松果体区肿瘤诊治策略的探讨

目的 探讨松果体区肿瘤的诊治策略.方法 回顾性分析154例松果体区肿瘤的病例资料.结果 松果体区肿瘤多以颅高压、眼球运动障碍起病,诊断需进行CT、MRI及肿瘤标记物检查.基本确诊或高度怀疑生殖细胞瘤时直接放疗或活检后放疗23例,肿瘤均消失,5年生存率88.9%;其他肿瘤手术治疗131例,肿瘤全切除124例,次全切除7例,5年生存率84.4%.手术患者的病理结果:生殖细胞肿瘤60例,松果体实质肿瘤17例,神经上皮肿瘤27例,其他肿瘤27例.结论 松果体区肿瘤常合并脑积水,影像学表现有一定特征,联合肿瘤标记物检测能进一步鉴别肿瘤性质.基本确诊生殖细胞瘤直接选择放、化疗,高度怀疑生殖细胞瘤选择活检后放疗或实验性放疗,不能确定生殖细胞瘤时选择显微手术联合术后辅助放、化疗,在治疗过程中兼顾脑积水的处理是较理想的松果体区肿瘤的治疗策略.

Abstract：

Objective To define the optimal diagnosis and theraputic strategy of pineal region tumors.Method Clinical materials of 154 cases with pineal region tumors were analyzed retrospectively.Results The patients with pineal region tumors often complained with increased intracranial pressure and ocular movement deficiency.The procedure of diagnosis was imaging checking included CT and MRI,tumor mark testing.23 cases which were essential exact diagnosed or high doubt germinomas were choosed to direct radiotherapy or radiotherapy after biopsy.All the tumors disappeared during the follow up time.5 years survival rate was 88.9%.Other 131 cases were chosen for operation treatment.Total removal were achieved in 124 cases and subtotal were achieved in 7 cases.The 5 years survival rate was 84.4%.The operation pathological result included 60 germ cell tumors, 17 pineal parenchymal tumors, 27 neural epithelium tumors and 27 other tumors.Conclusions Pineal region tumors are often combined with hydrocephalus.There was some characteristic feature in the imaging appearance.The cases should be chosen to direct radiotherapy and chemotherapy if was diagnosed germinomas, and be choosed to radiotherapy after biopsy or experimental radiotherapy if was high doubt germinomas.The cases which unable determined germionmas should be choosed microsurgery and assist radiotherapy and chemotherapy postoperation.Hydrocephalus should be treated in consideration during the procedure of tumor treatment.     

Effects of durotomy versus myelotomy in the repair of spinal cord injury

Current management for spinal cord injury aims to reduce secondary damage and recover sensation and movement.Acute spinal cord injury is often accompanied by spinal cord compartment syndrome.Decompression by durotomy and/or myelotomy attempts to relieve secondary damage by completelyrelieving the compression of the spinal cord,removing the necrotic tissue,decreasing edema,reducing hemorrhage,and improving blood circulation in the spinal cord.However,it is controversial whether durotomy and/or myelotomy after spinal cord injury are beneficial to neurological recovery.This review compares the clinical effects of durotomy with those of myelotomy in the treatment of spinal cord injury.We found that durotomy has been performed more than myelotomy in the clinic,and that durotomy may be safer and more effective than myelotomy.Durotomy performed in humans had positive effects on neurological function in 92.3% of studies in this review,while durotomy in animals had positive effects on neurological function in 83.3% of studies.Myelotomy procedures were effective in 80% of animal studies,but only one clinical study of myelotomy has reported positive results,of motor and sensory improvement,in humans.However,a number of new animal studies have reported that durotomy and myelotomy are ineffective for spinal cord injury.More clinical data,in the form of a randomized controlled study,are needed to understand the effectiveness of durotomy and myelotomy.     

Markers for neural degeneration and regeneration:novel highly sensitive methods for the measurement of thrombin and activated protein C in human cerebrospinal fluid

Inflammation and coagulation are tightly interconnected in the pathophysiology of neuronal diseases.Thrombin,a pro-coagulant serine protease is associated with neurodegeneration and its indirect inhibitor,activated protein C(aPC),is considered neuroprotective.While levels of thrombin and aPC activity are readily measured in the blood,similar assays in the cerebrospinal fluid(CSF)have not been described.The aim of this study was to establish a specific and sensitive enzymatic assay to measure both thrombin and aPC activity in the CSF.CSF was collected from 14 patients with suspected normal pressure hydrocephalus served as a control group,while seven patients with central nervous system infections served as an acute neuro-inflammatory study group and one sample of CSF following traumatic lumbar puncture served as a positive control.Thrombin and aPC activities were measured by fluorescence released by specific proteolytic cleavage in the presence of endopeptidase and amino-peptidase inhibitors to ensure specificity.Specificity of the method was verified by thrombin and serine-protease inhibitors N-alpha-((2-naphthylsulfinyl)glycyl)-DL-p-amidinophenylalanylpiperidine and phenylmethanesulfonyl fluoride.Inhibition of thrombin activity by CSF samples and levels of specific thrombin inhibitors were also assessed.Thrombin and aPC activities were reliably measured and were significantly higher in the CSF of patients with central nervous system infections compared to normal pressure hydrocephalus controls,suggesting the involvement of these factors in neuro-inflammation.CSF thrombin activity levels in the presence of known thrombin concentration were high in patients with central nervous system infections,and low in normal pressure hydrocephalus patients.Quantification of endogenous thrombin inhibitors protease nexin 1,amyloid precursor protein and anti-thrombin III in CSF by western blot indicated a significant elevation of amyloid precursor protein in infectious CSF.In conclusion,this study describes a novel and sensitive assay aimed at the detection of thrombin and aPC activity in CSF.This method may be useful for measuring these factors that reflect degenerative and protective influences of coagulation on neurological disorders.The study procedure was approved by the Ethics Committee of the Chaim Sheba Medical Center(approval No.4245-17-SMC)on October 18,2018.     

神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.     

神经电生理监测颅内动脉瘤介入治疗

Objective To study the application of neuroelectrophysiological monitoring for interventional therapy of intracranial aneurysms. Methods 22 patients with intracranial aneurysm were received neuroelectrophysiological monitoring during interventional therapy. Somatosensory evoked potential(SSEP) 、brainstem auditory evoked potential (BAEP) and visual evoked potential(VEP) were monitored during operation according to the position of intracranial aneurysm. Results 20 patients recovered well after operation. Temporary and hemiplegia were observed in 1 patient respectively. SSEP changes were observed in 8 patients, BAEP change in 1, and VEP change in 1. Cerebral ischemia was detected in 8 patients by neuroelectrophysiological monitoring and patients were given adequate management immediately. The therapeutic schedule of 2 patients were changed during neuroelectrophysiological monitoring in order to decrease the risk. 1 patient was evaluated again during neuroelectrophysiological monitoring so that the original interventional therapy schedule was not given up. Conclusion Neuroelectrophysiological monitoring is significantly important during interventional therapy of intracranial aneurysm, which could reduce the risk of cerebral ischemia and enhance treatment security.     

Virtual reality training improves balance function

Virtual reality is a new technology that simulates a three-dimensional virtual world on a com- puter and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can acti- vate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.     

颅内动脉瘤术中诱发电位监测的初步探讨

目的 初步探讨颅内动脉瘤手术中躯体感觉诱发电位、脑干听觉诱发电位及运动诱发电位的临床应用价值.方法 在16例动脉瘤手术中开展诱发电位监测,观察术中电生理信号改变与术后神经功能状态的关系.结果 11例术中未出现电生理信号异常改变,5例术中出现了异常信号,其中信号未能恢复正常的4例术后均出现新发神经功能障碍.结论 诱发电位监测可实时了解颅内动脉瘤手术中有无脑缺血所致的神经功能障碍,对指导手术及评估预后均有重要意义.

Abstract：

Objective To explore the application of intraoperative neuroelectrophysiological monitoring on somatosensory evoked potentials (SEP), brainstem auditory evoked potentials (BAEP) and motor evoked potentials (MEP) during intracranial aneurysm surgery.Methods SEP, BAEP or MEPs were monitored during operations on 16 patients with intracranial aneurysms.The relationship between the intraoperative changes of electrophysiological signals and the postoperative outcomes of neurological deficits was evaluated.Results 11 patients without abnormal intraoperative electrophysiological signal changes demonstrated no new neurological deficits after surgery.However, in the left 5 patients, abnormal changes of intraoperative electrophysiological signals were detected.Among these 5 patients, 4 with abnormal electrophysiological signals which were not recovered intraoperatively demonstrated new developed functional deficits immediately after surgery.Conclusion During intracranial aneurysm surgery, the monitoring on SEP, MEP and BAEP is beneficial not only to timely detecting neurological functional deficits resulted from intraoperative cerebral ischemia, but also to properly guiding surgical manipulation, and to reliably predicting postoperative outcome as well.     

Intracranial Large Artery Occlusive Disease

Intracranial large artery stenosis is the most commonly found vascular lesion in stroke patient of Chinese, Hispanic and African ancestry. There .have been few studies on the epidemiology, pathophysiology, treatment and prognosis of this important disease. Recent advances in technology provide safe and reliable investigation for studying large number of patients. Transcranial Doppler is an easily accessible, cheap and reliable method to diagnose intracranial stenosis. It is suitable for screening for and monitoring the progress of intracranial stenosis. Magnetic resonance angiography and CT angiography provide the morphology of lumenal stenosis but are less accessible.     

儿童颅内蛛网膜囊肿的外科干预

目的 探讨小儿颅内蛛网膜囊肿的治疗方法.方法 收治15岁以下颅内蛛网膜囊肿患者37例,其中手术切除囊肿壁同时打通颅底蛛网膜池12例,囊肿-腹腔分流术20例,神经内镜造瘘术5例.对患者术后症状体征改善、影像学囊肿变化以及术后并发症等进行回顾性对比分析.结果 37例患者神经系统症状和体征均有不同程度的改善.影像学随访结果表明无论是哪种方法均能够使囊肿有不同程度的缩小,脑组织膨隆比较理想.改善情况并未因手术方式的不同而存在明显的差异(P>0.05).但开颅手术组并发症发生率明显高于分流组和神经内镜组.结论 囊肿-腹腔分流术治疗儿童颅内蛛网膜囊肿具有近期效果明显和并发症少的优点.

Abstract：

Objective Arachnoid cysts are non-tumorous intra-arachnoid fluid collections that account for about 1 % of all intracranial space-occupying lesions.So far, the optimal method of treatment for symptomatic arachnoid cysts remains controversial.In this article,we want to find an ideal technique to deal with this condition.Method The hospital records of 37 consecutive patients with intracranial arachnoid cysts who were treated in Tianjin Huanhu Hospital between January 2004 and December 2009, were analyzed retrospectively.All the patients were children below the age of 15 years old with an average of 6, 7 years old.The diagnosis of arachnoid cyst was based on computerized tomography (CT) and MRI scan findings demonstrating a well-circumscribed and non-enhancing cystic lesion that had attenuation values similar to those of the cerebrospinal fluid ( CSF) and did not communicate with the ventricular system.They were divided into three groups as follow, group A ( 12 patients ) , open craniotomy; group B ( 20 patients ) , cyst-peritoneal shunting, and group C(5 patients), endoscopic fenestration.Results The symptoms and neurological signs were improved more or little in all the 3 group patients who accepted the neurosurgical treatment.There were no significant differences between among the 3 groups in releasing of the symptom and sign caused by cysts.On the other hand,there were high percentage of complications,including intracranial infections and subdural fluid collections in the group A.Conclusions The technique of cysto-peritoneal shunting is likely the optimal method for treating the intracranial arachnoid cysts in children.     

SARS-CoV-2 involvement in central nervous system tissue damage

As the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)continues to spread globally,it became evident that the SARS-CoV-2 virus infects multiple organs including the brain.Several clinical studies revealed that patients with COVID-19 infection experience an array of neurological signs ranging in severity from headaches to life-threatening strokes.Although the exact mechanism by which the SARS-CoV-2 virus directly impacts the brain is not fully understood,several theories have been suggested including direct and indirect pathways induced by the virus.One possible theory is the invasion of SARS-CoV-2 to the brain occurs either through the bloodstream or via the nerve endings which is considered to be the direct route.Such findings are based on studies reporting the presence of viral material in the cerebrospinal fluid and brain cells.Nevertheless,the indirect mechanisms,including blood-clotting abnormalities and prolonged activation of the immune system,can result in further tissue and organ damages seen during the course of the disease.This overview attempts to give a thorough insight into SARS-CoV-2 coronavirus neurological infection and highlights the possible mechanisms leading to the neurological manifestations observed in infected patients.     

脑膜癌病的脑脊液细胞学与临床观察

目的研究脑膜癌病(LC)的脑脊液(CSF、)细胞学、临床及神经影像学特点。方法回顾分析16例LC。结果16例LC患者中，男6例、女10例，年龄29～69岁。亚急性起病，头痛14例，伴恶心、呕吐、眼底视乳头水肿；出现脑膜刺激征12例；双下肢无力5例，排尿困难3例；意识丧失、抽搐7例；视力减退5例，眼肌麻痹4例，听力下降1例，吞咽困难2例，偏瘫1例，多饮多尿1例。消瘦10例，低热5例。7例有癌症病史。CSF压力升高13例，CSF、常规计数白细胞升高10例，蛋白均升高，糖减低9例。CSF细胞学均见癌细胞，4例行免疫组化检查示，肿瘤细胞上皮膜抗原和细胞角蛋白阳性。临床及病理学确定来源肺癌6例、乳腺癌3例、胃癌2例、卵巢癌1例，来源未明4例。结论LC可作为首发症状和主要症状而缺少肿瘤原发灶表现。表现为亚急性脑膜炎，进行性颅内压升高，常合并多脑神经和脊髓神经根损害。CSF细胞学是确诊LC主要方法，结合免疫细胞化学方法对确诊有重要帮助。     

脑膜淋巴瘤的临床脑脊液细胞学研究

目的探讨脑脊液细胞学、免疫细胞化学和流式细胞分析在脑膜淋巴瘤诊断中的灵敏性和特异性。方法13例诊断为脑膜淋巴瘤的患者，其中原发性中枢神经系统淋巴瘤5例，均为非霍奇金淋巴瘤B细胞型（NHL-B）；继发性8例，包括NHL-B6例，非霍奇金淋巴瘤T细胞型（NHL-T）1例，mantle型1例。神经系统表现为头痛、视乳头水肿、脑脊膜刺激征、脊髓腰骶神经根受累和多脑神经麻痹等。腰穿脑脊液压力升高，细胞计数、蛋白均升高，糖减低。所有患者均采用沉淀池法，免疫细胞化学单克隆抗体CD19、CD20、CD79a、CD34和免疫球蛋白轻链等；其中3例脑脊液进行淋巴细胞亚群流式细胞分析。以4例病毒性脑炎和5例炎性脱髓鞘病患者的脑脊液为对照。结果脑脊液细胞学发现每例患者均有淋巴瘤细胞或异型淋巴细胞。免疫细胞化学发现5例患者多数细胞B细胞标记物阳性；例6多数细胞CD34阳性；例8CD20阳性细胞比例升高；例7CD19、CD20阴性。除例8外，其余脑脊液中细胞呈CD4和CD8阴性或极少数阳性。对照组CD4阳性细胞为主，伴有少量CD8阳性细胞，CD19和CD20阴性或极少数阳性。脑脊液流式细胞分析发现例9和例11的B淋巴细胞占85．9％～97．4％，提示异常的B细胞克隆。对照组以CD4、CD8阳性细胞为主，CD19阳性细胞低于4．0％。结论脑脊液细胞学和免疫细胞化学是诊断脑膜淋巴瘤的重要方法，脑脊液淋巴细胞亚群的流式分析能够对诊断脑膜淋巴瘤有所帮助。     

三例貌似脑炎的幕上原始神经外胚层肿瘤的临床病理分析

目的分析幕上原始神经外胚层肿瘤(s-PNET)的临床、影像学和病理特点,以期早期诊断,早期治疗,从而改善预后。方法回顾分析3例临床上貌似脑炎的s-PNET的临床资料、脑脊液细胞学、头颅核磁共振和脑活检组织病理学特点。结果本文3例患者起病相对较急,主要表现颅高压的症状和局灶神经系统症状,如单肢或偏侧肢体无力,或癫痫发作等。例1脑脊液细胞学可见异形细胞,符合肿瘤细胞。3例患者影像学上病灶边界不清晰,无明显强化。随病情发展,病灶局部扩大或者蔓延至对侧,甚至出现脑脊液播散,并且局部囊性变。3例肿瘤组织绝大部分均由原始幼稚的小细胞构成,弥漫浸润性生长,可见Homer Wright菊形团形成。3例肿瘤细胞一致性表达CD99、Syn、NSE、Nestin和S-100,散在表达CgA、GFAP、NeuN和oligo-2;Ki-67阳性率40%～60%。结论 s-PNET临床和影像学表现多样,确诊需要脑组织病理诊断。     

Re-evaluation of the significance of cerebrospinal fluid human chorionic gonadotropin in detecting intracranial ectopic germinomas

This study was conducted to establish a reference value for cerebrospinal fluid (CSF) human chorionic gonadotropin (hCG) levels. We also evaluated the sensitivity of CSF hCG as a biomarker to detect intracranial ectopic germinomas that arise in rare sites other than the pineal and suprasellar regions. CSF hCG was measured in 201 male patients who had various types of neurological disease (not tumours of germ cell origin or other malignant tumours). A reference value of 1.009 U/L was established, and the CSF hCG level among different age groups was not significantly different. CSF and serum hCG were measured before and after radiotherapy in 14 consecutive patients with intracranial ectopic germinomas. The CSF hCG levels were all above 1.009 U/L before radiotherapy. In male patients, a CSF hCG value above 1.009 U/L suggests abnormal intrathecal hCG secretion. These results demonstrate that the CSF hCG assay is a sensitive method for diagnosing intracranial ectopic germinoma.     

Malignant cells in cerebrospinal fluid (CSF): the meaning of a positive CSF cytology

We reviewed the correlation between malignant cells in cerebrospinal fluid (CSF) (positive cytology) and pathologic findings at autopsy. The purpose was to discover: (1) the incidence of negative CSF cytology in patients with CNS malignancy, (2) the incidence of false-positive cytology, and (3) the relationship between a true-positive cytology and the distribution of malignant tumor at autopsy. Of 117 patients with CNS tumor and premortem cytologic examination of the CSF, 31 (26 percent) were positive and 86 (74 percent) were negative. Only 1 of 66 patients with tumor that did not reach the leptomeninges had a positive cytology. Of 51 patients with leptomeningeal tumor at autopsy, cytology was positive in 30 (59 percent) and negative in 21 (41 percent). Five potentially "false-positive" cytologies were encountered: three patients were treated, and tumor may have been eradicated; in two patients with lymphoma, inflammatory cells associated with infection were apparently mistaken for malignant cells. These data indicate that a positive CSF cytology is a reliable indicator of CNS malignancy and almost always reflects leptomeningeal tumor.     

神经白塞综合征的临床和脑脊液细胞学特点

目的回顾性分析神经白塞综合征(NBS)临床和脑脊液(CSF)细胞学资料,探讨该病的临床和CSF细胞学特点。方法回顾1991-2010年间北京协和医院NBS住院患者共27例,分析其临床表现、神经影像学和CSF细胞学特点。结果 27例患者中,神经科症状急性病程19例,亚急性病程6例,慢性病程2例。临床表现:头痛9例,偏瘫8例,复视6例,偏身感觉障碍5例,意识障碍5例,失语3例,癫痫发作3例,精神行为异常、智能减退6例,截瘫2例,共济失调2例,呛咳、吞咽困难2例,帕金森综合征1例。头MRI异常16例,多发片状T1低或较低信号,T2高信号,病灶分布于基底节、脑干、丘脑等处,9例行增强MRI均有强化;2例颈段脊髓MRI可见强化病灶。磁共振静脉成像(MRV):1例符合上矢状窦血栓形成。CSF检查:19例行腰穿查CSF,其中8例压力升高,17例蛋白升高(0.48～1.08g/L);行CSF细胞学检查(沉淀池法制片,迈-格-姬染色)的11例中7例表现为淋巴细胞为主的炎性反应,其中6例伴有中性粒细胞比例升高,余4例中3例为淋巴细胞与中性粒细胞为主的混合性炎性反应,1例为中性粒细胞性炎性反应,8例可见激活淋巴细胞,4例可见浆细胞。结论 NBS临床表现多样,神经影像学改变以基底节、脑干和丘脑等邻近中线的结构受累为主,CSF细胞学呈炎性反应表现。CSF细胞学炎性反应类型,特别是CSF中性粒细胞比例升高对NBS的诊断具有一定意义。     

广州管圆线虫病致嗜酸细胞性脑膜炎九例患者临床和脑脊液细胞学特点

目的 总结北方地区出现的广州管圆线虫感染引起的嗜酸细胞性脑膜炎病例的临床特点,并探讨脑脊液细胞学对该病的诊断意义.方法 对中国医学科学院北京协和医院收治的9例在北京地区发病的患者进行临床观察和脑脊液细胞学等检查,总结分析并复习文献.结果 9例患者中男性4例,女性5例.临床表现为急性起病(9例)、发热(9例)、头痛(9例),伴恶心或呕吐(3例)、脑膜刺激征(7例)、视乳头水肿(2例)、肢体感觉异常(7例)、脑神经受累(3例)和肢体瘫痪(1例)等.临床分型:脑膜型8例,脊髓型1例.神经影像学:4例存在软脑膜弥漫强化,脑和脊髓实质点片状异常信号者4例.脑脊液检查:全部患者均有压力升高,白细胞均升高[(70～780)×106/L],蛋白均升高,5例有葡萄糖减低.脑脊液细胞学:嗜酸细胞比例均升高.1例(仅行1次腰穿)嗜酸细胞比例5%,其余8例脑脊液嗜酸细胞多次枪查在45%～90%,呈现以嗜酸细胞为主的炎症,伴激活淋巴细胞和单核细胞,偶见浆细胞,未见寄生虫虫体.结论 脑脊液嗜酸细胞比例超过50%的脑膜炎应高度怀疑广州管圆线虫病.临床结合脑脊液细胞学对诊断广州管圆线虫病有一定实用意义.     

Experience with pineal region tumors

The results are reported of a retrospective review of the presentation and outcome of 43 pineal region tumors treated from 1982 to 1996, including 20 identified tumors: 5 germinomas, 8 teratomas, 2 embryonal carcinomas, 1 endodermal sinus tumor, 2 pineocytomas and 2 pineoblastomas. Of the 43 tumors reviewed, 36 were located in the pineal region, 5 in the suprasellar, and 2 in both the pineal and suprasellar regions. Twenty patients underwent surgical resection: total in 6 and partial in 10, while only a biopsy was taken in 4 cases. Fifteen patients were managed on the basis of serum CSF tumor markers and radiation response. Twenty-three patients with germinomas received radiotherapy (RT) and had a 5-year survival rate of 87%. Fifteen patients with non-germinomatous germ cell tumors received RT and chemotherapy following direct surgery, and 5 died (mortality rate of 33.3%). The overall survival rate of the 43 patients with pineal tumors was 79.1% (34/43) and the death rate was 20.9% (9/43). It is now recognized that the wide variety of tumor types found in the pineal region necessitates different modes of treatment, and improved microsurgical and stereotactic surgical techniques have made mortality and morbidity rates acceptably low. Because the radiation response and CSF cytology are not enough to determine optimum treatment, a tissue diagnosis should be obtained in all patients.     

Human chorionic gonadotrophin in CSF, not serum, predicts outcome in germinoma

OBJECTIVES: Some intracranial germinomas, which may contain syncytiotrophoblastic giant cells (STGCs), are associated with a mildly to moderately increased human chorionic gonadotropin (HCG) concentration in serum, and patients with such germinomas are thus treated more aggressively than those with "pure" germinoma. However, the patients with germinoma and detectable HCG in CSF but not in serum have been classified and treated similarly to those with "pure" germinomas. The outcome of these patients and the relevance of HCG in the CSF were analysed. METHODS: The outcomes of patients with germinoma and increased serum HCG concentration (n=7) were compared with those of patients having detectable HCG titre in the CSF but not in the serum (n=5). RESULTS: Both groups in our series received similar treatments and also showed similar recurrence rates. The 40% recurrence rate in the group with HCG only in CSF did not correspond to the rate typical for "pure" germinoma: these tumours would be expected to have a better outcome. An additional patient whose CSF HCG were raised without increased serum HCG at recurrence is presented. CONCLUSIONS: It is recommended that patients with an increased HCG concentration in CSF should be considered to have "HCG producing germinoma", and they should be treated and followed up accordingly.     

Flow cytometric analysis of T cell subsets in paired samples of cerebrospinal fluid and peripheral blood from patients with neurological and psychiatric disorders

Recent studies suggest inflammatory mechanisms involved in the pathogenesis of major psychiatric disorders (MPD). T cells play a major role during inflammation, but little is known about T cell subpopulations in the cerebrospinal fluid (CSF). We investigated the frequency of cells positive for the surface markers CD4, CD8, CD25, CD45, CD69, and CD127 in 45 paired cerebrospinal fluid (CSF) and peripheral blood (PB) samples by multiparameter flow cytometry from patients with MPD of the schizophrenic and affective spectrum with normal CSF cell counts and compared them with those from patients with non-inflammatory (NIND), chronic inflammatory (CIND) neurological disorders, and meningitis (MEN). In MEN patients, CD4+ cell frequency in PB, but not in CSF, was significantly increased as compared to CIND and NIND. No difference between patient groups was observed for CD8+. CD4+CD45RO+ double positive cells in PB were significantly lower in CIND than in MEN or NIND. The frequency of CD4+CD25+ cells in PB was significantly higher in MEN than in MPD or CIND. For CSF, the percentage of CD4+CD127(dim) cells was significantly lower in MEN than in MPD. CD4+CD127(dim) in PB and CSF showed overlapping characteristic clusters between MPD and CIND and MEN patients. Overall, the hypothesis of low degree inflammation in a subgroup of MPD is supported. The analysis of lymphocyte subsets in PB and CSF constitutes a novel promising tool to understand underlying pathomechanisms in psychiatric and neurological disorders on an individual case level.