bluuebunny/crossref_metadata_2025 huggingface dataset:
Gliosarcoma with infratemporal fossa extension
Authors: Sade Burak , Prayson Richard A. , Lee Joung H.
Published: January 2008

✓ Gliosarcomas are bimorphic intraaxial tumors. Involvement of the skull base is highly unexpected. The authors present the case of a temporal lobe gliosarcoma with significant infratemporal fossa extension. This 55-year-old man presented with a 1-month history of severe progressive headache. Neurological examination was unremarkable except for bilateral papilledema. Magnetic resonance imaging revealed a 6-cm right temporal mass with extension into the infratemporal fossa. The patient underwent a right frontotemporal craniotomy together with drilling of the sphenoid ridge and middle fossa floor. The tumor consisted of intraaxial, intracranial as well as extradural, and extracranial components with extension to the posterolateral wall of the sphenoid sinus. It had a relatively well-circumscribed dissection plane. Gross-total resection was achieved, and the middle fossa floor was reconstructed using a rotated temporalis muscle flap. The postoperative course was uneventful except for hypesthesia in the distribution of the maxillary division of the right trigeminal nerve. The histopathological diagnosis was consistent with gliosarcoma. Radiotherapy and chemotherapy consisting of temozolomide were administered subsequently, and the patient was recurrence free 12 months after his initial diagnosis.

In the presence of a mass lesion with both intraaxial and extracranial involvement, gliosarcoma should be considered among the differential diagnoses. Aggressive resection should be attempted, including the use of skull base surgical techniques to ensure an optimal outcome. The effect of skull base involvement to the overall treatment and outcome of patients with gliosarcomas would be difficult to determine given the rare occurrence of these lesions in such locations.
Granulocytic sarcoma: an unusual complication of acute promyelocytic leukemia causing cerebellar hemorrhage
Authors: Fukushima Shintaro , Terasaki Mizuhiko , Tajima Yutaka , Shigemori Minoru
Published: January 2008

✓Granulocytic sarcomas are rare tumors that occur primarily in patients with acute myelogenous leukemia or other myeloproliferative disorders, are seldom seen in patients with acute promyelocytic leukemia (APL), and have never been reported to occur in the cerebellum. The authors describe the case of a patient with APL who harbored a hemorrhagic granulocytic sarcoma in the cerebellum. This 39-year-old woman presented with cerebellar ataxia. Magnetic resonance images revealed an intraaxial tumor in the cerebellum. Bone marrow samples showing infiltration by leukemic blast cells and data from hematological tests led to a diagnosis of APL. The patient was treated with chemotherapy and surgery. She had no response to chemotherapy and died of progressive intratumoral hemorrhage. Results of histopathological studies and immunohistochemical staining of the cerebellar tumor confirmed a granulocytic sarcoma. Flow cytometry showed that the blast cells were positive for leukocyte common antigen, CD13, and CD33 markers. Bone marrow cytogenetics revealed that the patient had a 46, XX karyotype. Although no cytogenetic abnormality was present, fluorescence in situ hybridization detected a chimeric fusion of PML and RARA.

This is the first report to document a granulocytic sarcoma in the cerebellum as the primary presentation in a patient with APL and abnormal coagulation. As predicted by the unusual clinical manifestations and radiological findings, the patient’s survival was short. Although central nervous system complications in patients with APL are rare, the data in this case highlight the need for individualized treatment when such conditions occur.
Endoscopic opening of the foramen of Magendie using transaqueductal navigation for membrane obstruction of the fourth ventricle outlets
Authors: Longatti Pierluigi , Fiorindi Alessandro , Feletti Alberto , Baratto Vittorio
Published: January 2008

✓A membrane obstruction of the foramina of Magendie and Luschka is an uncommon origin of hydrocephalus characterized by unusual clinical symptoms of rhomboid fossa hypertension. Various surgical approaches have been proposed to alleviate this obstruction, including opening the obstructed foramen of Magendie using suboccipital craniectomy, shunting procedures, and more recently, endoscopic third ventriculostomy (ETV). In some cases, however, reshaping of the posterior fossa due to the collapse of the prepontine cistern could make ETV difficult for the surgeon and dangerous to the patient. In these cases, endoscopic opening of the foramen of Magendie by transaqueductal navigation of the fourth ventricle is a suitable and feasible therapeutic option.
Statistical determination of the optimal subthalamic nucleus stimulation site in patients with Parkinson disease
Authors: Guehl Dominique , Edwards Roderick , Cuny Emmanuel , Burbaud Pierre , Rougier Alain , Modolo Julien , Beuter Anne
Published: January 2008

Object

The subthalamic nucleus (STN) is currently recognized as the preferred target for deep brain stimulation (DBS) in patients with Parkinson disease (PD). If there is agreement in the literature that DBS improves motor symptoms significantly, the situation is less clear with respect to the side effects of this procedure. The goal of this study was to correlate the coordinate values of active electrode contacts with the amplitude of residual clinical symptoms and side effects using a mathematical approach.

Methods

In this study the investigators examined a cohort of 41 patients with PD who received clinical benefits from DBS after stimulating electrodes had been implanted bilaterally into the STN. The combined scores of residual clinical symptoms plus side effects, including speech disturbance, postural instability, and weight gain, were fitted by using either inverted ellipsoidal exponentials or smooth splines.

These analyses showed evidence of lower combined scores for stimulating contacts at an x coordinate approximately 12.0 to 12.3 mm lateral to the anterior commissure–posterior commissure (AC–PC) line and at a z coordinate approximately 3.1 to 3.3 mm under the AC–PC line. There was insufficient evidence for a preferred y coordinate location.

Conclusions

The authors propose a “best” therapeutic ellipse area that is centered at an x, z location of 12.5 mm, −3.3 mm and characterized by an extension of 1.85 mm in the x direction and 2.22 mm in the z direction. Therapeutic electrode contacts located within this area are well correlated with the lowest occurrence of residual symptoms and the lowest occurrence of side effects independent of STN anatomical considerations. The lack of a significant result in the y direction remains to be explored further.
Probabilistic cortical surface map of the middle cerebral artery territory for single-photon emission computed tomography studies
Authors: Hosoda Kohkichi , Ishii Kazunari , Minoshima Satoshi , Kohmura Eiji
Published: January 2008

Object

The middle cerebral artery (MCA) is the intracranial vessel most frequently affected by cerebrovascular diseases. A more accurate knowledge of the topography of this vessel may have an impact on treatment strategies for ischemic cerebrovascular diseases. The aim of this study was to construct a topographic map of the MCA territory for single-photon emission computed tomography (SPECT) using statistical brain mapping.

Methods

The margin of the perfusion deficit associated with infarction due to arterial occlusion, as seen on SPECT imaging, is presumed to approximate the borders of the territory of the artery. Basing the study on this hypothesis, SPECT images obtained in 12 patients with large MCA infarctions due to angiographically confirmed MCA trunk occlusion were selected, anatomically standardized, and compared with SPECT images obtained in healthy volunteers to construct probabilistic cortical surface maps of the MCA territory. Crossed cerebellar diaschisis was used as a primary cutoff marker for creation of the map. This MCA map (Method C) was compared with the conventional region of interest (ROI) method (Method A) and previously reported predefined cortical templates (Method B) for preliminary clinical application.

The probabilistic cortical surface map of the MCA territory showed that regions with the highest ratio of MCA territory included the transverse temporal gyrus (100%), supramarginal gyrus (100%), and inferior parietal lobule (91–92%). For preliminarily clinical application, this map (Method C) was compared with the conventional ROI method (Method A) in predicting hyperperfusion after carotid endarterectomy by performing a receiver operating characteristic (ROC) analysis, which demonstrated the statistically significant superiority of the MCA map (area under the ROC curve [Az] = 0.91) to the ROI method (Az = 0.75; p = 0.025). The ROC analysis also demonstrated a diagnostic value of the MCA map (Az = 0.95) that equaled predefined cortical templates (Method B) (Az = 0.93).

Conclusions

The probabilistic cortical surface map of the MCA territory used for SPECT, which was created using statistical brain mapping techniques, would be useful for an objective assessment of the cerebral perfusion status of patients with cerebrovascular diseases.
Trigeminal schwannomas: results of Gamma Knife surgery in 37 cases
Authors: Hasegawa Toshinori , Kida Yoshihisa , Yoshimoto Masayuki , Koike Jouji
Published: January 2008

Object

Information on outcomes of Gamma Knife surgery (GKS) for patients harboring trigeminal schwannomas is limited because these tumors are rare. The authors evaluated tumor control and functional outcomes in patients who underwent GKS for trigeminal schwannomas to clarify the efficacy of this treatment.

Methods

Forty-two patients with trigeminal schwannomas but no evidence of neurofibromatosis Type 2 were treated with GKS at Komaki City Hospital between November 1991 and December 2003. Of these, 37 patients were assessed. The mean tumor volume in these patients was 10 cm3. The mean maximum radiation dose directed to the tumor was 27.9 Gy and the mean dose directed to the tumor margin was 14.2 Gy. The mean follow-up period was 54 months. In four patients (11%) there was complete tumor remission; in 20 (54%) there was partial tumor remission; in eight (22%) the disease remained stable; and in five (14%) the tumor enlarged or uncontrollable facial pain developed with radiation-induced edema requiring resection. The actuarial 5- and 10-year tumor control rates were both 84%. With respect to functional outcomes, 40% of patients noted an improvement in their symptoms, and one patient experienced new symptoms despite good tumor control.

Conclusions

Gamma Knife surgery was a safe and effective treatment for a select group of patients harboring trigeminal schwannomas. Large tumors that compress the brainstem and cause deviation of the fourth ventricle should first be removed surgically and any remnant should be treated by GKS.
Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair
Authors: Cosgrove G. Rees , Delashaw Johnny B. , Grotenhuis J. Andre , Tew John M. , van Loveren Harry , Spetzler Robert F. , Payner Troy , Rosseau Gail , Shaffrey Mark E. , Hopkins L. Nelson , Byrne Richard , Norbash Alex
Published: January 2008

Object

The authors prospectively evaluated the safety and efficacy of a novel polyethylene glycol (PEG) hydrogel sealant in patients undergoing elective cranial surgery with documented cerebrospinal fluid (CSF) leakage after sutured dural repair.

Methods

The PEG hydrogel sealant was used at 11 different study sites in 111 patients with documented intraoperative CSF leakage after neurosurgical dural repair for a variety of conditions. Intraoperative CSF leakage was either spontaneous or induced by a Valsalva maneuver. Patients were monitored for 3 months postoperatively with physical examinations, clinical laboratory analyses, and diagnostic imaging.

The PEG hydrogel sealant was 100% effective in stopping CSF leakage in all patients. There were no sealant-related adverse events and all clinical outcomes were consistent with expectations for seriously ill patients undergoing prolonged neurosurgical procedures.

Conclusions

The PEG hydrogel sealant provides a safe and effective watertight closure when used as an adjunct to sutured dural repair during cranial surgery.
Decompressive hemicraniectomy in malignant middle cerebral artery infarction: an analysis of long-term outcome and factors in patient selection
Authors: Pillai Ashok , Menon Sajesh K. , Kumar Satyendra , Rajeev Kariyattil , Kumar Anand , Panikar Dilip
Published: January 2008

Object

Middle cerebral artery infarction often occurs at a younger age than other strokes and is associated with significant rates of mortality and morbidity. After a period of pessimism regarding decompressive hemicraniectomy in the management of acute stroke, the method has reemerged in the past decade. The present study was undertaken to assess the immediate and long-term outcome of this intervention and to help better define the selection criteria for surgery.

Methods

The authors conducted a nonrandomized prospective study using decompressive hemicraniectomy with duraplasty in patients at various stages of clinical deterioration due to a space-occupying middle cerebral artery infarct. Patients were assessed at 6 and 12 months postinfarction by using functional scales. Subjective reconsideration was assessed using a questionnaire.

Twenty-six patients were included in the study. The mean age was 48.4 ± 11.2 years, and the mean preoperative Glasgow Coma Scale score was 9.9 ± 3.2. The median time from ictus to surgery was 54 hours (range 13–288 hours). The rate of survival at 1 year postsurgery was 73%. Among survivors, 33.3% were independent (Barthel Index [BI] > 95) and 55.6% were partially dependent (BI 60–95) at 1 year postsurgery, with 72% attaining the ability to walk independently by 1 year postsurgery. No patient remained in a vegetative state. The 1-year BI score was inversely related to patient age (r = − 0.47, p = 0.048).

Conclusions

Survival after decompressive hemicraniectomy was better than previously reported using medical management alone. A vegetative state was avoided and functional independence was possible, especially in younger patients. Increasing age was a statistically significant predictor of disability and long-term functional dependence.
Discrimination of capsular stage brain abscesses from necrotic or cystic neoplasms using diffusion-weighted magnetic resonance imaging
Authors: Fertikh Djamil , Krejza Jaroslaw , Cunqueiro Alain , Danish Shabbar , Alokaili Riyadh , Melhem Elias R.
Published: January 2008

Object

The authors’ aim was to assess the ability of apparent diffusion coefficient (ADC) ratios in distinguishing brain abscesses from cystic or necrotic neoplasms.

Methods

Fifty-three patients with rim-enhancing masses in the brain observed on T1-weighted MR images were included: 26 had abscesses (14 bacterial, six nonbacterial, and six of unknown origin), 11 had glioblastoma multiforme, and 16 had rim-enhancing metastasis.

The ADC values, derived from diffusion-weighted imaging, were measured in the most homogeneous portion of the cystic component of the mass. The ADC ratios were calculated by dividing the ADC values from the nonenhancing cystic portion of the mass by the ADC values from contralateral normal-appearing white matter. Lesions were further differentiated based on presence, absence, or incompleteness of a T2 hypointensity rim.

The mean (± standard deviation) ADC ratios were significantly higher in neoplasms than in abscesses (2.45 ± 0.91 compared with 1.12 ± 0.53, p < 0.01). The accuracy of ADC ratios in discriminating abscesses from neoplasms, determined by the area under the receiver operating characteristic curve (Az), was high: 0.91 ± 0.04 (mean ± standard error of the mean [SEM]). The threshold of 1.7 was associated with highest efficiency (87%) in discriminating abscesses from neoplasms. If only bacterial abscesses were analyzed compared with neoplasms, the Az increased to 0.96 ± 0.03 (SEM). Using ADC ratios and T2 rim characteristics, 50 of 53 lesions were correctly classified (efficiency 94.3%).

Conclusions

The accuracy of ADC ratios in discriminating brain abscesses from cystic or necrotic neoplasms is very high and can be further improved using T2 rim characteristics.
Visualization of the frontotemporal language fibers by tractography combined with functional magnetic resonance imaging and magnetoencephalography
Authors: Kamada Kyousuke , Todo Tomoki , Masutani Yoshitaka , Aoki Shigeki , Ino Kenji , R.T.  , Morita Akio , Saito Nobuhito
Published: January 2008

Object

There is continuous interest in the monitoring of language function during tumor resection around the fron-totemporal regions of the dominant hemisphere. The aim of this study was to visualize language-related subcortical connections, such as the arcuate fasciculus (AF) by diffusion tensor (DT) imaging–based tractography.

Methods

Twenty-two patients with brain lesions adjacent to the AF in the frontotemporal regions of the dominant hemisphere were studied. The AF tractography was accomplished by placing initiation and termination sites (seed and target points) in the frontal and temporal regions, which were functionally identified by using functional magnetic resonance (fMR) imaging in conjunction with a verb generation task and magnetoencephalography (MEG) in conjunction with a reading task. The combination of fMR imaging and MEG data clearly demonstrated the hemispheric dominance of language functions, which was confirmed by an intracranial amobarbital test (Wada procedure). In all 22 patients, the authors were able to consistently visualize the AF by DT imaging–based tractography, using the functionally identified seed and target points and a fractional anisotropy value of 0.16. In two of 22 cases investigated, the functional information, including the results of AF tractography, fMR imaging, and MEG, was imported to a neuronavigation system and was validated by bipolar electric stimulation of the cortical and subcortical areas during awake surgery. The cortical stimulation to the gyrus that included the area of activation identified in fMR imaging with the language task evoked speech arrest, while the subcortical stimulation close to the AF reproducibly caused paranomia without speech arrest. Postoperative AF tractography showed that the distances between the stimulus points and the AF were within 6 mm.

Conclusions

The combination of these techniques facilitated accurate identification of the location of the AF and verification of the language fibers.
Prospective evaluation of pain and analgesic use following major elective intracranial surgery
Authors: Gottschalk Allan , Berkow Lauren C. , Stevens Robert D. , Mirski Marek , Thompson Richard E. , White Elizabeth D. , Weingart Jon D. , Long Donlin M. , Yaster Myron
Published: January 2008

Object

Opioid administration after major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect the postoperative neurological examination. The authors conducted a prospective study to evaluate the incidence, severity, and treatment of postoperative pain in patients who underwent major intracranial surgery.

Methods

One hundred eighty-seven patients (77 men and 110 women, mean age 52 ± 15 years, mean weight 78.1 ± 19.9 kg) underwent either supratentorial (129 patients) or infratentorial (58 patients) procedures. Sixty-nine percent of the patients reported experiencing moderate to severe pain (≥ 4 on a 0–10 scale) during the 1st postoperative day. Pain scores greater than or equal to 4 persisted in 48% on the 2nd postoperative day. Approximately 80% of patients were treated with acetaminophen on the 1st postoperative day, whereas opioids (primarily intravenous fentanyl) were administered to 58%. Compared with patients who underwent supratentorial procedures, those who underwent infratentorial procedures reported more severe pain at rest (mean score 4.9 ± 2.2 compared with 3.8 ± 2.6; p = 0.015) and with movement (mean score 6.3 ± 2.6 compared with 4.5 ± 2.7; p < 0.001) on the 1st postoperative day. On both the 1st and 2nd postoperative days, patients who underwent infratentorial procedures received greater quantities of opioid (p ≤ 0.019) and nonopioid (p ≤ 0.013) analgesics than those who underwent supratentorial procedures. Patients’ dissatisfaction with analgesic therapy was significantly associated with elevated pain levels on the first 2 postoperative days (p < 0.001).

Conclusions

In contrast to prevailing assumptions, the study findings reveal that most patients undergoing elective major intracranial surgery will experience moderate to severe pain for the first 2 days after surgery and that this pain is often inadequately treated.
Optimal reverse Trendelenburg position in patients undergoing craniotomy for cerebral tumors
Authors: Tankisi Alp , Cold Georg Emil
Published: January 2008

Object

To the authors’ knowledge, repeated measurements of intracranial pressure (ICP), cerebral perfusion pressure (CPP), and the degree of dural tension during different positions on the operating table (reverse Trendelenburg position [rTp]) have not been studied in patients undergoing craniotomy.

Methods

In the present study 53 patients with supratentorial cerebral tumors who underwent craniotomy in the supine position were included. Subdural ICP, mean arterial blood pressure (MABP), CPP, and jugular bulb (JB) pressure were recorded, and the degree of dural tension was analyzed while patients were in the neutral operating position and at 5, 10, and 15° rTp. The optimal operating position was defined as the one at which subdural ICP was as low as possible, and CPP was greater than or equal to 60 mm Hg or as high as possible.

Subdural ICP, MABP, and JB pressure decreased significantly after each 5° change in rTp compared with the preceding position. Dural tension decreased significantly up to 10° rTp, but was unchanged at 15° rTp. At 5° rTp CPP remained unchanged, but it decreased significantly during 10 and 15° rTp. The optimal position in the majority of patients was determined to be 15° rTp.

Conclusions

Before opening the dura mater for craniotomy, repeated measurements of ICP and CPP, in the neutral position and at 5, 10, and 15° rTp, provide valuable information regarding the optimal level of ICP and CPP.
Prolonged survival of mice with established intracerebral glioma receiving combined treatment with peroxisome proliferator-activated receptor–γ thiazolidinedione agonists and interleukin-2–secreting syngeneic/allogeneic fibroblasts
Authors: Spagnolo Alessandra , Glick Roberta P. , Lin Henry , Cohen Edward P. , Feinstein Douglas L. , Lichtor Terry
Published: January 2008

Object

In this study the authors explored the benefits of treating C57Bl/6 mice with an established intracerebral glioma by combining immunotherapy with interleukin (IL)-2–secreting syngeneic/allogeneic fibroblasts administered into the tumor bed along with the chemotherapeutic agent pioglitazone, a thiazolidinedione (TZD). The TZDs are agonists of the peroxisome proliferator-activated receptor–γ. They have been found to exert antiproliferative effects on several transformed cell lines. Data from prior studies by these authors have revealed the immunotherapeutic properties of the IL-2–secreting fibroblasts in treating intracerebral gliomas in mice.

Methods

The sensitivity of GL261 glioma cells and primary astrocytes to pioglitazone was determined in vitro by incubating the cells with increasing amounts of the drug. Viability was assessed by measuring lactate dehydrogenase release, and effects on metabolism were determined by measuring superoxide production and levels of superoxide dismutase. The GL261 cells were injected intracerebrally into C57Bl/6 mice, followed by treatment with pioglitazone either orally or intracerebrally into the tumor bed. The effect of the combined therapy was determined by injecting C57Bl/6 mice with an established intracerebral GL261 glioma with IL-2–secreting allogeneic fibroblasts and pioglitazone directly into the tumor bed through a unique cannula system.

Pioglitazone was found to induce cell death in GL261 glioma cells grown in vitro while causing only modest damage to astrocytes. The application of pioglitazone also resulted in a significantly greater induction of cellular superoxide in glioma cells than in astrocytes, which can activate apoptotic pathways. Pioglitazone administered intracerebrally (p < 0.05) but not orally was found to prolong survival in mice harboring an intracerebral glioma. Synergistic effects of combination therapy on prolonging survival were found in mice receiving both pioglitazone and IL-2–secreting fibroblasts (p < 0.005, compared with untreated animals). Pioglitazone induces metabolic and oxidative stresses that are tolerated by astrocytes but not glioma cells, which could account for selective vulnerability and increased sensitivity to IL-2, suggesting potential for the use of this Food and Drug Administration–approved drug in the treatment of brain tumors.

Conclusions

The data indicate the beneficial effects of combination therapy using pioglitazone and immunotherapy in mice harboring intracerebral glioma.
Magnetic resonance imaging of in vitro glioma cell invasion
Authors: Bernas Lisa M. , Foster Paula J. , Rutt Brian K.
Published: January 2008

Object

An understanding of single glioma cell invasion has been limited by the static picture provided by histological studies. The ability to nondestructively assess cell invasion dynamically in a full 3D volume would improve the quality and quantity of information available from both in vivo and in vitro experiments. The purpose of this study was to observe glioma cell invasion in a 3D in vitro model using a microimaging protocol at 1.5 tesla and to assess the uptake of micron-sized particles of iron oxide (MPIO) and the consequent effects on cell function.

Methods

Rat C6 glioma cells were labeled with MPIO to a sufficient extent to allow single cell detection in vitro without significant effects on cell proliferation or plating efficiency. When placed on agar-coated plates, the cells formed stable multicellular tumor spheroids (MCTSs), which were embedded in collagen type I gel and serially visualized using magnetic resonance (MR) imaging and phase-contrast microscopy over 8 days. The MCTSs initially appeared as large susceptibility artifacts on MR images, but within 2 days, as cells moved away from the main MCTS, small discrete areas of signal loss, possibly due to single cells, could be observed and tracked.

Conclusions

Glioma cell invasion can be nondestructively observed using MR imaging. The sensitivity of MR imaging, along with its ability to represent full 3D volumes noninvasively over time, makes it ideal for longitudinal in vivo cell tracking studies.
Synergistic cytotoxicity through the activation of multiple apoptosis pathways in human glioma cells induced by combined treatment with ionizing radiation and tumor necrosis factor–related apoptosis-inducing ligand
Authors: Nagane Motoo , Cavenee Webster K. , Shiokawa Yoshiaki
Published: January 2008

Object

Malignant gliomas remain incurable despite modern multimodality treatments. Tumor necrosis factor (TNF)–related apoptosis-inducing ligand (TRAIL), also known as Apo2L, a member of the TNF family, preferentially induces apoptosis in human tumor cells through its cognate death receptors DR4 or DR5, suggesting that it may serve as a potential therapeutic agent for intractable malignant gliomas. Here, the authors show that genotoxic ionizing radiation synergistically enhances TRAIL-induced cell death in human glioma cells expressing DR5.

Methods

Combination treatment with soluble human TRAIL plus radiation induced robust cell death, while each of them singly led to only limited cytotoxicity. The combination resulted in cleavage and activation of the apoptotic initiator caspase-8 and the effector caspase-3 as well as cleavage of Bid and another initiator caspase-9, a downstream component of the apoptosome. Accordingly, it augmented the release of cytochrome c from the mitochondria into the cytosol, as well as apoptosis-inducing factor. Synergistic cell death was suppressed by TRAIL-neutralizing DR5-Fc, caspase inhibitors, expression of dominant-negative Fasassociated protein with death domain and CrmA, which selectively blocks caspase-8, and overexpression of Bcl-XL. Finally, combination treatment had no influence on the viability of normal human astrocytes.

Conclusions

These results suggest that combination treatment with TRAIL and ionizing radiation kills human glioma cells through the activation of DR5-mediated death receptor pathways. This therapy involves direct activation of effector caspases as well as mitochondria-mediated pathways and provides a novel strategy in which TRAIL could be synergistically combined with DNA-damaging radiation.
Irinotecan: a potential new chemotherapeutic agent for atypical or malignant meningiomas
Authors: Gupta Vinay , Su Yuzhuang S. , Samuelson Christian G. , Liebes Leonard F. , Chamberlain Marc C. , Hofman Florence M. , Schönthal Axel H. , Chen Thomas C.
Published: January 2008

Object

There is currently no effective chemotherapy for meningiomas. Although most meningiomas are treated surgically, atypical or malignant meningiomas and surgically inaccessible meningiomas may not be removed completely. The authors have investigated the effects of the topoisomerase I inhibitor irinotecan (CPT-11) on primary meningioma cultures and a malignant meningioma cell line in vitro and in vivo.

Methods

The effects of irinotecan on cellular proliferation in primary meningioma cultures and the IOMM-Lee malignant meningioma cell line were measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl tetrazolium bromide assay and flow cytometry. Apoptosis following drug treatment was evaluated by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling and the DNA laddering assays. The effects of irinotecan in vivo on a meningioma model were determined with a subcutaneous murine tumor model using the IOMM-Lee cell line.

Irinotecan induced a dose-dependent antiproliferative effect with subsequent apoptosis in the primary meningioma cultures (at doses up to 100 μM) as well as in the IOMM-Lee human malignant meningioma cell line (at doses up to 20 μM) irinotecan. In the animal model, irinotecan treatment led to a statistically significant decrease in tumor growth that was accompanied by a decrease in Bcl-2 and survivin levels and an increase in apoptotic cell death.

Conclusions

Irinotecan demonstrated growth-inhibitory effects in meningiomas both in vitro and in vivo. Irinotecan was much more effective against the malignant meningioma cell line than against primary meningioma cultures. Therefore, this drug may have an important therapeutic role in the treatment of atypical or malignant meningiomas and should be evaluated further for this purpose.
Management of a retained catheter in an arteriovenous malformation
Authors: Bingöl Hakan , Sirin Gokçe , Akay Hakki Tankut , Iyem Hikmet , Demirkilic Ufuk , Tatar Harun
Published: January 2008

✓The long-term effects of retained catheters in patients are not well known; therefore, the clinical presentation may differ. The authors present the case of a 21-year-old man with a pseudoaneurysm of the left common femoral artery, which developed 3 months after a transfemoral microcatheter embolization of a cerebral arteriovenous malformation (AVM) in which the catheter was inadvertently glued into the AVM and was retained at the groin.
Electrocorticographically controlled brain–computer interfaces using motor and sensory imagery in patients with temporary subdural electrode implants
Authors: Felton Elizabeth A. , Wilson J. Adam , Williams Justin C. , Garell P. Charles
Published: January 2008

✓Brain–computer interface (BCI) technology can offer individuals with severe motor disabilities greater independence and a higher quality of life. The BCI systems take recorded brain signals and translate them into real-time actions, for improved communication, movement, or perception. Four patient participants with a clinical need for intracranial electrocorticography (ECoG) participated in this study. The participants were trained over multiple sessions to use motor and/or auditory imagery to modulate their brain signals in order to control the movement of a computer cursor. Participants with electrodes over motor and/or sensory areas were able to achieve cursor control over 2 to 7 days of training. These findings indicate that sensory and other brain areas not previously considered ideal for ECoG-based control can provide additional channels of control that may be useful for a motor BCI.
Image-guided vascular neurosurgery based on three-dimensional rotational angiography
Authors: Willems Peter W. A. , Van Walsum Theo , Woerdeman Peter A. , Van De Kraats Everine B. , De Kort Gerard A. P. , Niessen Wiro J. , Van Der Sprenkel Jan Willem Berkelbach
Published: January 2008

✓Three-dimensional rotational angiography is capable of exquisite visualization of cerebral blood vessels and their pathophysiology. Unfortunately, images obtained using this modality typically show a small region of interest without exterior landmarks to allow patient-to-image registration, precluding their use for neuronavigation purposes. The aim of this study was to find an alternative technique to enable 3D rotational angiography–guided vascular neurosurgery. Three-dimensional rotational angiograms were obtained in an angiographic suite with direct navigation capabilities. After image acquisition, a navigated pointer was used to touch fiducial positions on the patient's head. These positions were located outside the image volume but could nevertheless be transformed into image coordinates and stored in the navigation system. Prior to surgery, the data set was transferred to the navigation system in the operating room, and the same fiducial positions were touched again to complete the patient-to-image registration. This technique was tested on a Perspex phantom representing the cerebral vascular tree and on two patients with an intracranial aneurysm. In both the phantom and patients, the neuronavigation system provided 3D images representing the vascular tree in its correct orientation, that is, the orientation seen by the neurosurgeon through the microscope. In one patient, tissue shift was clearly observed without significant changes in the orientation of the structures. Results in this study demonstrate the feasibility of using 3D rotational angiography data sets for neuronavigation purposes. Determining the benefit of this type of navigation should be the subject of future studies.
Endoscopic identification and biopsy sampling of an intraventricular malignant glioma using a 5–aminolevulinic acid–induced protoporphyrin IX fluorescence imaging system
Authors: Tamura Yoji , Kuroiwa Toshihiko , Kajimoto Yoshinaga , Miki Yoshihito , Miyatake Shin-Ichi , Tsuji Masao
Published: January 2008

✓Several neurosurgical studies have provided descriptions of the utility of fluorescence-guided tumor resection using a microscope. However, fluorescence-guided endoscopic detection of a deep-seated brain tumor has not yet been reported. The authors report their experience with an endoscopic biopsy procedure for a malignant glioma within the third ventricle using a 5–aminolevulinic acid (5-ALA)–induced protoporphyrin IX fluorescence imaging system. A 5-ALA–induced fluorescence image of an intraventricular tumor is barely visible with the typical fluorescence endoscopic system used in other clinical fields because the intensity of excitation light at wavelengths of 390 to 405 nm through a cutoff filter is too weak to delineate a brain tumor.

The technique described in this study made use of a laser illumination system with a high-powered output that delivered a violet-blue light at wavelengths of 405 nm. In addition, a common ultraviolet cutoff filter was fitted between the endoscope and the high-sensitivity camera to block the backscattered excitation light. A 5-ALA–induced fluorescence endoscopy performed using this system allowed the intraventricular tumor to be clearly visualized as a red fluorescent lesion. Several biopsy specimens obtained from the fluorescent lesion provided a definitive histological diagnosis. The results indicate that this endoscopic system is useful in detecting an intraventricular fluorescent tumor.
Sex and genetic associations with cerebrospinal fluid dopamine and metabolite production after severe traumatic brain injury
Authors: Wagner Amy K. , Ren Dianxu , Conley Yvette P. , Ma Xiecheng , Kerr Mary E. , Zafonte Ross D. , Puccio Ava M. , Marion Donald W. , Dixon C. Edward
Published: January 2008

Object

Dopamine (DA) pathways have been implicated in cognitive deficits after traumatic brain injury (TBI). Both sex and the dopamine transporter (DAT) 3′ variable number of tandem repeat polymorphism have been associated with differences in DAT protein density, and DAT protein affects both presynaptic DA release, through reverse transport, and DA reuptake. Catecholamines and associated metabolites are subject to autooxidation, resulting in the formation of reactive oxygen species that may contribute to subsequent oxidative injury. The purpose of this study was to determine associations between factors that affect DAT expression and cerebrospinal fluid (CSF) DA and metabolite levels after severe TBI.

Methods

Sixty-three patients with severe TBI (Glasgow Coma Scale score ≤ 8) were evaluated. The patients' genotypes were obtained using previously banked samples of CSF, and serial CSF samples (416 samples) were used to evaluate DA and metabolite levels. High-performance liquid chromatography was used to determine CSF levels of DA, 3,4-dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) during the first 5 days after injury.

Mixed-effects multivariate regression modeling revealed that patients with the DAT 10/10 genotype had higher CSF DA levels than patients with either the DAT 9/9 or DAT 9/10 genotypes (p = 0.009). Females with the DAT 10/10 genotype had higher CSF DA levels than females with the DAT 9/9 or DAT 9/10 genotypes, and sex was associated with higher DOPAC levels (p = 0.004). Inotrope administration also contributed to higher DA levels (p = 0.002).

Conclusions

In addition to systemic administration of DA, inherent factors such as sex and DAT genotype affect post-TBI CSF DA and DA metabolite levels, a phenomenon that may modulate susceptibility to DA-mediated oxidative injury.
Motor tract monitoring during insular glioma surgery
Authors: Neuloh Georg , Pechstein Ulrich , Schramm Johannes
Published: January 2008

Object

Surgery for insular gliomas incurs a considerable risk of motor morbidity. In this study the authors explore the validity and utility of continuous motor tract monitoring to detect and reverse impending motor impairment during insular glioma resection.

Methods

Motor evoked potentials (MEPs) were successfully monitored during 73 operations to remove insular gliomas. Seventy-two cases were assessable, and one patient died during the early postoperative course. In this prospective observational approach, MEP monitoring results were correlated with intraoperative events and perioperative clinical data.

Intraoperative recordings of MEPs remained stable in 40 cases (56%), indicating unimpaired motor outcome and allowing safe completion of the hazardous steps of the procedure. Deterioration of MEPs occurred in 32 cases (44%). This deterioration was reversible after intervention in 21 cases (29%), and there was no new motor deficit except for transient paresis in nine of these cases (13%). Surgical measures could not prevent irreversible MEP deterioration in 11 cases (15%). Transient mild or moderate paresis occurred if complete MEP loss was avoided. Irreversible MEP loss in seven cases (10%) occurred after completion of resection in four of these seven cases, and was consistently an indicator of both a stroke within the deep motor pathways and permanent paresis, which remained severely disabling in three patients (4%). In contrast, permanently severe paresis occurred in two (18%) of 11 cases without useful MEP monitoring.

Conclusions

Continuous MEP monitoring is a valid indicator of motor pathway function during insular glioma surgery. This method indicates that remote ischemia, in this study the leading cause of impending motor deterioration, helps to avert definitive stroke of the motor pathways and permanent new paresis in the majority of cases. The rate of permanently severe new deficit appears to be greater in unmonitored cases.
Association between fluorine-18–labeled fluorodeoxyglucose uptake and 1p and 19q loss of heterozygosity in World Health Organization Grade II gliomas
Authors: Stockhammer Florian , Thomale Ulrich-Wilhelm , Plotkin Michail , Hartmann Christian , von Deimling Andreas
Published: January 2008

Object

Oligodendroglial tumors harboring combined 1p and 19q loss (1p/19q LOH) are characterized by a favorable prognosis and response to chemotherapy and radiotherapy, but detection of 1p/19q LOH relies on postoperative procedures. The authors investigated the potential of fluorine-18–labeled fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) to predict 1p/19q LOH preoperatively in tumors whose appearance on initial magnetic resonance images was consistent with that of low-grade glioma.

Methods

The study population comprised 25 patients who had undergone preoperative FDG-PET followed by tumor resection. Neuronavigation ensured a precise match of FDG uptake wi th the site of biopsy. All tumor specimens were graded according to the World Health Organization (WHO) classification system. Microsatellite analysis was used to identify 1p/19q LOH.

In this series, 16 of 25 gliomas corresponded to WHO Grade II. In eight of these 16, 1p/19q LOH was detected. Raised glucose utilization within the tumor was seen in the six of eight WHO Grade II gliomas with 1p/19q LOH and in none of the WHO Grade II gliomas without this genetic alteration (p = 0.003).

Conclusions

These findings demonstrate the potential of FDG-PET to predict 1p/19q LOH in WHO Grade II gliomas.
Protection of mitochondrial function and improvement in cognitive recovery in rats treated with hyperbaric oxygen following lateral fluid-percussion injury
Authors: Zhou Zhengwen , Daugherty Wilson P. , Sun Dong , Levasseur Joseph E. , Altememi Nabil , Hamm Robert J. , Rockswold Gaylan L. , Bullock M. Ross
Published: January 2008

Object

Hyperbaric oxygen (HBO2) has been shown to improve outcome after severe traumatic brain injury, but its underlying mechanisms are unknown. Following lateral fluid-percussion injury (FPI), the authors tested the effects of HBO2 treatment as well as enhanced normobaric oxygenation on mitochondrial function, as measured by both cognitive recovery and cellular adenosine triphosphate (ATP) levels.

Methods

Adult male Sprague–Dawley rats were subjected to moderate lateral FPI or sham injury and were allocated to one of four treatment groups: 1) FPI treated with 4 hours of normobaric 30% O2; 2) FPI treated with 4 hours of normobaric 100% O2; 3) FPI treated with 1 hour of HBO2 plus 3 hours of normobaric 100% O2; and 4) sham-injured treated with normobaric 30% O2. Cognitive outcome was assessed using the Morris water maze (MWM) on Days 11 to 15 after injury. Animals were then killed 21 days postinjury to assess hippocampal neuronal loss. Adenosine triphosphate was extracted from the neocortex and measured using high-performance liquid chromatography. The results showed that injured animals treated with HBO2 or normobaric 100% O2 alone had significantly higher levels of cerebral ATP as compared with animals treated using normobaric 30% O2 (p ≤ 0.05). The injured animals treated with HBO2 had significant improvements in cognitive recovery, as characterized by a shorter latency in MWM performance (p ≤ 0.05), and decreased neuronal loss in the CA2/3 and hilar regions as compared with those treated with 30% or 100% O2 (p ≤ 0.05).

Conclusions

Both hyperbaric and normobaric hyperoxia increased cerebral ATP levels after lateral FPI. In addition, HBO2 treatment improved cognitive recovery and reduced hippocampal neuronal cell loss after brain injury in the rat.
Ventriculoperitoneal shunt dysfunction in a patient presenting with neurogenic pulmonary edema
Authors: Hofstetter Thomas , Mirzayan M. Javad , Krauss Joachim K.
Published: January 2008

✓ The authors report on a patient with dysfunction of a ventriculoperitoneal shunt who presented with two episodes of neurogenic pulmonary edema within the space of a few months. The edema resolved on correction of the shunt dysfunction. Because neurogenic pulmonary edema may be a rare consequence of shunt dysfunction, it is important to recognize this unusual association and provide appropriate diagnostic measures and treatment.
Historical evolution of stereotactic amygdalotomy for the management of severe aggression
Authors: Fountas Kostas N. , Smith Joseph R.
Published: January 2008

✓Friedrich Goltz first reported in the 1890s that temporal lobe removal had a taming effect in animals. The results of studies by Klüver and Bucy, and later Terzian and Ore, demonstrated that an amygdalectomy combined with a temporal lobectomy had a significant taming effect in both animals and humans. Based on these observations, Narabayashi and colleagues reported the first clinical series of patients with temporal lobe epilepsy and/or severe behavioral disturbances in which stereotactic amygdalotomy was performed to address aggressive disorders, using a frame-based stereo-tactic device designed by Narabayashi. Use of pneumoencephalography, combined with physiological localization by means of olfactory stimulation and field potential recordings, enabled these investigators to define the lateral part of the amygdala, while simultaneously using wax injections to create lesions. Chitanondh used a similar localization technique to produce medial amygdala lesions by injecting a mixture of olive oil, wax, and iodized oil.

In 1966, Heimburger and coworkers reported results from a series of 25 patients with epilepsy and aggressive behavior who underwent stereotactic amygdalotomy. Their technique was slightly different and their target localization was solely anatomical, based on pneumoencephalography or contrast ventriculography, and they utilized a cryoprobe to make lesions. In 1970, Balasubramaniam and Ramamurthi reported the largest clinical series to date on this technique; pneumoencephalography or contrast ventriculography was used for anatomical localization, and depth electrode recordings were used to obtain physiological confirmation of their targets, whereas either diathermy or a Bertrand loop was used for making lesions. The development of magnetic resonance imaging technology in late 1980 allowed for a more accurate anatomical localization of the amygdala, and the improvement of radiofrequency generators also made lesioning more precise. Despite these and subsequent technological advances, the number of amygdalotomies performed has geometrically decreased during the last 20 years.