Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal?

Background

Ten to 40% of children operated on for a posterior fossa tumour require a further surgical procedure for the management of a persisting active ventricular dilation. The management of this kind of hydrocephalus is still controversial.

Objective

To prospectively evaluate the effectiveness of post-operative endoscopic third ventriculostomy (ETV) in the management of persistent active hydrocephalus in a series of children operated on for a posterior cranial fossa tumour.

Methods

The management protocol consisted of: (1) placement of a peri-operative antibiotic impregnated external ventricular catheter (Bactiseal®) and tumour removal, (2) post-operative intracranial pressure (ICP) monitoring through the external ventricular drainage, (3) ETV in case of persistent ventricular dilation and persistently abnormal high ICP values and (4) ventriculoperitoneal shunt implantation in case of ETV failure.

Results

Thirty on a total of 104 children (28.8%) operated on between January 2001 and February 2007 at our institution needed a further surgical treatment for the persistence of the hydrocephalus after the removal of their posterior cranial fossa tumour. They were sub-divided in two groups according to the early (group 1—21 patients) or later (group 2—nine patients) definition of the persistence of an active ventricular dilation based on clinical, radiological and ICP monitoring data. ETV was successful in 90.0% of the patients in the present series (27/30 patients), without statistically significant differences among the two groups considered.

Conclusions

Post-operative ETV should be considered the best option to treat persistent hydrocephalus after the removal of posterior fossa tumours.

     

The earliest evidence of true lambdoid craniosynostosis: the case of “Benjamina”, a Homo heidelbergensis child

Background  

The authors report the morphological and neuroimaging findings of an immature human fossil (Cranium 14) diagnosed with left lambdoid synostosis.     

Endotoxin-induced changes in human working and declarative memory associate with cleavage of plasma “readthrough” acetylcholinesterase

Endotoxin stimulation of the immune system produces marked alterations in memory functioning. However, molecular links between this cognitive response and infection-responding neurotransmission pathways are still unknown. The cytokine and memory responses of volunteers injected with 0.8 ng/kg Salmonella endotoxin were compared with changes in plasma levels and integrity of the stress-induced acetylcholinesterase variant, AChE-R. Vascular endothelial cells were found to express AChE-R messenger RNA and protein both in healthy and inflamed human tissues. Plasma AChE activity was reduced after endotoxin treatment, but not placebo treatment, parallel to the decline in cortisol after the endotoxin-induced peak and inversely to the accumulation of a C-terminal immunopositive AChE-R peptide of 36 amino acid residues. AChE-R cleavage coincided with significant endotoxin-induced improvement in working memory and impairment in declarative memory. By 3 h posttreatment, working memory improvement was negatively correlated with AChE-R cleavage, which showed association to proinflammatory cytokine levels. By 9 h posttreatment, declarative memory impairment was negatively correlated with AChE-R cleavage and positively correlated with the suppressed AChE activity. Endotoxin-induced peripheral cholinergic stress responses are hence associated with greater impairment in declarative memory and lower improvement in working memory, pointing at AChE-R as a surrogate marker of psychoneuroimmunological stress. These two authors contributed equally.     

The power of“touch”and early enriched stimulation:neuroplasticity effects in rodents and preterm infants

Early postnatal stimulation,e.g.,neonatal handling(NH)in its most frequent form,and environmental enrichment(EE,the exposure of juvenile animals,usually during several weeks,to environments involving rich and variable sensory stimulation)produce profound and long-lasting behavioral and neurobiological effects.Both treatments reduce anxiety and stress sensitivity,and improve neurodevelopment and learning/memory in unconditioned and conditioned tasks in laboratory rodents.     

“How to do things with Words”: Role of motor cortex in semantic representation of action words

Language, believed to have originated from actions, not only functions as a medium to access other minds, but it also helps us commit actions and enriches our social life. This fMRI study investigated the semantic and neural representations of actions and mental states. We focused mainly on language semantics (comprehending sentences with action words versus those with mental state words). While in an fMRI scanner, twenty-four healthy, right-handed adult volunteers read a series of sentences with a verb depicting either a mental state (e.g., deceive, persuade) or an action (e.g., punch, kick), and answered a comprehension question that followed. Overall, this task showed brain activation in the left inferior frontal gyrus and in the left posterior superior temporal sulci. While comprehending sentences with mental state terms, participants showed greater activation in left orbitofrontal, and in left precuneus areas. On the other hand, the action sentences recruited more primary motor, left inferior parietal, bilateral occipital, right superior temporal, and right inferior frontal areas. The findings of this study underscore the role of motor and visuospatial involvement in action word representation in the human brain.     

Magnetic resonance imaging in “typical” and “late onset” Friedreich''s disease and early onset cerebellar ataxia with retained tendon reflexes

MRI makes it possible to study the in vivo brain and spinal cord morphology of patients with hereditary ataxia. We performed T1-and T2-weighted studies in eleven patients with Friedreich's disease (FD), five with late onset FD and ten with early onset cerebellar ataxia with retained tendon reflexes (EOCA). Cervical cord atrophy was constant in FD and late onset FD and often associated with atrophy of the cerebellum and of the brainstem; T2-weighted studies showed posterior column degeneration in the cervical cord. The most frequent finding in EOCA was cerebellar atrophy, pure or associated with cervical cord or brainstem atrophy; the cerebellar atrophy was marked in a few cases and was related to disease duration.This study was partially supported by the CNR (Grant 91.04180) and the Ministry of Health.     

Quantitative changes in number of “synaptic” ribbons in rat pinealocytes after orchidectomy and in organ culture

Summary A quantitative study of synaptic ribbons in rat pinealocytes was performed after orchidectomy and in organ culture. Both orchidectomy and culturing the pineal organ caused an increase in number and size of these structures.Present study indicate that microtubular sheaves and/or microtubules may represent precursors of synaptic ribbons.It is suggested that synaptic ribbons of rat pinealocytes, far from being phylogenetic relics of no functional significance play a role in the function of the pineal organ. An exact functional interpretation of the synaptic ribbons, however, is still a matter of conjecture.In gratitude and with admiration this paper is dedicated to Professor Dr. J. Ariëns Kappers.     

The “Liquid Biopsy”: the Role of Circulating DNA and RNA in Central Nervous System Tumors

The detection of tumor-derived circulating nucleic acids in patients with cancer, known as the “liquid biopsy,” has expanded from use in plasma to other bodily fluids in an increasing number of malignancies. Circulating nucleic acids could be of particular use in central nervous system tumors as biopsy carries a 5-7 % risk of major morbidity. This application presents unique challenges that have limited the use of cell-free DNA and RNA in the diagnosis and monitoring of CNS tumors. Recent work suggests that cerebrospinal fluid may be a useful source of CNS tumor-derived circulating nucleic acids. In this review, we discuss the available data and future outlook on the use of the liquid biopsy for CNS tumors.     

Lowered zinc and copper levels in drug-naïve patients with major depression: Effects of antidepressants,ketoprofen and immune activation

Abstract

Objectives: The aim of the present work is to examine the effects of treatment with sertraline with and without ketoprofen on serum levels of zinc and copper in association with immune-inflammatory biomarkers in drug-naïve major depressed patients.

Methods: We measured serum zinc and copper, interleukin (IL)-1β, IL-4, IL-6, IL-18, interferon-γ, and transforming growth factor-β1 in 40 controls and 133 depressed patients. The clinical efficacy of the treatment was measured using the Beck Depression Inventory-II (BDI-II) at baseline and 8?weeks later.

Results: We found significantly reduced serum zinc and copper in association with upregulation of all cytokines, indicating activation of the immune-inflammatory responses system (IRS) and the compensatory immune regulatory system (CIRS). Treatment with sertraline significantly increased zinc and decreased copper. During treatment, there was a significant inverse association between serum zinc and immune activation. The improvement in the BDI-II during treatment was significantly associated with increments in serum zinc coupled with attenuation of the IRS/CIRS.

Conclusions: Lower zinc is a hallmark of depression, while increments in serum zinc and attenuation of the immune-inflammatory response during treatment appear to play a role in the clinical efficacy of sertraline.     

A decision analysis tool for the assessment of posterior fossa tumour surgery outcomes in children—the “Liverpool Neurosurgical Complication Causality Assessment Tool”

Introduction

Complications may occur following posterior fossa tumour surgery in children. Such complications are subjectively and inconsistently reported even though they may have significant long-term behavioural and cognitive consequences for the child. This makes comparison of surgeons, programmes and treatments problematic.

Materials and methods

We have devised a causality tool for assessing if an adverse event after surgery can be classified as a surgical complication using a series of simple questions, based on a tool used in assessing adverse drug reactions. This tool, which we have called the “Liverpool Neurosurgical Complication Causality Assessment Tool”, was developed by reviewing a series of ten posterior fossa tumour cases with a panel of neurosurgery, neurology, oncology and neuropsychology specialists working in a multidisciplinary paediatric tumour treatment programme.

Discussion and conclusion

We have demonstrated its use and hope that it may improve reliability between different assessors both in evaluating the outcomes of existing programmes and treatments as well as aiding in trials which may directly compare the effects of surgical and medical treatments.     

“Loser” or “Popular”?: Neural response to social status words in adolescents with major depressive disorder

Concerns about social status are ubiquitous during adolescence, with information about social status often conveyed in text formats. Depressed adolescents may show alterations in the functioning of neural systems supporting processing of social status information. We examined whether depressed youth exhibited altered neural activation to social status words in temporal and prefrontal cortical regions thought to be involved in social cognitive processing, and whether this response was associated with development. Forty-nine adolescents (ages 10–18; 35 female), including 20 with major depressive disorder and 29 controls, were scanned while identifying the valence of words that connoted positive and negative social status. Results indicated that depressed youth showed reduced late activation to social status (vs neutral) words in the superior temporal cortex (STC) and medial prefrontal cortex (MPFC); whereas healthy youth did not show any significant differences between word types. Depressed youth also showed reduced late activation in the dorsolateral prefrontal cortex and fusiform gyrus to negative (vs positive) social status words; whereas healthy youth showed the opposite pattern. Finally, age was positively associated with MPFC activation to social status words. Findings suggest that hypoactivation in the “social cognitive brain network” might be implicated in altered interpersonal functioning in adolescent depression.