Paediatric meningeal tumours

We review our experience of meningeal tumours in patients under 16 years who were treated between 1957 and 1993. These were 16 with meningiomas (median age 12 years) and 5 with poorly differentiated malignant meningeal tumours (median age 3 years). The incidence of meningeal tumours in this period was 1.62% of all CNS tumours. There were 19 supratentorial tumours (5 intraventricular), 1 tentorial and 1 cervical. Surgical excision was complete in 12 patients and incomplete in 6; in 2 patients a biopsy only was undertaken. The remaining patient had radiological diagnosis only. All 5 patients in the group with malignant poorly differentiated tumours died (median survival 5 months), confirming the aggressive nature of these lesions. Of the 16 patients with meningiomas, 4 died during follow-up but 11 of the 12 meningioma patients remaining alive had complete resections. There is a strong tendency for paediatric meningeal tumours to have a supratentorial origin and intraventricular location. The female preponderance found in adults is not evident in children. Incomplete surgical excision or focal neurological deficit at presentation was associated with poor outcome.     

Ribosome-lamella complexes in intracranial tumours

Summary A report is given of four intracranial tumours which contained ribosome-lamella complexes (RLCs). Three of the tumours were of neuroectodermal origin (two gangliogliomas and an astrocytoma), in which these structures have not previously been documented, and one was a haemangioblastoma. This study supports the view that RLCs may be related to abnormal protein synthesis.     

Paroxysmal raised intracranial pressure associated with spinal meningeal cysts

Raised intracranial pressure in association with spinal meningeal cysts has rarely been reported. We describe four patients in whom evidence of paroxysmal raised intracranial pressure was found in association with spinal meningeal cysts. Cerebrospinal fluid diversion procedures have previously been shown to relieve local symptoms due to spinal cysts. In our patients symptoms of paroxysmal headache were alleviated by this method, suggesting a causal relationship with the raised pressure. This association may be an under diagnosed cause of paroxysmal headaches. We review the medical literature on the classification of spinal meningeal cysts, evaluate the theories of their origin and offer suggestions on the pathogenesis of the abnormal CSF dynamics that may allow an interplay between raised intracranial pressure and spinal meningeal cysts to produce paroxysmal symptoms.     

Radiotherapy by particle beams (hadrontherapy) of intracranial tumours: a survey on pathology

Abstract A review of the principal contributions of radiotherapy of brain tumours by beam particles is carried out. Neutrons, protons and light ions are considered along with their pros and cons in relation to types and locations of brain tumours. A particular emphasis is given to the pathologic studies of their effects directly on tumours and on the normal nervous tissue, considering mainly the relevant action mechanisms of the radiation types and the requirements of the clinical therapeutic strategies. For comparison the main features of the pathologic effects of radiotherapy by photons are described. From the review it emerges that the new modality of radiation by protons and light ions, because of their peculiar physical characteristics, may represent a new way of destroying the tumour and sparing normal nervous tissue, especially when deeply located and irregularly shaped tumours are concerned. More neuropathological studies are needed in order to better understand the potentiality of the new treatment modalities.*Member of the Scientific Committee of CNAO (Centro Nazionale di Adroterapia Oncologica), Milan, Italy     

Primary intracranial germ cell tumours: Experience of a single South-East Asian institution

Primary intracranial germ cell tumours (ICGCT) are a rare group of brain tumours arising predominantly in the paediatric and pre-adult population, accounting for up to 9.5% of paediatric brain tumours in East Asia. The National Cancer Centre Singapore (NCCS) is a tertiary referral centre for patients from all over South-East Asia. Our study aims to describe the characteristics of ICGCT patients in South-East Asia. Data on all patients with ICGCT who were seen at the Therapeutic Radiology Department of NCCS from 2000 to 2013 were collected retrospectively. Patient demographics, disease characteristics and treatment outcomes were analysed. Characteristics and survival of our patients were similar to other centres. Pure germinomas demonstrated 5 year overall survival (OS) and disease-free survival (DFS) rates of 89.2% (95% confidence interval [CI] 60.2–97.5) and 85.2% (95%CI 60.8–95.0) respectively. Secreting germinomas, non-germinomatous germ cell tumours and mixed germ cell tumours were evaluated together and demonstrated 5 year OS of 70.6% (95%CI 41.0–87.3) and DFS of 61.4% (95%CI 31.9–81.3). Patients ⩽12 years had marginally better 5 year OS than their older counterparts (81.0% [95%CI 49.5–93.9] versus 77.9% [95%CI 47.3–92.0], respectively). Patients who underwent extended field radiotherapy had longer OS and DFS than those who received local field irradiation. Treatment outcomes of our ICGCT patients are comparable with those in other Asian and Western centres. Extended field radiotherapy is a pivotal component of ICGCT treatment. Adding chemotherapy confers no extra survival benefit in treating germinomas. Treatment of mixed germ cell tumours and non-germinomatous germ cell tumours involves a multidisciplinary approach that varies for each histological subtype.     

A study of glutamine synthetase in normal human brain and intracranial tumours

Glutamine synthetase (GS) activity was measured in selected areas of three normal brains and in 262 biopsies from patients with suspected intracranial tumours. In general, levels were higher in grey matter than in white matter and the highest activities of all were found in the hypothalamus which is consistent with its high glutamatergic activity. In the biopsy material, GS activity was greatest in gliotic brain, in keeping with the predominantly astrocytic localization of the enzyme. High levels were also found in astrocytomas and oligodendrogliomas but there was considerable variation between tumours, suggesting a random loss of GS expression during neoplastic transformation or heterogeneity in their cellular origin. The immunocytochemical demonstration of GS in neoplastic oligodendrocytes and in meningioma cells argues against absolute cell-type specificity for this enzyme.     

Cryosurgery re-visited for the removal and destruction of brain,spinal and orbital tumours

Abstract

Advances in neuroimaging and cryosurgical techniques have prompted us to re-evaluate the potential of cryosurgical techniques for the removal and the destruction of various neoplasms. We have used cryosurgical instrumentation to remove tumours in the brain, spine and orbit in 71 patients without complications. Cryosurgery was used to facilitate removal and extraction in 64 and to destroy residual neoplasms when removal was incomplete in 7. Intraoperative real time ultrasonic imaging permitted precise delimitation of tumours from surrounding tissues and allowed monitoring during the production of cryosurgical lesions thus permitting heretofore unavailable visualization of the production of cryogenic lesions in the central nervous system. New cryosurgical instrumentation was used to produce lesions up to three times larger than similar sized probes previously available. Our results reconfirm that cryosurgery facilitates the removal of tumours in the brain, spinal cord and orbit, reduces blood loss in vascular tumours and is effective in ablating residual neoplasms involving the superior saggital sinus, torcula and parasaggital areas. A Doppler flowmeter proved useful for monitoring saggital sinus blood flow during the production of cryosurgical ablation of residual tumour attached to the walls of the saggital sinus. Recent advances in ultrasonic and neuroimaging coupled with stereotactic techniques and improvements in cryosurgical instrumentation may prove useful in the future percutaneous destruction of selective intracranial neoplasms. [Neurol Res 1992; 14:294-302]     

An autopsy case of meningeal carcinomatosis with parenchymal invasion through the cranial and spinal nerve roots

Meningeal carcinomatosis is a well‐known complication of malignant neoplasms. We report a case of meningeal carcinomatosis of 2 months' duration in a 22‐year‐old man, in whom the initial symptom was gradually worsening headache. Postmortem examination revealed infiltrating adenocarcinoma of the stomach. Carcinoma cells showed diffuse spread to the subarachnoid space of the brain and spinal cord. In many places, subarachnoid tumor cells had infiltrated to the cranial and spinal nerves. Moreover, carcinoma cells in the nerve roots extended to the parenchyma of the brain and spinal cord beyond the CNS‐peripheral nervous system junction. These findings suggest that cranial and spinal nerve roots can be a possible route of parenchymal invasion in meningeal carcinomatosis.     

脑膜中动脉栓塞治疗难治性慢性硬膜下血肿的Meta分析

目的研究脑膜中动脉(MMA)栓塞治疗难治性慢性硬膜下血肿(CSDH)的有效性及安全性。方法应用系统评价的方法,检索知网、维普、PubMed、Embase等中英文数据库收录的脑膜中动脉栓塞治疗慢性硬膜下血肿的相关文献,采用RevMan 5.3软件进行Meta分析。结果共纳入14篇文献,其中5篇为对照研究,9篇为病例系列研究;将5篇对照研究的栓塞组和传统手术组患者进行Meta分析。结果显示,栓塞组患者的血肿复发率(3.0%)明显低于传统手术组(23.5%),差异有统计学意义(OR=0.12;95%CI0.05～0.25;P<0.000 01;I2=47%);两组患者手术并发症发生率(3.4%,5.3%)的差异无统计学意义(OR=0.51;95%CI0.23～1.15;P=0.11;I2=0%)。合并14篇文献,栓塞治疗患者的术后血肿复发率为3.9%,手术并发症发生率为2.4%,均低于传统手术治疗患者;其中难治性慢性硬膜下血肿患者栓塞术后的复发率及手术并发症发生率均为4.5%。结论脑膜中动脉栓塞治疗慢性硬膜下血肿安全、有效,尤其适用于多次复发或存在高复发风险的难治性硬膜下血肿。     

脑膜中动脉栓塞治疗合并血液恶性肿瘤的慢性硬膜下血肿2例

报道2例合并血液恶性肿瘤的慢性硬膜下血肿患者,经脑膜中动脉栓塞治疗,取得较良好的临床疗效,回顾其诊治过程并复习相关文献资料,分析病例特点及处理方式,以期为该类型患者诊治提供参考。 [国际神经病学神经外科学杂志, 2023, 50(2): 53-55]     

Survival after reoperation for recurrent glioblastoma

Determining which patients will benefit from reoperation for recurrent glioblastoma remains difficult and the impact of the volume of FLAIR signal hyperintensity is not well known. The primary purpose of this study is to analyze the impact of preoperative volume of FLAIR hyperintensity on prognosis. 37 patients who underwent a reoperation for recurrent glioblastoma after initial gross total resection followed by standard chemoradiation were retrospectively reviewed. Volumetric analysis of preoperative MR images from the initial and second surgery was performed and correlated with clinical data. Survival probabilities were estimated using the Kaplan-Meier method and Cox regression to assess the effect of risk factors on time to reoperation (TTR), progression-free survival (PFS) after reoperation, and overall survival (OS). The volumes of FLAIR signal hyperintensity prior to the initial surgery and reoperation were not associated with prognosis. TTR and OS were significantly affected by the preoperative enhancement volume at the initial surgery, with increasing volumes yielding poorer prognosis. Patients with tumor in critical/eloquent areas were found to have a worse prognosis. Median TTR was 11 months, median PFS after reoperation was 3 months, and OS in patients undergoing a reoperation was 21 months. The results suggest FLAIR signal change seen in patients with glioblastoma does not influence time to reoperation, progression-free survival, or overall survival. These findings suggest the amount of FLAIR signal change should not greatly influence a surgeon’s decision to perform a second surgical resection compare to other factors, and when appropriate, aggressive surgical intervention should be considered.     

Radiation-induced brain tumours in nevoid basal cell carcinoma syndrome: implications for treatment and surveillance

Introduction We report two cases of radiation-induced intracranial tumours after treatment for medulloblastoma presenting in children with nevoid basal cell carcinoma syndrome.Discussion These cases illustrate the need for judicious use of post-operative radiotherapy as secondary tumors are commonly reported. This is particularly important as the initial tumour in this cohort is of the ‘less aggressive’ desmoplastic subtype.     

Diffusion tensor imaging for differentiation of recurrent brain tumor and radiation necrosis after radiotherapy--three case reports

Fractional anisotropy (FA) is influenced by histological data such as cellularity, vascularity and/or fiber structure in astrocytic tumors. We describe two patients with tumor recurrence and one patient with radiation necrosis who were diagnosed using assessment of FA value. The assessment of FA value in enhanced lesions after radiotherapy may be able to differentiate radiation necrosis from tumor recurrence.     

Gamma knife radiosurgery for residual or recurrent intracranial hemangiopericytomas

Residual or recurrent hemangiopericytoma (HPC) has been treated with radiosurgery; however, its long-term outcome is not well known. This study is to investigate the long-term outcome of gamma knife radiosurgery (GKS) for residual or recurrent HPCs. We conducted a retrospective analysis of 18 patients who underwent gamma knife radiosurgery for residual or recurrent HPCs. Of the 18 patients, 10 patients had high-grade HPCs (27 tumors) and 8 had low-grade HPCs (13 tumors). Median overall survival (OS) after the first GKS was 134.7 months and actuarial survival rate at 1, 5, and 10 years was 85.6%, 85.6%, and 37.4%, respectively. At the last follow-up, local tumor control was achieved in 32 (80.0%) of the 40 GKS-treated tumors. New lesions developed out of initial GKS target in 8 patients (44.4%). They were also treated with additional GKS. The actuarial local control rate of 40 tumors at 1-, 3-, and 5-years was 89.3%, 60.9%, and 37.5%, respectively. The median local recurrence-free interval of 40 tumors after initial GKS for each lesion was 86.1 months for low-grade and 40.5 months for high-grade tumors (p = 0.010). Extracranial metastases developed in 7 (38.9%) patients with high-grade pathology and became a cause of death in 3 patients. Intracranial tumor control can be achieved over the long term, though additional GKS is frequently necessary. Extracranial metastasis is common in HPC of high-grade pathology. Close surveillance and aggressive treatment is recommended not only for intracranial tumor but also for possible extracranial metastases.     

Cells encapsulated in alginate: a potential system for delivery of recombinant proteins to malignant brain tumours

Growth and progression of malignant brain tumours occurs in a micromilieu consisting of both tumour and normal cells. Several proteins have been identified with the potential of interfering directly with tumour cells or with the neovascularisation process, thereby inhibiting tumour growth. A continuous delivery of such inhibitory proteins to the tumour microenvironment by genetically engineered cells could theoretically be of considerable therapeutic importance. In this study we have investigated the growth characteristics of cells encapsulated in alginate, which represents a potential delivery system for recombinant proteins that may have antitumour effects. Three different cell lines, NHI 3T3, 293 and BT4C were encapsulated in alginate, which is an immuno-isolating substance extracted from brown seaweed. The encapsulated cells were observed at specific intervals during a 4-month period after in vitro propagation and as transplants into the cortex of BD-IX rats. Morphological studies showed that encapsulated cells proliferated and formed spheroids within the alginate in the in vitro cultures and after implantation into the brain. Even after 4 months in vivo a substantial amount of living cells were observed within the alginate beads. A vigorous infiltration of mononuclear cells was observed in the brain bordering the alginate beads, one week after implantation. However, there was a gradual decrease of mononuclear cells at the border zone beyond the first week of implantation. The majority of inflammatory cells were reactive microglia and invading monocytes, as verified by immunohistochemistry. The data further shows that alginate encapsulated cells can be frozen in liquid N2 and will retain their viability and proliferative capacity.     

面部血管痣合并脑积水的颅内静脉异常回流三例

目的 探讨面部血管痣合并脑积水患者的颅内静脉异常回流特征及其临床表现.方法 结合文献复习,回顾性分析3例面部血管痣合并先天脑积水患儿的脑血管造影资料及临床表现.结果 3例患儿均有多处广泛的静脉窦闭塞且影响全脑静脉回流,颅内静脉回流主要经异常扩张的导静脉或代偿形成的侧副路静脉反流至头面部,引起双侧头面部及颈部静脉扩张.结论 广泛的颅内静脉窦闭塞导致颅内异常的静脉回流是面部血管痣患儿发生脑积水的主要原因,而这种静脉窦闭塞及异常回流静脉的形成很可能源于胎儿胚胎期发育缺陷.     

Outcome and complications of reconstruction of the thoracolumbar spine for vertebral tumours

Forty-six patients with progressive neurological deficits or severe pain underwent subtotal vertebrectomy and resection of thoracic and lumbar vertebral tumours. Following subtotal vertebrectomy, 22 spinal segments were reconstructed with titanium mesh cylinders, 13 with allograft struts, 7 with methyl methacrylate, one with autograft bone, and 2 patients underwent spinal reconstruction with miscellaneous materials. In one patient, 40 mm cancellous screws and a titanium mesh cylinder filled with methyl methacrylate were used. Following the reconstruction, 34 patients underwent stabilisation with anterior plates, and 5 patients with posterior rods and pedicle screws. No instrumental fixation was used in 7 patients. Postoperatively, 9 patients who had severe pain but no preoperative neurological deficits remained neurologically intact. Of 33 patients with preoperative incomplete deficit (Frankel grades C and D), 14 improved, 18 were unchanged, and one was worse. Of 3 patients in Frankel grade B, 2 improved to grade C but did not recover ambulation and the third patient remained at Frankel grade B. Other complications included 2 perioperative deaths due to respiratory failure and coagulopathy, one postoperative deterioration, and optic neuropathy in one patient. Backed out screws were seen in 2 patients. Although spinal reconstruction and instrumentation systems allow for immediate stability and mobilisation, a significant perioperative morbidity warrants a careful patient selection.