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We reviewed the clinical, radiological, surgical, and histopathological features of patients with meningiomas to identify factors that can predict tumor recurrence after "microscopic total removal," to improve preoperative surgical planning, and to help determine the need for close radiological observation at shorter intervals or the need for radiotherapy as an adjuvant treatment in the early postoperative period. Clinical data, magnetic resonance imaging studies, angiographic data, operative reports, and histopathological findings were examined retrospectively in 137 patients with a meningioma treated microsurgically and with no evidence of residual tumor on postoperative MR images. Based on univariate analysis, tumor size, a mushroom shape, proximity to major sinuses, edema, osteolysis, cortical penetration, signal intensity on T2-weighted MRIs, pial-cortical arterial supply, presence of a brain-tumor interface in surgery, Simpson's criteria, and histopathological classification were significant predictors for recurrence. However, age, gender, location of tumor, dural tail, calcification, signal intensity on T1-weighted images, and histopathologic subtypes in the benign group were not significant predictors. By Cox regression analysis the most important variables related to the time to recurrence were mushroom shape, osteolysis, dural tail, and proximity to major sinuses. Aggressive surgical therapy with wider dural removal should be considered in the presence of the preoperative predictors of a recurrence. Close radiological observation at shorter intervals or radiotherapy should be considered as adjuvant therapy in high-risk patients based on surgical findings predicting recurrence related to the brain-tumor interface, Simpson's criteria, and histopathological findings in the early post-operative period. Copyright © 2007 by Thieme Medical Publishers, Inc.

The ventriculoperitoneal shunt is accepted as the simplest and most effective treatment for hydrocephalus. The major problem with these devices is obstruction of the proximal end of the tubing. In this study, we examined deposits in the proximal ends of Codman shunts from 20 of our patients whose catheter failed. Light microscopic examination revealed that the deposited material contained fibrin, other proteinaceous material, erythrocytes, lymphocytes, macrophages, eosinophils, leukocytes, giant cells, and evidence of neovascularization. Electron microscopy confirmed the presence of fibrin, other proteinaceous material, many phagocytic cells, giant cells, and bacteria within the cytoplasm of these two types of cells. Immunohistochemically, the deposited material stained intensely for IgA, moderately for IgG, and weakly for IgM. This report discusses on ventriculoperitoneal shunt failure and the types of deposits that accumulate at the proximal end of the catheter, and reviews the relevant literature. The authors conclude that such deposits do cause shunt failure.

Surgical procedures designed to decompress and stabilize unstable trauma-related thoracolumbar fractures are primarily anterior or posterior operative approaches combined with anterior or posterior instrumentation. Our goal is to identify patients that are likely to benefit from either fixation system. Two treatment groups were studied. The first group of 20 patients underwent posterior instrumentation and fusion. Also, eighteen patients with evidence of neural compression were treated with posterior decompressive surgery. The second group, consisting of 10 patients with neurological deficits, was managed with single-stage anterior decompression, interbody strut grafting, and anterior instrumentation. There were no statistically significant differences between the groups with regard to postoperative neurological outcome (Mann-Whitney U, P>0.05), pain assessment and ability to return to work (Chi-square, P>0.05), rate of instrument failure (Chi-square, P>0,05), rate of solid fusion (Chi-square, P>0,05) and loss of reduction (Mann-Whitney U, P>0.05). When surgery is indicated, the operative approach (anterior or posterior) and type of instrumentation used (anterior or posterior) are determined by the location and characteristics of the fracture (e.g., neural compression and instability) and the surgeon's familiarity with the various techniques. Based on the results of this study, we conclude that posterior spinal instrumentation is as effective as anterior instrumentation in the treatment of unstable thoracolumbar fractures.

PubMedID: 9713842 Neovascularization, the development of a new microvasculature, has an important role in physiological and pathological processes. The vascular changes in the brain can be easily detected because the proliferation of endothelial cells in its vascular structure is quite small, and so constitutes a good model for neovascularization studies. In the present investigation, to induce intracerebral neovascularization, we implanted collagen, Interleukin-1 alpha (IL-1?) and glicosaminoglycan into the brain of pigs, in order to test the hypothesis that IL-1?, collagen and glicosaminoglycan play a pivotal role in the process of neovascularization. Both pure collagen and collagen combined with IL-1? induced neovascularization according to light-electron microscopic findings and values of enzymes, activities. In particular; collagen combined with IL-1? synergically affected the increase of neovascularization. However, glicosaminoglycan did not affect it significantly. Although the results of this study provided us with some interesting data indicating the beneficial effects of collagen combined with IL-1? on neovascularization, further studies should be done to study the short term effect of these biochemical substances.

WOS: 000078715800013 PubMed ID: 10068192 Intracranial dissecting and giant serpentine aneurysms are rare vascular anomalies. Their precise cause has not yet been completely clarified, and the radiological appearance of such lesions can be different in each case according to the effect of hemodynamic stress on a pathologic vessel wall. For berry aneurysms, available evidence overwhelmingly favors their causation by hemodynamically induced degenerative vascular disease and there is an obvious need to determine the hemodynamic parameters most likely to induce the precursor atrophic lesions. In this study, a case of a giant dissecting aneurysm angiographically mimicking serpentine aneurysm of the right ophthalmic artery is reported and the relevant literature is reviewed to investigate the pathological characteristics and pathogenesis of this lesion. In the present case, radiological investigation of the lesion suggested a serpentine aneurysm, but the diagnosis was corrected to dissecting aneurysm subsequent to the pathological examination of the resected aneurysm. A giant dissecting aneurysm angiographically mimicking serpentine aneurysm and developing as the result of a circumferential dissection located between the internal elastic lamina and media is of particular interest when the etiology of these aneurysms is considered. To our knowledge this is the first report on intracranial dissecting aneurysm mimicking serpentine aneurysm angiographically Our case illustrates the importance of careful serial section studies for a better understanding of the vascular pathology underlying the processes involved in intracranial serpentine aneurysms. We conclude that serpentine, dissecting and berry aneurysms may all arise by way of similar pathophysiological mechanisms.

WOS: A1994NZ97200007 PubMed ID: 7970020 Subependymomas are uncommon and relatively benign tumors with a distinctive histological appearance. They are generally asymptomatic and most of them are found incidentally at postmortem examination. These tumors are usually located in the fourth and lateral ventricle, and sometimes in the spinal cord. The authors present a series of 5 pure subependymomas of the central nervous system all of which were symptomatic and all of which were treated by microsurgical removal. The clinicopathological findings and the results of microsurgical treatment in this series are presented.

Successful results in well selected patients have been reported following percutaneous laser discolysis in the treatment of herniated intervertebral disc disease. Two groups with four pigs in each were formed. First four pigs were used as the control group and the second four was used as the treatment group. Intervertebral disc spaces of the treatment group was hydrated with 0, 1 cc saline. Intervertebral disc spaces of each pig in both groups have been irradiated with Nd:YAG laser of 1318 nm wavelength and designated energy level. Macroscopic and microscopic findings of the lesions formed have been evaluated. As a result we can say that percutaneous discolysis can be more successful especially in the young patients due to our observation obvious evaporation in the hydrated group.

Although the main advantage of the CO2 laser lies in the possibility of a less traumatic effect on the surrounding tissue, its use in neurosurgery still necessitates a thorough and detailed evaluation of the effect on surrounding normal central nervous system (CNS) tissue, Therefore this study was undertaken to investigate the ultrastructural and biochemical effects of the CO2 laser on the application area and the surrounding normal central nervous system tissue. Sodium-potassium activated and magnesium-dependent adenosine-5'-triphosphatase (Na+-K+/Mg2+ ATPase E.C.3.6.3.1), magnesium dependent adenosine-5'-triphosphatase (Mg2+ ATPase E.C.3.6.1.3) and calcium activated magnesium dependent adenosine-5'-triphosphatase (Ca2+/Mg2+ ATPase E.C.3.6.1.3) enzymes, superoxide dismutase, light microscopic and ultrastructural findings were determined in dog brain following laser application with and without thyrotropin releasing hormone (TRH) treatment. Laser lesions were created by a CO2 laser in the cerebrum. Fifteen days later, after thyrotropin releasing hormone injection, ultrastructural and biochemical investigations were undertaken to evaluate the effect of thyrotropin releasing hormone on the laser induced lesion and particularly surrounding cerebral tissue. Ultrastructural findings, showed that thyrotropin releasing hormone reduced degeneration on the CO2 laser-applied lesion.

Intrasellar meningioma is a rare disease which is difficult to diagnose preoperatively. We describe an interesting case of intrasellar meningioma in a 39-year-old woman who presented with amenorrhea, galactorrhea and severe headaches for six months. An intrasellar mass was demonstrated by computed tomography. The mass was approached by the transcranial route, an intrasellar tumour was found pushing against the diaphragma sellae. After complete removal of the tumour, the patient was discharged with resolution of visual and endocrine abnormalities and normal serum prolactin level. Histopathological examination revealed meningioma. Within six months, the lesion reappeared with the same visual and endocrine abnormalities. Computed tomography revealed a contrast enhancing intrasellar lesion and serum prolactin level was again elevated. At reexploration, the tumour was excised. Pure subdiaphragmatic intrasellar meningiomas simulating prolactinomas are unusual lesions. Such early recurrences may be attributed to incomplete resection or to the histological character of the tumour. In spite of the rarity of intrasellar meningioma, preoperative differentiation from a pituitary adenoma is vital for the proper surgical approach.

WOS: A1994NZ97200005 PubMed ID: 7970018 Since computerized tomography scanning became available at the Division of Neurosurgery in July, 1979, 13 patients have undergone removal of colloid cysts of the third ventricle by transfrontal or transcallosal routes. Computerized tomography has increased the number of colloid cysts detected in the foramen of Monro during neurological diagnostic workups. The clinical and diagnostic aspects and changing concepts in the treatment of colloid cysts are reviewed.

Lipomas of the corpus callosum are rare congenital conditions. These lesions are often asymptomatic but may present as epilepsy, hemiplegia, dementia or headache. Computerized tomography and magnetic resonance imaging make the diagnosis of lipomas feasible at any site of the intracranial space, because of very low density attenuation values on computerized tomography and the short T1 and T2 on magnetic resonance. A direct surgical approach is very rarely necessary in these lesions. Four cases with lipoma of the corpus callosum diagnosed by computed tomography are presented and the literature is reviewed. Basic diagnostic considerations and therapeutic options are discussed.

PubMedID: 1484299 [No abstract available]

Tumour Necrosis Factor (TNF) and Interleukin-2 (IL-2) values were determined in 44 intracranial tumour patients pre- and postoperatively and compared with the values in 20 healthy persons and 14 with Behcet's disease, who were used as the control group. There was no significant difference in IL-2 values of the control group and preoperative values of the tumour group except for meningioma and acustic neurinoma. We think that macrophages and glycoaminogaycans which encapsulate the tumour prevent stimulation of T helpers by the tumour antigens, so IL-2 is not secreted from the T helpers. Probably for the same reason we could not find significant TNF values between the control group and the preoperative tumour group. Postoperative decrease in IL-2 is considered to be the result of corticosteroids used for 7 days. Increased TNF values in the postoperative tumour group can be due to the breakdown of the glycoaminoglycan barrier and stimulation of macrophages by the tumour antigens.

[No abstract available]