Pediatric glioblastoma multiforme (GBM) tumors, which have been established as 'de novo' neoplasms, are known to differ from their adult counterparts in terms of biology, genetics and ultimately ...survival of patients. In order to evaluate the utility of markers of tumor biology for refining prognostic assessment, we retrospectively analyzed 54 pediatric GBMs (age range 9 months to 15 years) occurring at different anatomical sites in the brain, operated at our institute between 1995 and 2001. The expression of p53, epidermal growth factor receptor (EGFR), bcl-2 and retinoblastoma proteins (pRb) was analyzed by immunohistochemistry and the results were compared with the clinical profile, MIB-1 labeling index (LI) and patient survival. p53 immunoreactivity was noted in 53.7% of cases, predominantly in thalamic (75%) and cerebral lobar (62.2%), followed by brainstem tumors (30%). It was absent in cerebellar tumors. p53-positive tumors had a higher MIB-1 LI, compared to p53-negative tumors (p=0.003). EGFR and bcl-2 overexpression was observed in 25.9% and 33.3% of cases, respectively, and loss of pRb expression was evident in only 7.4% of cases, indicating that loss of this gene function is not significantly involved in pediatric GBMs. p53 and bcl-2 expression were maximally noted in patients with poorer outcome. Our results indicate that p53 expression status is noted in a significant number of pediatric supratentorial neoplasms. p53 with bcl-2 overexpression is more often associated with ominous prognosis. Further molecular characterization would provide newer insights into the biology of these neoplasms and form a basis for future therapeutic decision making.
Low-grade diffuse astrocytoma (DA) is considered benign tumor (World Health Organization WHO grade II), but it has an inherent tendency for malignant progression, which is quite variable.
To identify ...malignant progression in an individual case of DA, we studied the clinico-radiological and immunohistochemical factors and correlated with progression of DA at a dedicated tertiary level neurosciences centre NIMHANS, Bangalore, India.
Consecutive adult patients who had undergone tumor decompression for lobar supratentorial DA at our institute from 1994 to 1998 were retrospectively selected and followed up for clinico-radiological progression. The clinico-radiological and histomorphological features were studied. With the use of immunohistochemistry, proliferation index MIB-1 labeling index (LI), p53 protein expression, microvessel density (MVD) count assessed using anti-CD34 antibody were analyzed and correlated with progression-free survival (PFS) Results: There were 13 patients. Mean age was 34 years. The most common presenting symptom was seizures. The median follow-up was 54 months. There were four recurrences, with median interval of 75 months. Eight patients received radiotherapy. Younger patients (<40 years), seizure as the presenting symptom and postoperative radiotherapy were associated with longer PFS, while gemistocytic morphology (>20% gemistocytic cells), MVD value >20 correlated with shorter PFS, albeit statistically insignificant. MIB1 LI did not correlate with recurrence pattern. Moreover, p53 LI > 10% correlated with early progression (P = 0.04).
Our study highlights some of the clinical, histological and immunohistochemical parameters that predict progression on DA. Validation on a larger sample may be useful to plan appropriate treatment in an individual case.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Nocardial infection of the central nervous system is rare and usually manifests as brain abscess. Here we describe an elderly gentleman who presented with signs and symptoms of an intracranial mass ...lesion localising to the frontal lobe. Clinical examination and CT scan suggested neoplasia as the probable diagnosis. A biloculated abscess was seen at surgery. Aspiration of the contents and examination of pus revealed Nocardia asteroides. Treatment included total excision and prolonged antibiotic therapy which resulted in an excellent outcome.
OBJECTIVE AND IMPORTANCE:Subarachnoid hemorrhage (SAH) caused by spinal hemangioblastomas (HGBs) is extremely rare. Natural history of bleed in HGBs has been poorly studied.
CLINICAL PRESENTATION:We ...report a 19-year-old male who presented with clinical features of SAH. Evaluation with computed tomography confirmed SAH. Cerebral angiography revealed tumor-like blush at cervicomedullary junction, cerebellum, and cervical spinal cord with feeders from bilateral vertebral arteries. Diagnosis of von Hippel-Lindau (VHL) syndrome with multiple cerebellar and cervical spinal HGBs presenting with SAH was made. Magnetic resonance imaging revealed multiple lesions corresponding to the blush seen on angiography.
INTERVENTION:Patient underwent excision of both cervicomedullary and cervical lesions. Histopathology revealed characteristic features of HGBs.
CONCLUSIONS:HGBs is a rare cause of SAH and in patients of VHL syndrome with HGBs, SAH is extremely rare. Magnetic resonance imaging and angiogram will be diagnostic. In patients presenting with SAH with family history of HGBs or VHL syndrome, diagnosis of HGB should be considered.
Presurgical evaluation of children with mesial temporal sclerosis has shown severe neurocognitive impairments. There is debate about lateralized material-specific deficits in memory in children with ...mesial temporal sclerosis. The authors examined lateralization of brain dysfunction and age appropriate development of cognitive functions in 17 children (7-15 years) with mesial temporal sclerosis who had histories of uncontrolled epilepsy. The National Institute of Mental Health and Neurosciences (NIMHANS) neuropsychological battery for children was employed and each participant’s performance was compared with the norms. Results showed that the battery was sensitive to deficits in learning and memory associated with mesial temporal sclerosis. However, a lack of clearly lateralized material-specific memory deficits in children with left/right mesial temporal sclerosis was also observed. Performance on tests that assess learning, attention, working memory, and visuospatial functions was found to be below the age appropriate level. Children with mesial temporal sclerosis showed widely distributed neuropsychological deficits.
Spinal neurenteric cysts are intradural cystic lesions. These represent a part of the spectrum of developmental anomalies. These are rare lesions. Most of the data in literature is review of case ...reports. This made us evaluate our results of 23 cases and review the literature. This is a retrospective study of 23 patients managed at our institute over 20 years. The slides were retrieved and histopathological features studied. Twenty patients were less than 30 years old and 21 were males. Follow-up was available for 21 patients with mean duration of 71 months (range 2 months to 23 years). The typical presentation was backache with progressive neurological deficits pertaining to the level. Atypical presentations as acute onset, recurrent episodic events and aseptic meningitis were also noted. The cervicothoracic region was the most common site. 16 patients had cyst in intradural extramedullary plane and seven had intramedullary location. Associated vertebral anomalies as hemivertebrae, Klippel - Feil and spina bifida were noted in seven patients. There were two histological types of cysts with no correlation between the type of cysts and associated vertebral anomalies and extent of outcome. Partial excision though had higher risk of recurrence, was not associated with poorer outcome. Dorsal approach is an acceptable route with reasonably good results for this lesion. Spinal neurenteric cysts present at younger age with varied clinical presentations. These are commonly located intradurally ventral to the cord. Histological types have no effect on the outcome. Total excision is the choice of treatment. However, partial excision is a feasible option in intramedullary lesions and when significant adhesions occur. Although associated with higher risk of recurrence, the outcome is still good in these patients on re-excision.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Contrast computed tomography (CECT) scan of brain Figure 1a and b revealed a large intraventricular uniformly enhancing mass predominantly in the right lateral ventricle with a septal attachment. ...Magnetic resonance imaging (MRI) of brain revealed two fresh lesions, a small local recurrence within the right lateral ventricle and another distant extraventricular lesion in the right parasagittal interhemispheric region in proximity to the falx Figure 1d. He underwent re-exploration and excision of the parasagittal lesion.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The pineal parenchymal tumors are rare, comprising 15-30% of all tumors of pineal region. Their histological classification alone has been found to be inadequate for prognostication. Hence, we ...correlated their immunohistochemical profile with the prognosis.
A retrospective analysis of 33 pineal parenchymal tumors treated from 1990-2004 was performed. The histological features of the tumors were reviewed and immunohistochemical staining for neurofilament protein (NF), MIB-1, synaptophysin and GFAP were performed. Results were correlated with the patients' survival.
The study comprised 6 pineocytomas (PC), 17 pineoblastomas (PB) and 10 pineal parenchymal tumors with intermediate differentiation (PPT-ID) which included 3 mixed PC/PB. The histological diagnosis was obtained from microsurgical biopsy/decompression, stereotactic or endoscopic biopsy. Adjuvant therapy was advised based on histology. All pineocytomas stained positive for NF. Most pineoblastomas (13/16) failed to show any immunoreactivity with NF. The mean MIB-1 labeling index in pineocytomas, PPT of ID and pineoblastomas were 1.58, 16.1 and 23.52 respectively (p < 0.001). All the tumors stained positive for synaptophysin, although the intensity of the staining varied. NF-positive tumors had a higher chance of disease-free state, irrespective of histological subgroup (p = 0.0036). The median disease-free survival in pineoblastomas with negative NF staining was 5 months, which was less than that of pineoblastomas with positive NF staining (32 months).
Neurofilament immunoreactivity indicates better prognosis in pineal parenchymal tumors. The MIB-1 labeling index can be utilized as an additional tool to differentiate pineal parenchymal tumors into various subgroups.
ABSTRACT
Background:
Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during ...awake surgery for brain tumors and in functional neurosurgery.
Materials and Methods:
This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N
2
O and isoflurane were decreased to zero. Anesthesia was maintained with O
2
:air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO
2
) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine.
Results:
Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits.
Conclusion:
The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range.
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