Search

Introduction: Cerebrospinal fluid (CSF) from amyotrophic lateral sclerosis (ALS) patients induces cytotoxic effects in in vitro cultured motor neurons., Material and Methods: We selected CSF with previously reported cytotoxic effects from 32 ALS patients. Twenty-eight adult male rats were intracerebroventricularly implanted with osmotic mini-pumps and divided into 3 groups: 9 rats injected with CSF from non-ALS patients, 15 rats injected with cytotoxic ALS-CSF, and 4 rats injected with a physiological saline solution. CSF was intracerebroventricularly and continuously infused for periods of 20 or 43days after implantation. We conducted clinical assessments and electromyographic examinations, and histological analyses were conducted in rats euthanised 20, 45, and 82days after surgery., Results: Immunohistochemical studies revealed tissue damage with similar characteristics to those found in the sporadic forms of ALS, such as overexpression of cystatinC, transferrin, and TDP-43 protein in the cytoplasm. The earliest changes observed seemed to play a protective role due to the overexpression of peripherin, AKTpan, AKTphospho, and metallothioneins; this expression had diminished by the time we analysed rats euthanised on day 82, when an increase in apoptosis was observed. The first cellular changes identified were activated microglia followed by astrogliosis and overexpression of GFAP and S100B proteins., Conclusion: Our data suggest that ALS could spread through CSF and that intracerebroventricular administration of cytotoxic ALS-CSF provokes changes similar to those found in sporadic forms of the disease., (Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Scalp metastases of meningiomas seldom have been reported. Here, we report a series of 4 cases of this rare event and discuss the relevant potential risk factors., Methods: We performed a retrospective review of patients treated for scalp metastases of meningiomas at our institution. A literature review was performed for the terms "scalp meningioma," "cutaneous meningioma," "skin meningioma," "extracranial meningioma," and "subcutaneous meningioma.", Results: Four patients showed scalp metastases of recurrent meningiomas with the following associated clinical features: multiple reoperations (n = 4), immunosuppression (n = 2), radiation therapy (n = 3), surgical wound complications with cerebrospinal fluid fistula (n = 2), and histologic grade progression (n = 2). The timescale for development of scalp metastasis was between 5 months and 13 years after intracranial meningioma surgery. In all cases, the metastases were located close to the surgical scalp incision for the craniotomy. Previously, 11 cases of meningioma with scalp metastasis, with similar features to those described here, were reported in the literature., Conclusions: Spreading of meningioma cells during surgery is a possible mechanism for scalp metastases of recurrent meningiomas. Factors associated with scalp metastases include reoperations, immunosuppression, radiation therapy, torpid course of the surgical wound with cerebrospinal fluid fistula, and histologic progression. Awareness of these features is advisable for neurosurgeons involved in the care of patients with similar profiles., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Supplemental education is desirable for neurosurgical training, and the use of human cadaver specimen and virtual reality models is routine. An in vivo porcine training model for cranial neurosurgery was introduced in 2005, and our recent experience with this unique model is outlined here. For the first time, porcine anatomy is illustrated with particular respect to neurosurgical procedures. The pros and cons of this model are described. The aim of the course was to set up a laboratory scenery imitating an almost realistic operating room in which anatomy of the brain and neurosurgical techniques in a mentored environment free from time constraints could be trained. Learning objectives of the course were to learn about the microsurgical techniques in cranial neurosurgery and the management of complications. Participants were asked to evaluate the quality and utility of the programme via standardized questionnaires by a grading scale from A (best) to E (worst). In total, 154 residents have been trained on the porcine model to date. None of the participants regarded his own residency programme as structured. The bleeding and complication management (97%), the realistic laboratory set-up (89%) and the working environment (94%) were favoured by the vast majority of trainees and confirmed our previous findings. After finishing the course, the participants graded that their skills in bone drilling, dissecting the brain and preserving cerebral vessels under microscopic magnification had improved to level A and B. In vivo hands-on courses, fully equipped with microsurgical instruments, offer an outstanding training opportunity in which bleeding management on a pulsating, vital brain represents a unique training approach. Our results have shown that education programmes still lack practical training facilities in which in vivo models may act as a complementary approach in surgical training.

Reconstruction of lost axonal pathways in the central nervous system (CNS) is possible with the use of peripheral nerve grafts (PNG). However, these permit the entry of axons, while their reentry back into the CNS is compromised. Olfactory ensheathing glia (OEG) may permit this reentry of axons if cografted with PNG. We compared the number of tyrosine-hydroxylase positive (TH+) fibers reinnervating PNGs and crossing the graft-striatum interface in PNG placed between the substantia nigra and the striatum in rats receiving both PNG and OEGs and animals receiving PNG only. More TH fibers were seen inside the grafts when OEG was cografted. Although the number of fibers decreases along the graft's length, this effect is less severe when OEG is present. TH+ fibers are seen crossing the PNG-striatum interface in the OEG group. This is correlated with a higher synaptic density at the striatum near the graft when OEG is co-grafted. While these results must be replicated in animal models of Parkinsonism, their implications may apply both to the treatment of Parkinson's disease and to other pathologies, such as spinal cord lesions, where regeneration of long axonal pathways is necessary., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Peripheral nerve grafts have shown the ability to facilitate central axonal growth and regenerate the adult central nervous system. However, the detailed description of a technique for atraumatic graft placement within the brain is lacking. We present a stereotactic procedure to implant a peripheral nerve graft within a rat's brain with minimal brain tissue damage. The procedure permits a correct graft placement joining two chosen points, and the survival and integration of the graft in the host tissue with a light glial reaction, with evidence of central axonal growth inside the graft, at least up to 8 weeks after its implantation.

In spite of the great efforts made by the scientific community, up to now there is no agreement about the rheoencephalography (REG) capability to reflect cerebral blood flow (CBF). Moreover, a standard procedure and the optimal electrode arrangement have not been established yet. In a previous study, we found, using a classical four-shell spherical model of the head and solving it by numerical methods that, theoretically, there could exist an electrode arrangement to register an REG II free of extracranial contribution. In this paper, we have studied the influence of scalp thickness on the intracranial contribution to REG II. The study has been performed by solving the head model, using in this case analytical methods, and then estimating the partial contribution of CBF pulsatility to REG for a given set of scalp thicknesses. Although our theoretical results validate the previous finding and suggest that, in some cases, an optimal electrode arrangement to register REG II exists, such an arrangement, and even its existence, is very sensitive to the subject's scalp thickness. According to this, there could not exist a universal electrode arrangement suitable for all individuals to register an REG II free of extracranial contribution, since it depends on the subject's physical constitution. This fact could explain the lack of agreement in the literature about REG interpretation.

Objectives: Partial contributions of intracranial and extracranial circulation to rheoencephalography (REG) remain uncertain. The main goal of this work is to determine theoretically the capability of REG techniques to reflect intracranial blood flow., Methods: Head and current injection electrodes were computationally modeled to assess REG sensitivity to brain and scalp conductivity changes. Data obtained were related to tissue perfusions to calculate the partial contribution of cerebral blood perfusion to REG I, REG II and monopolar REG and to assess their amplitudes., Results: When REG I and monopolar REG were used, the theoretical maximum of intracranial contribution was reached with large current injection electrodes, being 8% for REG I and 12% for monopolar REG. However, some specific REG II electrode arrangements showed a nil contribution of the extracranial circulation and a minimum influence of the electrode size., Conclusions: These results may explain the disagreement on REG origin and suggest a theoretically optimum electrode arrangement.

The authors report the results of a series of 16 cases of low-grade gliomas in whom radiosurgery was performed. This series started in 1977. All the tumours received a single radiosurgical session (with a mean dose of 21.7 Gy, 5-10 mm. collimator; one patient received two sessions and in another patient two different targets were irradiated in the same session). Prior to radiosurgery, six patients received conventional external fractionated radiotherapy, with two lateral fields of up to 10 x 10 cm. and a mean dose of 55.1 Gy and another six patients with tumours less than 5 cm. in diameter, received stereotactic radiotherapy using four fields of up to 5 x 5 cm. and a mean dose of 53.1 Gy. In both cases, conventional fractionation was used, giving a dose of 1.8 to 2 Gy/day. The tumour disappeared in 8 cases (50%) and shunk or ceased its growth in 5 additional cases (31%). In 3 cases of brainstem gliomas in which the clinical condition was previously very poor there was no evolutional change and the patients eventually died. We conclude that radiosurgery is effective in the treatment of deeply seated low-grade gliomas, where it may become the treatment of choice in the absence of other more definitive choices.

Small sized AVMs respond well to stereotactic radiosurgery, while larger AVMs do poorly with stereotactic radiosurgery or stereotactic fractionated radiotherapy. A combination of both methods is proposed for the treatment of these larger lesions.

Since 1982 a series of 11 epileptic patients have been treated with stereotactic radiosurgery. Patients were intracranially recorded with cortical and deep electrodes until the location of the epileptogenic focus was determined. A deep electrode was stereotactically placed at this point to confirm the accuracy of the location. All patients received radiosurgery with a gamma source and a dose of 10 to 20 Gy, except two of them in which a betatron was used. The results were: Total disappearance of the crises and withdrawal of medication: 4 cases (36%). More than 80% reduction of crises: 3 cases (27%). More than 50% reduction of crises: 2 cases (18%). Less than 50% reduction of crises: 2 cases (18%). No complications were observed, even in those cases in which the focus was located near critical areas of the brain. The efficacy of the low doses used accounts for non-destructive mechanisms, probably mediated by a neuronal plasticity phenomenon, as experimental studies suggest. The lack of complications can make this therapeutic approach an alternative to be considered when critical areas are involved.