recurrence, 0.13
years for patients with combined recurrence, and 0.41 years for patients
with bone marrow recurrence (P = .11). The only 2 survivors underwent stem
cell transplantation. The frequency of CNS recurrence in adult patients with
ALL who do not receive radiotherapy for CNS prophylaxis was similar to the
frequency observed in protocols that included cranial irradiation. A lactate
dehydrogenase value >1000 U/L was the only factor found to be associated
with CNS recurrence. The prognosis for patients who develop CNS recurrence
is poor, identical to that for patients who develop bone marrow recurrence.
Copyright 2006 American Cancer Society.
PMID: 16700036 [PubMed - indexed for MEDLINE]2
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| 3: Cancer Res. 2006 Jul
15;66(14):7270-5. |
|
-
Acting via a Cell Surface Receptor, Thyroid Hormone Is a
Growth Factor for Glioma Cells.
Davis FB, Tang HY, Shih A, Keating T, Lansing
L, Hercbergs A, Fenstermaker RA, Mousa A, Mousa
SA, Davis PJ, Lin HY.
Ordway Research Institute, Inc.
Recent evidence suggests that the thyroid hormone l-thyroxine (T(4))
stimulates growth of cancer cells via a plasma membrane receptor on integrin
alpha(V)beta(3). The contribution of this recently described receptor for
thyroid hormone and receptor-based stimulation of cellular mitogen-activated
protein kinase [MAPK; extracellular signal-regulated kinase 1/2 (ERK1/2)]
activity, to enhancement of cell proliferation by thyroid hormone was
quantitated functionally and by immunologic means in three glioma cell lines
exposed to T(4). At concentrations of 1 to 100 nmol/L, T(4) caused
proliferation of C6, F98, and GL261 cells, measured by accumulation of
proliferating cell nuclear antigen (PCNA) and radiolabeled thymidine
incorporation. This effect was inhibited by the T(4) analogue,
tetraiodothyroacetic acid, and by an alpha(V)beta(3) RGD recognition site
peptide, both of which block T(4) binding to integrin alpha(V)beta(3) but
are not agonists. Activation of MAPK by T(4) was similarly inhibited by
tetraiodothyroacetic acid and the RGD peptide. The thyroid hormone
3,5,3'-triiodo-l-thyronine (T(3)) and T(4) were equipotent stimulators of
PCNA accumulation in C6, F98, and GL261 cells, but physiologic
concentrations of T(3) are 50-fold lower than those of T(4). In conclusion,
our studies suggest that glioblastoma cells are thyroid hormone dependent
and provide a molecular basis for recent clinical observations that
induction of mild hypothyroidism may improve duration of survival in
glioblastoma patients. The present experiments infer a novel cell membrane
receptor-mediated basis for the growth-promoting activity of thyroid hormone
in such tumors and suggest new therapeutic approaches to the treatment of
patients with glioblastoma. (Cancer Res 2006; 66(14): 7270-5).
PMID: 16849576 [PubMed - in process]3
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| 4: Cancer Res. 2006 Jul
15;66(14):7067-74. |
|
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Early Growth Response Gene-1 Regulates Hypoxia-Induced
Expression of Tissue Factor in Glioblastoma Multiforme through
Hypoxia-Inducible Factor-1-Independent Mechanisms.
Rong Y, Hu F, Huang R, Mackman N, Horowitz JM,
Jensen RL, Durden DL, Van Meir EG, Brat DJ.
Departments of Pathology and Laboratory Medicine, Psychiatry and Behavioral
Science, Obstetrics and Gynecology, Pediatrics, Hematology/Oncology, and
Neurosurgery, Winship Cancer Institute, Emory University School of Medicine,
Atlanta, Georgia.
Hypoxia strongly up-regulates tissue factor and promotes plasma clotting by
glioblastoma multiforme, but transcriptional mechanisms remain undefined.
Here, we investigated the potential roles of early growth response gene-1
(Egr-1), Sp1, nuclear factor-kappaB (NF-kappaB), activator protein-1 (AP-1),
and hypoxia-inducible factor-1 (HIF-1) in the hypoxic regulation of tissue
factor by glioblastoma multiforme cells in vitro. Hypoxia (1% O(2)) strongly
induced Egr-1 mRNA within 1 hour and led to nuclear localization of Egr-1
protein. Using luciferase reporter plasmids in glioma cells, we found that
hypoxia dramatically increased luciferase activity in cells with constructs
containing Egr-1-binding sites but not in cells with constructs containing
AP-1- or NF-kappaB-binding sites. Electrophoretic mobility shift assays
revealed hypoxia-induced Egr-1, but not Sp1, binding to oligonucleotides
containing the Egr-1/Sp1 motif of tissue factor gene promoter. Using an
expression vector containing the minimal tissue factor promoter (-111 to +14
bp) and small interfering RNA (siRNA) directed at Egr-1 and Sp1 mRNAs, we
found that Egr-1 was required for maximal hypoxic induction of promoter
activity. Forced overexpression of Egr-1 but not Sp1 by cDNA transfection
caused up-regulation of tissue factor in glioma cells under normoxia (21%
O(2)), whereas siRNA directed at Egr-1 strongly attenuated hypoxia-induced
tissue factor expression. To examine the effects of HIF-1alpha on tissue
factor expression, we used glioma cells stably transfected with a HIF-1alpha
siRNA expression vector and found that HIF-1alpha mRNA silencing did not
affect tissue factor expression under hypoxia. We conclude that hypoxic
up-regulation of tissue factor in glioblastoma multiforme cells depends
largely on Egr-1 and is independent of HIF-1. (Cancer Res 2006; 66(14):
7067-74).
PMID: 16849552 [PubMed - in process]
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| 5: Clin Neuropathol.
2006 May-Jun;25(3):123-7. |
|
Fronto-laterally located supratentorial bronchogenic
cyst: case report and review of the literature.
Stubenvoll F, Beschorner R, Danz S, Freudenstein D.
Department of Neurosurgery, University Hospital Tubingen, Germany.
stubenvoll@gmx.de
Bronchogenic cysts are rare findings within the central nervous system and
even extremely seldom if they are located supratentorially. We report on a
25-year-old man who presented with a single generalized seizure without any
accompanying neurological deficit 6 weeks prior to admission. MRI showed a
smoothly limited, non-calcified cyst of a maximum of 55 mm in diameter.
Large parts of the membrane were removed through a right anterior
craniotomy, and a fenestration into the subarachnoidal space was performed.
Histopathological examinations revealed a bronchogenic cyst. Previous
reports of neurenteric cysts are reviewed. Therapeutic options, pathogenesis
and categorization of this uncommon congenital entity are discussed.
Publication Types:
PMID: 16719408 [PubMed - indexed for MEDLINE]
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| 6: Clin Neuropathol.
2006 May-Jun;25(3):107-14. |
|
Two novel cell specific receptor proteins, CRLR and CD
117 in human glial tumors.
Mennel HD, Hallier-Neelsen M, Hagner S, Benes L.
Department of Neuropathology, Philipps University, Marburg, Germany. mennelh@med.uni-marburg.de
OBJECTIVE: CRLR (calcitonin receptor-like receptor) and CD 117, the gene
product of c-kit have been shown to be expressed in cells of glial tumors,
especially in those with higher malignancy. Here we report the distribution
of these peptides in various cellular compartments within those tumors.
MATERIAL: Both receptor proteins have been investigated in 95 glial tumor
biopsies of different grades. METHODS: Both proteins were visualized by
immunohistochemistry with antibodies either commercially available or raised
for this purpose. RESULTS: Both receptor peptides can be identified in or
around tumor blood vessels. CRLR occurs in some endothelial cells,
especially in the microvascular proliferations of glioblastoma multiforme,
whereas CD 117 preferentially occurs in cells of the thickened vascular wall
within cells of pericyte or fibroblast morphology. Both antigens are found
in addition in few neoplastic cells of overt astrocyte morphology.
CONCLUSIONS: The occurrence of identical antigens in glial tumor blood
vessels and in neighboring tumor cells underlines the common origin of
"mesenchymal" and "neuroepithelial" components of such
(malignant) glial neoplasms.
PMID: 16719406 [PubMed - indexed for MEDLINE]
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| 7: J
Clin Oncol. 2006 Jul 20;24(21):3431-7. |
|
-
O6-Methylguanine-DNA Methyltransferase Expression
Strongly Correlates With Outcome in Childhood Malignant Gliomas: Results
From the CCG-945 Cohort.
Pollack IF, Hamilton RL, Sobol RW, Burnham J, Yates
AJ, Holmes EJ, Zhou T, Finlay JL.
Department of Neurosurgery, Children's Hospital of Pittsburgh, 3705 Fifth
Avenue, Pittsburgh, PA 15213; e-mail: ian.pollack@chp.edu.
PURPOSE O(6)-Methylguanine-DNA methyltransferase (MGMT) functions to
counteract the cytotoxic effects of alkylating agents, such as nitrosoureas,
which play a central role in the treatment of childhood malignant gliomas.
Epigenetic silencing of MGMT has been associated with prolonged survival in
adults with malignant gliomas, although the association between MGMT
expression status and outcome in pediatric malignant gliomas has not been
defined. METHODS We examined the association between MGMT expression and
survival duration using tumor samples from the Children's Cancer Group 945
study, the largest randomized trial for childhood malignant gliomas
completed to date. All patients received alkylator-based chemotherapy as a
component of adjuvant therapy. Archival histopathologic material yielded
tissue of sufficient quality for immunohistochemical assessment of MGMT
expression status in 109 specimens. Results Twelve of the 109 samples
demonstrated overexpression of MGMT compared with normal brain. Five-year
progression-free survival was 42.1% +/- 5% in the 97 patients whose tumors
had low levels of MGMT expression versus 8.3% +/- 8% in the 12 patients
whose tumors overexpressed MGMT (P = .017, exact log-rank test). The
association between MGMT overexpression and adverse outcome remained
significant after stratifying for institutional histologic diagnosis (eg,
anaplastic astrocytoma or glioblastoma multiforme), as well as age, amount
of residual tumor, and tumor location. CONCLUSION Overexpression of MGMT in
childhood malignant gliomas is strongly associated with an adverse outcome
in children treated with alkylator-based chemotherapy, independently of a
variety of clinical prognostic factors.
PMID: 16849758 [PubMed - in process]4
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| 8: J
Clin Oncol. 2006 Jul 1;24(19):3142-9. |
|
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Isolated CNS relapse of acute lymphoblastic leukemia
treated with intensive systemic chemotherapy and delayed CNS radiation: a
pediatric oncology group study.
Barredo JC, Devidas M, Lauer SJ, Billett A, Marymont
M, Pullen J, Camitta B, Winick N, Carroll W,
Ritchey AK.
Department of Pediatrics, Medical University of South Carolina, Charleston,
SC, USA. barredjc@musc.edu
PURPOSE: Prognosis and outcome of children with isolated CNS relapse of
acute lymphoblastic leukemia (ALL) has depended on duration of first
complete remission (CR1). This study intensified systemic therapy by
delaying CNS radiation for 12 months and tailored CNS radiation by CR1
duration. PATIENTS AND METHODS: Seventy-six children with first isolated CNS
relapse of ALL were treated with systemic chemotherapy that effectively
penetrates into the CSF and intrathecal chemotherapy for 12 months. Patients
with CR1 of less than 18 months received craniospinal radiation (24 Gy
cranial/15 Gy spinal), whereas those with CR1 of 18 months or more received
cranial radiation only (18 Gy), followed by maintenance chemotherapy.
Additionally, asymptomatic patients were enrolled in a thiotepa up-front
therapeutic window. RESULTS: Seventy-four (97.4%) of 76 eligible patients
achieved a second remission. Overall 4-year event-free survival (EFS) for
the 71 precursor B-cell patients was 70.1% +/- 5.8%. CR1 duration and
National Cancer Institute (NCI; National Institutes of Health, Bethesda, MD)
risk group at initial diagnosis predicted outcome. Patients with CR1 of less
than 18 months and 18 months or more had a 4-year EFS of 51.6% +/- 11.3% and
77.7% +/- 6.4% (P = .027), respectively. NCI high- versus standard-risk
4-year EFS was 51.4% +/- 10.8% and 80.2% +/- 6.3% (P = .0018), respectively.
A significant difference in EFS between standard risk/CR1 of at least 18
months and both high risk/CR1 of less than 18 months and high risk/CR1 of at
least 18 months groups was detected (P = .0068 and .0314, respectively).
Response rate to thiotepa was 78%. Most relapses involved the bone marrow,
and three second malignancies were reported. CONCLUSION: Twelve months of
intensive systemic chemotherapy with reduced dose cranial radiation (18 Gy)
is highly effective for children with isolated CNS relapse and CR1 of 18
months or more. Novel strategies are needed for patients with CR1 of less
than 18 months.
Publication Types:
- Clinical Trial
- Multicenter Study
PMID: 16809737 [PubMed - indexed for MEDLINE]3
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| 9: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
-
Limitations of diffusion-weighted imaging in
distinguishing between a brain tumor and a central nervous system
histoplasmoma.
Smith JS, Quinones-Hinojosa A, Phillips JJ, Bollen
AW, McDermott MW, Cha S.
Department of Neurological Surgery, Brain Tumor Research Center, School of
Medicine, University of California, San Francisco, 505 Parnassus Avenue,
M-779, 94143-0112, San Francisco, 0112, CA, USA, jsmith1enator@gmail.com.
PMID: 16850113 [PubMed - as supplied by publisher]
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| 10: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
-
Ectopic recurrence of craniopharyngioma: a case report
and review of the literature.
Jeong IH, Lee JK, Moon KS, Joo SP, Kwak HJ,
Kim TS, Kim JH, Kim SH.
Department of Neurosurgery, Chonnam National University Hospital &
Medical School, Dong-ku, Gwangju, South Korea.
The ectopic recurrence of craniopharyngioma is a rare postoperative
complication, for which there are fifteen reported cases that have been
surgically verified. The authors present a rare case of ectopic recurrence
along the tract of the surgical route. A 12-year-old girl, who had undergone
total removal of a suprasellar craniopharyngioma 4 years previously,
presented with a generalized tonic-clonic seizure. Magnetic resonance
imaging revealed a strongly enhancing cystic tumor in the right frontal
lobe, under the bone flap used for the previous craniotomy. Gross total
resection was achieved by revision of previous craniotomy. The
intraoperative findings revealed that the recurrent tumor was anatomically
related to the previous surgical tract, suggesting dissemination along the
operative tract. The histopathological features of the mass were the same as
those of the previous suprasellar craniopharyngioma. The case presented here
and a review of the reports on the previous instances of ectopic recurrence
of craniopharyngioma suggest that meticulous protection of the surgical
field and careful handling of the tumor during the operation are required.
It should be emphasized that long-term follow-up is mandatory, even in
patients who underwent a gross total removal.
PMID: 16850111 [PubMed - as supplied by publisher]2
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| 11: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
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The role of (111)indium-octreotide brain scintigraphy in
the diagnosis of cranial, dural-based meningiomas.
Nathoo N, Ugokwe K, Chang AS, Li L, Ross J,
Suh JH, Vogelbaum MA, Barnett GH.
Department of Neurosurgery, The Taussig Cancer Center, The Cleveland Clinic
Foundation, Cleveland, OH, USA.
OBJECTIVE: Meningiomas are common brain tumors with somatostatin receptors
that bind octreotide. We report the use of (111)indium-octreotide brain
scintigraphy (OBS) for the non-invasive differentiation of meningiomas from
other cranial dural-based pathology. METHODS: A retrospective analysis of
our experience with OBS for non-invasive identification of meningiomas was
performed. Two neuroradiologists, blinded to clinical data, utilized a
standardized grading scheme to define the uptake of octreotide at 6 and 24 h
post-administration. The correlation between (18) F-fluoro-2-deoxy-d-glucose
positron emission tomography (FDG-PET), magnetic resonance imaging (MRI)
scans, and octreotide uptake was assessed. RESULTS: The cohort consisted of
50 patients having a mean age of 62.4 years and a median follow-up time of
24 months. Management consisted of biopsy (n = 4); resection (n = 10);
observation (n = 16); radiosurgery (n = 21); and external beam radiotherapy
(n = 3). OBS was correlated with MRI (n = 50); FDG-PET brain studies (n =
38); histology (n = 14), and angiography (n = 1). In cases where definitive
diagnosis could be made, the sensitivity, specificity, positive and negative
predictor values for OBS alone were 100; 50; 75; and 100, respectively. OBS
provided false positive data in 3 patients (metastasis, chronic
inflammation, lymphoma). Use of OBS with MRI to differentiate meningiomas
from other lesions was highly significant (P < 0.001). FDG-PET correctly
identified malignant pathology with 100% sensitivity and specificity.
CONCLUSION: OBS may increase the diagnostic specificity of conventional MRI
when differentiating meningioma from other dural-based pathologies, while
the addition of FDG-PET differentiates benign from malignant lesions.
PMID: 16850106 [PubMed - as supplied by publisher]2
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| 12: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
-
Independent motile microplast formation correlates with
glioma cell invasiveness.
Yount G, Taft RJ, Luu T, Rachlin K, Moore D,
Zhang W.
California Pacific Medical Center Research Institute, 475 Brannan Street,
Suite 220, San Francisco, CA, 94107, USA, YountG@cpmcri.org.
Diffuse brain invasion co ntributes to the poor prognosis for patients with
gliomas. Analyzing glioma cell migration in vitro, we have demonstrated the
spontaneous shedding of anucleate cell fragments that separate from glioma
cell bodies and maintain viability from hours to days. Unlike previously
described cell fragments that are released from cells as diffusible vectors,
glioma cell fragments are independently motile. We used computerized
time-lapse microscopy to characterize the formation of these independent
motile microplasts (IMMPs) in human cell cultures derived from the most
highly invasive glial tumor, glioblastoma. IMMPs were larger than previously
described cell fragments, ranging in size from approximately 2% to nearly
half of the area of their parent cells. Complex cell-like
behaviors-including establishment of polarity, extension of lamellipodia and
filopodia, and change in direction of movement-remained intact in IMMPs. The
average direction and velocity of the IMMPs were indistinguishable from
those of their parent cells. IMMPs formed at a significantly higher rate in
glioma cell lines rendered more invasive by overexpression of
invasion-related genes than in vector-transfected controls. The correlation
with cell invasiveness indicates that IMMP formation may be related to the
cell-invasive phenotype. Further investigation will determine whether IMMPs
represent a novel addition to the growing list of viable cell fragments with
biological relevance.
PMID: 16850105 [PubMed - as supplied by publisher]3
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| 13: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
-
Cognitive functions in low-grade gliomas: disease and
treatment effects.
Correa DD, Deangelis LM, Shi W, Thaler HT, Lin
M, Abrey LE.
Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York
Avenue, New York, NY, 10021, USA.
BACKGROUND: The role of radiotherapy and chemotherapy in the treatment of
low-grade gliomas (LGG) is controversial regarding their effect on survival
and the development of neurotoxicity. The few published studies examining
adverse treatment effects on cognition revealed conflicting results.
OBJECTIVE: To assess cognitive functioning in LGG patients who received
conformal radiation therapy (RT), chemotherapy, or no treatment. DESIGN: 40
LGG patients participated in the study; 16 patients had RT +/- chemotherapy,
and 24 patients had no treatment. All patients underwent a
neuropsychological evaluation. APOE genotype was obtained in 36 patients who
were classified in two groups based on the presence or absence of at least
one apolipoprotein E small je, Ukrainian-4 (APOE small je, Ukrainian-4)
allele. RESULTS: Treated LGG patients had lower scores than untreated
patients on several cognitive domains; patients who completed treatment at
intervals greater than 3 years and had long disease duration had
significantly lower scores on the Non-Verbal Memory domain. Antiepileptic
polytherapy, treatment history, and disease duration jointly contributed to
low Psychomotor domain scores. 62% of treated patients showed white matter
confluence on MRI, whereas only 9% of the untreated patients had such
changes. Preliminary comparisons between APOE small je, Ukrainian-4 carriers
(n = 9) and non-carriers (n = 27) on cognitive domain scores revealed no
statistically significant differences, but APOE small je, Ukrainian-4
carriers had lower mean scores on the Verbal Memory domain than did
non-small je, Ukrainian-4 carriers. CONCLUSIONS: RT +/- chemotherapy,
disease duration, and antiepileptic treatment contributed to mild cognitive
difficulties in LGG patients.
PMID: 16850104 [PubMed - as supplied by publisher]4
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| 14: J Neurooncol.
2006 Jul 19; [Epub ahead of print] |
|
-
Recurrent cytogenetic aberrations in histologically
benign, invasive meningiomas of the sphenoid region.
Korshunov A, Cherekaev V, Bekyashev A, Sycheva R.
Department of Neuropathology, N.N. Burdenko Neurosurgical Institute, 4-th
Tverskaya-Yamskaya str. 16, Fadeeva str. 5, Moscow, 125047, Russia,
akorshunov@nsi.ru.
Meningiomas that arise in the sphenoid region (MSR) often display growth
patterns leading to widespread invasion and destruction of the surrounding
structures. Consequently, there is still estimated recurrence rate up to 30%
with MSR. Conventional cytogenetic studies have failed to reveal aberrations
characteristic of invasive meningiomas. Here we investigated 10 invasive and
5 non-invasive MSR using the array-based comparative genomic hybridization
(array-CGH) with the GenoSensor Array 300. Mean number of aberrations
detected per tumor was significantly greater for invasive meningiomas-67.4
compared with 40.5 for non-invasive MSR. Additionally, invasive MSR
disclosed frequent losses on 1p, 6q, 14q and gains on 15q and 20, which were
identified previously as molecular hallmarks of stepwise meningioma
progression. Thus, the presence of a complex cytogenetic profile and
progression-associated chromosomal aberrations in benign MSR is associated
with their increased invasive potential. Inasmuch as no reliable adjuvant
therapy for recurrent meningiomas is available thus far, revealed genomic
aberrations can provide a potential targets for drug discovery and
therapeutic intervention in a future.
PMID: 16850103 [PubMed - as supplied by publisher]2
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| 15: J Neurosurg.
2006 May;104(5 Suppl):314-20. |
|
Vascularity and angiogenesis as predictors of growth in
optic pathway/hypothalamic gliomas.
Bartels U, Hawkins C, Jing M, Ho M, Dirks P,
Rutka J, Stephens D, Bouffet E.
Division of Hematology/Oncology, Pediatric Brain Tumor Program, The Hospital
for Sick Children, Toronto, Ontario, Canada. ute.bartels@sickkids.ca
OBJECT: The authors' aim in conducting this study was to investigate
retrospectively the prognostic significance of angiogenic features in optic
pathway/hypothalamic gliomas (OPHGs) in children. METHODS: Patients were
identified in whom a diagnosis of OPHG was made using pathological analysis
at the Toronto Hospital for Sick Children between 1985 and 2002. Tumor
specimens were reviewed for diagnostic accuracy and adequacy of the
specimen. Sections were immunostained with factor VIII to assess microvessel
density (MVD). A ratio of alpha-smooth muscle actin to factor VIII
immunostaining was calculated to arrive at a vascular maturity index (VMI).
Vascular endothelial growth factor (VEGF) and VEGF receptor (VEGFR)
immunostaining were performed to evaluate angiogenic factors. In addition,
the MIB-1 labeling index (LI) was used to assess proliferation. These
factors were evaluated with respect to progression-free survival (PFS).
Forty-one of 60 patients originally identified had adequate samples and
follow up for inclusion in the study. Of these, eight patients had
coexisting neurofibromatosis Type 1. Twenty-eight patients experienced tumor
progression after the initial treatment (surgery with or without adjuvant
treatment). Thirty-eight patients are still alive. A high MVD (> 21
vessels/1.2 mm2) was associated with a significantly higher rate of
progression compared with a low MVD (< 21 vessels/1.2 mm2; p = 0.017).
Microvessel density was also predictive of reduced PFS on multivariate
analysis stratified for extent of resection (p = 0.04), and VMI as well as
intensity and distribution of VEGF and VEGFR staining and the MIB-1 LI were
not significantly associated with PFS. CONCLUSIONS: These findings suggest
that MVD is the best current predictor of PFS in incompletely resected OPHGs.
This information highlights the importance of angiogenesis in regard to
low-grade gliomas.
PMID: 16848088 [PubMed - in process]2
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| 16: J Neurosurg.
2006 Jun;104(6 Suppl):426-8. |
|
Spontaneous development of a de novo suprasellar
arachnoid cyst. Case report.
Struck AF, Murphy MJ, Iskandar BJ.
Department of Neurological Surgery, University of Wisconsin, Madison,
Wisconsin 53792, USA.
Arachnoid cysts are commonly thought to arise from either congenital defects
or trauma. In this article the authors report the spontaneous development of
a suprasellar third ventricular arachnoid cyst whose origin was not clearly
congenital or traumatic. At the age of 4 months, the patient presented with
hypertonia, and a magnetic resonance (MR) imaging study showed no
abnormalities. At the age of 2 years, the boy presented with headaches and
projectile emesis, symptoms that prompted further imaging studies. An MR
image of the brain revealed a suprasellar cyst and obstructive
hydrocephalus. The cyst was endoscopically fenestrated, which led to
long-term symptom resolution.
Publication Types:
PMID: 16776380 [PubMed - indexed for MEDLINE]2
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| 17: J Neurosurg.
2006 Jun;104(6 Suppl):419-21. |
|
Preoperative embolization in the treatment of choroid
plexus papilloma in an infant. Case report.
Otten ML, Riina HA, Gobin YP, Souweidane MM.
Department of Neurological Surgery, New York Presbyterian Hospital-Weill
Medical College of Cornell University, New York, New York 10021, USA.
The authors report a case of preoperative embolization and resection of a
choroid plexus papilloma of the lateral ventricle in a 4-month-old boy.
These vascular tumors of the central nervous system present a significant
intraoperative bleeding risk. Attempts at preoperative embolization to
reduce the bleeding risk have rarely succeeded because of the small and
tortuous vessels feeding these tumors in infants. The case presented here
supports the feasibility of preoperative embolization as a therapeutic
adjunct in infants.
Publication Types:
PMID: 16776378 [PubMed - indexed for MEDLINE]1
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| 18: J Neurosurg.
2006 Jun;104(6 Suppl):377-82. |
|
Seizures in children with low-grade tumors: outcome after
tumor resection and risk factors for uncontrolled seizures.
Khan RB, Boop FA, Onar A, Sanford RA.
Departments of Radiological Sciences, Biostatistics, and Neuro-surgical
Service, St. Jude Children's Research Hospital, Memphis, Tennessee
38105-2794, USA. raja.khan@stjude.org
OBJECT: The goals of this study were to define the incidence of seizures in
children with low-grade tumors, study seizure outcome after lesionectomy in
these children, and identify risk factors for poor seizure outcome. METHODS:
The authors performed a retrospective chart review of children who harbored
low-grade brain tumors, experienced seizures, and were treated in a single
institution. Statistical analyses included step-wise as well as
single-variable binary logistic regression analyses. Fifty-five children
(20%) with seizures were identified in a cohort of 280 children with
low-grade tumors. Of these 55 children, 35 harbored cortical cerebral tumors
and 20 had noncortical lesions, including six whose tumors were in the
posterior fossa. Seizures were defined as controlled if there was no seizure
in the 12 months preceding the last clinic visit. All cortical tumors were
treated by lesionectomy as an initial procedure. Of the 27 children with
cortical tumors whose seizures began before tumor diagnosis, 23 had complete
resection and 52% of these 23 experienced no further seizures after surgery.
Seizures are presently controlled in 84% of the total 55 patients at a
median follow-up time of 4.5 years after the first seizure (range 1-17.4
years). Only two variables, a pericavity hyperintense signal on T2-weighted
magnetic resonance (MR) images and at least 10 seizures prior to therapy for
seizures, were associated with uncontrolled seizures. CONCLUSIONS:
Lesionectomy may be appropriate in children with low-grade brain tumors. A
large number of seizures before therapy and a hyperintense area around the
tumor cavity on postresection MR images are associated with uncontrolled
seizures. Medical therapy and tumor resection will control seizures in the
majority of children with low-grade tumors.
PMID: 16776371 [PubMed - indexed for MEDLINE]4
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| 19: J Neurosurg.
2006 Jun;104(6 Suppl):369-76. |
|
Tectal plate lesions in children.
Ternier J, Wray A, Puget S, Bodaert N, Zerah
M, Sainte-Rose C.
Department of Pediatric Neurosurgery, Hopital Necker-Enfants Malades, Paris,
France.
OBJECT: The authors characterized the clinical course of tectal plate
lesions in a group of pediatric patients to identify the prognostic factors
at presentation that predict progression, in an attempt to differentiate
tectal hamartomas from tumors. METHODS: A retrospective review was conducted
of the management of tectal plate lesions in children since the advent of
magnetic resonance (MR) imaging at the authors' hospital (1984-2003). The
lesion volume seen on MR images, the clinical and radiological features at
presentation, and the clinical course of the population were analyzed for
correlations. Forty children with tectal lesions presented in the typical
delayed fashion (mean 8.5 months) with symptoms referable to hydrocephalus
(93%). Fourteen children whose tumors demonstrated radiological progression
(enlargement, contrast enhancement, or cystic change) were treated
surgically. Histologically, 80% of the surgically treated lesions were low
grade (with the other 20% consisting of one dysplasia, one high-grade tumor,
and one unidentified tumor). Five patients required a second operation and
one required a third. One patient died of a high-grade astrocytoma after
undergoing surgery and radiotherapy; the other 39 patients remain clinically
stable. The only factor predictive of tumor enlargement was lesion volume at
presentation (p = 0.002). Distribution analysis revealed three subgroups
based on lesion volume (< 4, 4-10, and > 10 cm3), which correlated
with the clinical course of the disease. CONCLUSIONS: Children with tectal
lesions should undergo contrast-enhanced MR imaging and volume assessment at
the time of presentation. After hydrocephalus has been managed with
endoscopic third ventriculostomy, these children require prolonged, close
clinical and radiological surveillance. Lesions with a volume less than 4
cm3 were likely to be hamartomas and followed a predominantly benign course,
with few atypical cases progressing. All large lesions, defined as having a
volume greater than 10 cm3 at presentation, eventually required treatment,
and all were histologically determined to be tumors. An argument is made for
earlier treatment of larger lesions with the aim of improving outcome.
PMID: 16776370 [PubMed - indexed for MEDLINE]
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| 20: J Neurosurg.
2006 Jun;104(6):931-7. |
|
Pituitary apoplexy: do histological features influence
the clinical presentation and outcome?
Semple PL, De Villiers JC, Bowen RM, Lopes MB, Laws
ER Jr.
Division of Neurosurgery, Department of Pathology, Groote Schuur Hospital,
University of Cape Town, South Africa.
OBJECT: A retrospective analysis of a contemporary series of patients with
pituitary apoplexy was performed to ascertain whether the histopathological
features influence the clinical presentation or the outcome. METHODS: A
retrospective analysis was performed in 59 patients treated for pituitary
apoplexy at the University of Virginia Health System, Charlottesville,
Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa.
The patients were divided into two groups according to the histological
features of their disease: one group with infarction alone, comprising 22
patients; and the other with hemorrhagic infarction and/or frank hemorrhage,
comprising 37 patients. The presenting symptoms, clinical features,
endocrinological status, and outcome were compared between the two groups.
CONCLUSIONS: The patients who presented with histological features of
pituitary tumor infarction alone had less severe clinical features on
presentation, a longer course prior to presentation, and a better outcome
than those presenting with hemorrhagic infarction or frank hemorrhage. The
endocrine replacement requirements were similar in both groups.
PMID: 16776337 [PubMed - indexed for MEDLINE]
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| 21: J Neurosurg.
2006 Jun;104(6):899-906. |
|
Presurgical treatment with somatostatin analogs in
patients with acromegaly: effects on the remission and complication rates.
Losa M, Mortini P, Urbaz L, Ribotto P, Castrignano
T, Giovanelli M.
Pituitary Unit, Department of Neurosurgery, Istituto Scientifico San
Raffaele, Universita Vita-Salute, Milano, Italy. losa.marco@hsr.it
OBJECT: The question of whether preoperative therapy with somatostatin
analogs can improve surgical outcome in acromegaly has not been definitively
answered. In this paper, the authors report the effects of preoperative
treatment with somatostatin analogs in a large sample of patients with
acromegaly. METHODS: Between 1990 and 2003, 399 consecutive patients with
acromegaly underwent surgery at the Istituto Scientifico San Raffaele.
Thirty-three patients who had previously undergone surgery or radiation
treatment, 48 patients treated with somatostatin analogs for fewer than 3
months, and patients who had stopped therapy for too long a time before
surgery were excluded from the study. One hundred forty-three patients who
had received somatostatin analogs prior to surgery (Group 1) were randomly
matched to 143 patients who had never been treated with somatostatin analogs
(Group 2). Matching criteria were tumor size and invasiveness into the
cavernous sinus. Before surgery, Group 1 patients showed reduction of growth
hormone levels to less than 50% of baseline in 64% of cases, but
insulin-like growth factor-I was normalized in only 19.5%. Surgical
remission occurred in 81 Group 1 patients (56.6%) and in 91 Group 2 patients
(63.6%; p = 0.28). No significant difference in the remission rate was
observed when cases were analyzed according to tumor size or invasiveness.
Logistic regression analysis confirmed that pretreatment with somatostatin
analogs was not associated with surgical outcome. Surgical morbidity was
mild and similar in Group 1 and Group 2 patients (7 and 5.6%, respectively;
p = 0.81). Surgical remission and complication rates in patients with
acromegaly who received treatment with somatostatin analogs prior to surgery
were not significantly different from those of matched patients who did not
receive these agents. CONCLUSIONS: At present, the routine use of
presurgical therapy with somatostatin analogs for patients with acromegaly
cannot be recommended.
PMID: 16776333 [PubMed - indexed for MEDLINE]
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| 22: J Neurosurg.
2006 Jun;104(6):892-8. |
|
Pituitary apoplexy in the magnetic resonance imaging era:
clinical significance of sphenoid sinus mucosal thickening.
Liu JK, Couldwell WT.
Department of Neurosurgery, University of Utah School of Medicine, Salt Lake
City, Utah 84132, USA.
OBJECT: The authors report their experience with pituitary apoplexy and
evaluate the clinical significance of sphenoid sinus mucosal thickening
found on magnetic resonance (MR) imaging. METHODS: The cases of 28 patients
(19 males and nine females) with pituitary apoplexy were reviewed
retrospectively. The mean age of the patients was 50 years (range 16-83
years), and the mean follow-up duration was 32 months (range 1-104 months).
Admission MR imaging demonstrated hemorrhage or infarction in a pituitary
tumor in each patient. A clinical grading scale for apoplexy was devised as
follows: Grade I, presence of acute headache and/or endocrine abnormality
(12 patients); Grade II, presence of the foregoing symptoms as well as
cranial nerve deficit (visual and/or oculomotor; 15 patients); and Grade
III, presence of all of these symptoms and a decreased level of
consciousness (one patient). Twenty-five patients (89%) underwent early
transsphenoidal resection within 9 days (80% within 72 hours) of diagnosis.
Headaches and oculomotor paresis resolved completely in 100%, visual
function resolved completely in 44% and partially in 56%, and
hypopituitarism was reversed in 25%. Twelve patients (43%) required
long-term hormone replacement therapy. Two of the three patients who were
treated conservatively had prolactin-secreting adenomas, which were treated
with dopamine agonist therapy. Thickening of sphenoid sinus mucosa was
present in 22 patients (79%). Fifty percent of patients in Grade I and 100%
of those in Grades II and III, including all those with persistent
hypopituitarism and residual visual deficits, had thickened sphenoid sinus
mucosa on MR imaging. Patients with thickened sphenoid sinus mucosa had
larger tumors that compressed the optic chiasm or cavernous sinus, and these
individuals also had a higher rate of cranial nerve deficits at presentation
than those without mucosal thickening (73% compared with 0%). Patients with
thickened mucosa had a higher rate of hypopituitarism and subsequent
long-term hormone replacement therapy than those without thickened mucosa
(55% compared with 17%). CONCLUSIONS: Thickened sphenoid sinus mucosa may
correlate with higher grades of pituitary apoplexy and worse neurological
and endocrinological outcomes.
PMID: 16776332 [PubMed - indexed for MEDLINE]
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| 23: J Neurosurg.
2006 Jun;104(6):884-91. |
|
Natural course of incidentally found nonfunctioning
pituitary adenoma, with special reference to pituitary apoplexy during
follow-up examination.
Arita K, Tominaga A, Sugiyama K, Eguchi K, Iida
K, Sumida M, Migita K, Kurisu K.
Department of Neurosurgery, Graduate School of Medical and Dental Sciences,
Kagoshima University, Kagoshima, Japan. karita@m2.kagoshima-u.ac.jp
OBJECT: The increase in the incidental detection of asymptomatic pituitary
adenomas, known as "pituitary incidentalomas," led the authors to
conduct a survey of the natural course of these lesions. METHODS: Forty-two
patients with clinically nonfunctioning pituitary adenomas who had
manifested no neurological or endocrinological disorders were monitored with
magnetic resonance imaging studies. The follow-up period ranged from 10.8 to
168.2 months (mean +/- standard deviation, 61.9 +/- 38.2 months). The mean
initial tumor size was 18.3 +/- 7 mm. In 21 patients, the tumor increased by
at least 10% of its measured size on detection. This increase was first
detected between 8.4 and 58.8 months (mean 31.8 +/- 17.6 months) after
diagnosis. There was no correlation between the original tumor size, patient
age, or the presence of intratumoral cysts and tumor growth. Symptoms were
noted in 10 patients during follow up; in four, extensive tumor necrosis
accompanied hemorrhage, leading to severe headache, acute ophthalmological
symptoms, and panhypopituitarism, which was indicative of pituitary
apoplexy. Transsphenoidal surgery was performed in 12 patients with enlarged
tumors, including three with apoplexy. With the exception of one apoplectic
patient, visual function was recovered in all who underwent surgery. All
apoplectic patients continue to manifest hypopituitarism. CONCLUSIONS: In
the course of 4 years, the size of the incidentalomas increased in 40% of 42
patients and became symptomatic in 20%. During the 5-year follow up,
pituitary apoplexy developed in 9.5%. These findings may justify early
intervention, especially in young individuals with incidentally found
macroadenoma.
PMID: 16776331 [PubMed - indexed for MEDLINE]
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| 24: J Neurosurg.
2006 Jun;104(6):876-83. |
|
Gamma surgery in the treatment of nonsecretory pituitary
macroadenoma.
Mingione V, Yen CP, Vance ML, Steiner M, Sheehan
J, Laws ER, Steiner L.
Department of Neurological Surgery, Lars Leksell Center for Gamma Surgery,
University of Virginia Health System, Charlottesville, Virginia 22908, USA.
OBJECT: The authors report on a retrospective analysis of the imaging and
clinical outcomes following gamma surgery in 100 patients with nonsecretory
pituitary macroadenoma. METHODS: Between June 1989 and March 2004, 100
consecutive patients with nonsecretory pituitary macroadenoma were treated
at the Lars Leksell Center for Gamma Surgery, University of Virginia Health
System (Charlottesville, VA). Ninety-two patients had residual or recurrent
macroadenoma following one or more surgical procedures. In eight patients,
gamma surgery was the primary treatment. Ten patients received conventional
fractionated radiotherapy before the gamma surgery. Sixty-nine patients
required hormone replacement therapy for one or more deficits before gamma
knife treatment. Peripheral doses between 5 and 25 Gy (mean 18.5 Gy) were
administered. Imaging and endocrinological follow-up evaluations were
performed in 90 patients; these studies ranged from 6 to 142 months (mean
44.9 months) and 6 to 127 months (mean 47.9 months), respectively. Tumor
volume decreased in 59 patients (65.6%), remained unchanged in 24 (26.7%),
and increased in seven (7.8%). The minimal effective peripheral dose was 12
Gy; peripheral doses greater than 20 Gy did not seem to provide additional
benefit. Of 61 patients with a partially or fully functioning pituitary
gland and follow-up data, 12 (19.7%) suffered new hormone deficits following
gamma surgery. In patients with endocrinological follow-up data that had
been collected over more than 2 years, the rate of new deficits was 25%. No
neurological morbidity or death was related to treatment. CONCLUSIONS:
Current experience suggests that gamma surgery is an appropriate means of
managing recurrent or residual nonsecretory pituitary macroadenoma following
microsurgery and a primary treatment in selected patients. To evaluate
definite rates of recurrence and new endocrine deficiencies, long-term
follow-up studies are needed.
PMID: 16776330 [PubMed - indexed for MEDLINE]
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| 25: Neurology. 2006 Jun
27;66(12):1937. |
|
-
Intracranial dermoid cyst rupture with subarachnoid and
intraventricular fat dissemination.
Plans G, Aparicio A, Majos C.
Department of Neurosurgery, Hospital Universitari de Bellvitge, C/ Feixa
Llarga s/n 08907 L'Hospitalet de Llobregat, Barcelona, Spain. gerard_plans@eresmas.com
Publication Types:
PMID: 16801666 [PubMed - indexed for MEDLINE]
-
| 26: Neurosurgery. 2006
Jun;58(6):1129-43; discussion 1129-43. |
|
-
Motor evoked potential monitoring improves outcome after
surgery for intramedullary spinal cord tumors: a historical control study.
Sala F, Palandri G, Basso E, Lanteri P, Deletis
V, Faccioli F, Bricolo A.
Department of Neurological and Visual Sciences, University Hospital, Verona,
Italy. francescosala@yahoo.com
OBJECTIVE: The value of intraoperative neurophysiological monitoring (INM)
during intramedullary spinal cord tumor surgery remains debated. This
historical control study tests the hypothesis that INM monitoring improves
neurological outcome. METHODS: In 50 patients operated on after September
2000, we monitored somatosensory evoked potentials and transcranially
elicited epidural (D-wave) and muscle motor evoked potentials (INM group).
The historical control group consisted of 50 patients selected from among
301 patients who underwent intramedullary spinal cord tumor surgery,
previously operated on by the same team without INM. Matching by
preoperative neurological status (McCormick scale), histological findings,
tumor location, and extent of removal were blind to outcome. A more than 50%
somatosensory evoked potential amplitude decrement influenced only myelotomy.
Muscle motor evoked potential disappearance modified surgery, but more than
50% D-wave amplitude decrement was the major indication to stop surgery. The
postoperative to preoperative McCormick grade variation at discharge and at
a follow-up of at least 3 months was compared between the two groups
(Student's t tests). RESULTS: Follow-up McCormick grade variation in the INM
group (mean, +0.28) was significantly better (P = 0.0016) than that of the
historical control group (mean, -0.16). At discharge, there was a trend (P =
0.1224) toward better McCormick grade variation in the INM group (mean,
-0.26) than in the historical control group (mean, -0.5). CONCLUSION: The
applied motor evoked potential methods seem to improve long-term motor
outcome significantly. Early motor outcome is similar because of transient
motor deficits in the INM group, which can be predicted at the end of
surgery by the neurophysiological profile of patients.
Publication Types:
PMID: 16723892 [PubMed - indexed for MEDLINE]2
-
| 27: Neurosurgery. 2006
Jun;58(6):1108-18; discussion 1108-18. |
|
-
Surgical treatment of recurrent Cushing's disease.
Hofmann BM, Hlavac M, Kreutzer J, Grabenbauer G,
Fahlbusch R.
Department of Neurosurgery, University of Erlangen-Nuremberg, Erlangen,
Germany. hofmann@nch.imed.uni-erlangen.de
OBJECTIVE: The aim of this study was to evaluate the role of transsphenoidal
selective adenomectomy alone or in combination with adjuvant therapy in
treatment of recurrent Cushing's disease. METHODS: A total of 16 patients
with recurrent Cushing's disease underwent reoperation, 15 via a
transsphenoidal approach and one via a combined transsphenoidal/transcranial
approach. Selective adenomectomies were performed in 13 patients and
hemihypophysectomies were performed in three patients. Endocrinologically,
recurrence was diagnosed by an overnight 2-mg dexamethasone suppression
test. All patients underwent a 1.5-T magnetic resonance imaging scan, and
eight patients underwent inferior petrosal sinus sampling. RESULTS: After
selective adenomectomy, six of the 13 patients went into remission.
Recurrence always occurred at the localization of the original tumor. In
three patients without intraoperative tumor detection, hypophysectomy did
not lead to remission. In 10 patients with persistent disease, adjuvant
therapy (radiotherapy, adrenalectomy) led to normalization of basal cortisol
levels in eight patients and clinical remission in one patient. One patient
was lost to follow-up. In 10 patients, no evidence of an adenoma was visible
on the preoperative magnetic resonance imaging scan. Inferior petrosal sinus
sampling allowed correct prediction of the tumor localization in two of
eight patients. CONCLUSION: By performing repeated selective adenomectomy,
patients with recurrent Cushing's disease can be cured without the risk of
endocrine deficits or major complications. Dynamic endocrine tests are of
paramount importance for surgical decision making. Imaging and inferior
petrosal sinus sampling are not helpful in locating the recurrent tumor. If
normalization can not be achieved, adjuvant therapy is mandatory.
PMID: 16723890 [PubMed - indexed for MEDLINE]
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| 28: Neurosurgery. 2006
Jun;58(6):E1214; discussion E1214. |
|
-
Concomitant conus medullaris ependymoma and filum
terminale lipoma: case report.
Gallia GL, Burger PC, Suk I, Bagley CA, Wolinsky
JP, Garonzik IM, Gokaslan ZL.
Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
21287, USA.
OBJECTIVE: Ependymomas of the conus medullaris-cauda equina-filum terminale
region are typically solitary lesions. In this report, we describe the
clinical presentation, radiographic findings, operative details, and
pathological features of a patient with a conus medullaris ependymoma and a
filum terminale lipoma. CLINICAL PRESENTATION: A 40-year-old woman presented
with increasing low back pain and bowel and bladder dysfunction. Magnetic
resonance imaging revealed a partially cystic enhancing lesion at the conus
medullaris and a T1-weighted hyperintense mass within the filum terminale.
INTERVENTION: An L2-L3 laminotomy/laminoplasty was performed for gross total
resection of the mass. Histopathological examination demonstrated a conus
medullaris ependymoma and filum terminale lipoma. The patient experienced
complete resolution of her preoperative symptoms. CONCLUSION: Spinal cord
ependymomas are almost exclusively single lesions and their coexistence with
other pathological entities is rare. In this report, we describe a patient
with a concomitant conus medullaris ependymoma and filum terminale lipoma.
Publication Types:
PMID: 16723873 [PubMed - indexed for MEDLINE]2
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| 29: Pediatr Neurosurg.
2006;42(4):258-63. |
|
-
Atypical teratoid-rhabdoid tumor spreading along the
trigeminal nerve.
Beschorner R, Mittelbronn M, Koerbel A, Ernemann U,
Thal DR, Scheel-Walter HG, Meyermann R, Tatagiba M.
Institute of Brain Research, Tubingen, Germany. rudi.beschorner@med.uni-tuebingen.de
We here describe the case of a boy with an atypical teratoid-rhabdoid tumor
(ATRT) of the 4th ventricle at 1 year of age and a local tumor recurrence at
19 months of age. Due to brainstem infiltration, only incomplete tumor
resection was possible each time. High-dose chemotherapy, stem cell
transplantation and irradiation resulted in complete tumor remission on a
control MRI. At 8 years of age, another tumor appeared extending from the
cerebellopontine angle along the right trigeminal nerve through Meckel's
cave into the cavernous sinus. The trigeminal tumor was not in continuity
with the primary ATRT but was located within the field of prior irradiation,
neuroradiologically mimicking a schwannoma or a meningioma. The origin of
the trigeminal tumor as a late metastasis of the former ATRT or as a less
likely irradiation-induced secondary ATRT and the operative approach are
discussed. Copyright (c) 2006 S. Karger AG, Basel.
Publication Types:
PMID: 16714870 [PubMed - indexed for MEDLINE]2
-
| 30: Pediatr Neurosurg.
2006;42(4):245-8. |
|
-
Third ventricular ependymal cyst presenting with acute
hydrocephalus.
Yano S, Kuroda J, Makino K, Tsuiki H, Morioka
M, Kuratsu J.
Department of Neurosurgery, Faculty of Medical and Pharmaceutical Sciences,
Kumamoto University Graduate School, Kumamoto, Japan. yanos@kaiju.medic.kumamato-u.ac.jp
Ependymal cysts are generally located in the cerebral parenchyma but rarely
found in the third ventricle. A 4-year-old boy presented with headache,
vomiting, and upward gaze palsy. His consciousness gradually deteriorated in
the course of 6 h. A magnetic resonance imaging study disclosed dilation of
the lateral ventricle and a cystic mass in the third ventricle. We performed
an endoscopic resection of the cyst wall. The cyst originated on the lateral
wall of the third ventricle and obstructed the aqueduct. Histological
examination confirmed a diagnosis of ependymal cyst. The patient recovered
quickly and his headache and nausea disappeared. Third ventricular ependymal
cysts are a rare cause of acute hydrocephalus but an important differential
diagnosis. Their neuroendoscopic resection can resolve disturbances in
cerebrospinal fluid circulation, is useful for cyst wall removal, and
appears to be superior to shunt placement. Copyright (c) 2006 S. Karger AG,
Basel.
Publication Types:
PMID: 16714867 [PubMed - indexed for MEDLINE]2
-
| 31: Pediatr Neurosurg.
2006;42(4):228-33. |
|
-
Aquaporin(s) expression in choroid plexus tumours.
Longatti P, Basaldella L, Orvieto E, Dei Tos A, Martinuzzi
A.
Neurosurgery Unit, Treviso Hospital, Treviso, Italy.
OBJECTIVE: It was the aim of this study to investigate the pattern of
aquaporin 1 (AQP1) expression in normal and neoplastic choroid plexus, with
specific reference to the association with communicating hydrocephalus or
liquoral cysts. Second, to infer a new view on the cerebrospinal fluid
plexus production and on the etiology of the cysts and communicating
hydrocephalus occasionally associated with choroid plexus papillomas.
MATERIALS AND METHODS: Nineteen paraffin-embedded specimens, 10 of normal
choroid plexus and 9 of choroid plexus tumours, were immunostained with a
monoclonal antibody raised against the intracellular C-terminal AQP1 epitope.
Results were analysed in terms of intensity and intracellular distribution
of immunostaining and in terms of number of stained cells; they were
considered in light of the clinical association with hydrocephalus or
liquoral cysts. RESULTS: AQP1 was heavily expressed in the apical side of
the choroid epithelium in normal plexus specimens. Choroid plexus papillomas
showed a very heterogeneous pattern of AQP1 expression. Immunostaining was
absent in the case of choroid plexus carcinoma. Very strong to strong and
diffuse AQP1 expression in large to very large papillomas was associated
with liquoral cysts or communicating hydrocephalus. CONCLUSIONS: AQP1
expression characterizes normal choroid plexus and plexus papillomas.
Intensity and diffusion of AQP1 expression together with the size of the
tumour mass are somewhat predictive of communicating hydrocephalus or
liquoral cyst, lesions possibly caused by a disturbance of cerebrospinal
fluid homeostasis. Copyright (c) 2006 S. Karger AG, Basel.
PMID: 16714863 [PubMed - indexed for MEDLINE]
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|
Volume 5, Number 30 - 24 July 2006