Estimation of cranial capacity and brain weight in 18-22-year-old Iranian adults

Objective

Cranial capacity, brain weight and cerebral index are important measurements in the study of racial differences. Clinically, an analysis of cranial capacity and weight exposes another aspect of growth and development and permits critical evaluation of unusually large, small, or misshapen crania.

Subjects and methods

Brain weight and cerebral index were estimated in 772 normal 18–22-year-old (320 males, 452 females) Iranian people of different socioeconomic groups, using linear dimensions of the head (using Lee–Pearson's formula) measured with spreading caliper and auricular head spanner.

Results

Cranial capacity, brain weight and cerebral index in males were 1343.45 ± 102.37 cm³ (mean ± S.D.), 1390.47 ± 105.95 g, and 2.17 ± 0.27% respectively. Cranial capacity, brain weight and cerebral index in females were 1163.02 ± 115.76 cm³, 1203.73 ± 119.81 g, and 2.25 ± 0.31% respectively.

Conclusion

It was shown that neurocranial volume and weight of male is higher than female. Also, the results are different from previous studies in Western countries which may be a result of racial, topodemic, and socioeconomic variations. Finally, we propose the new “cerebral quotient” for anthropometric measurements.     

Diffusion tensor and dynamic susceptibility contrast MRI in glioblastoma

Objective

We prospectively investigated the correlation between diffusion tensor (DTI), dynamic susceptibility contrast (DSC) perfusion MRI metrics and Ki-67 labelling index in glioblastomas.

Methods

We studied seventeen patients who were operated on for glioblastoma. DTI and DSC MRI were performed within a week prior to surgical excision. Lesion/normal ratios were calculated for the apparent diffusion coefficient (ADC), fractional anisotropy (FA), relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and relative mean transit time (rMTT) ratio. In the excised tumour specimens Ki-67 antigen expression was evaluated by the MIB-1 immunostaining method.

Results

A significant correlation was observed between Ki-67 index and ADC ratio (r = −0.528, p = 0.029) and FA ratio (r = 0.589, p = 0.012). rCBV and rMTT presented a trend towards significant correlation with Ki-67 index (r = 0.628, p = 0.07 and r = 0.644, p = 0.06 respectively). There was a trend towards better survival for patients with gross total tumour excision and FA values lower than 0.48 (p = 0.1 and p = 0.09 respectively). No significant correlation was found between ADC ratio, rCBV, rCBF, rMTT and overall survival.

Conclusion

ADC ratio, FA ratio, rCBV and rMTT tumour/normal tissue ratios may represent indicators of glioma proliferation. FA values may hold promise for predicting survival in patients with glioblastoma.     

The assessment of prognostic factors in surgical treatment of low-grade gliomas: A prospective study

Objective

A prospective volumetric analysis of extent of resection (EOR) was carried out to assess surgical outcomes in adults diagnosed with hemispheric low grade gliomas (LGGs).

Materials and methods

68 consecutive patients diagnosed with LGGs were enrolled in the study. Pre- and post-operative tumor volumes and EOR were measured based on FLAIR MRI. Dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC MRI) was used for the assessment of relative cerebral blood volume (rCBV). Three outcome measures were assessed: overall survival (OS), progression-free survival (PFS), and malignant degeneration-free survival (MFS).

Results

In 6 (9%) patients permanent neurologic deficits were observed. No statistically significant dependence between the EOR and the occurrence of permanent deficits was found. The eloquent or close to the eloquent location was statistically connected with lower EOR (p = 0.023). The preoperative volume of tumors treated with gross total resection was significantly smaller than the volume of tumors in subtotal or partial resection groups (p = 0.020, p < 0.001, respectively). OS was predicted by age at diagnosis (p = 0.032), and rCBV (p = 0.002). Progression and malignant transformation occurred in 22 (32%) and 11 (16%) out of 68 patients. PFS was predicted by preoperative tumor volume (p = 0.005), postoperative tumor volume (p = 0.008), the EOR (p = 0.001), and by the rCBV (p = 0.033). MFS was predicted by preoperative tumor volume (p = 0.034), the EOR (p p = 0.020), and by rCBV (p = 0.022). Postoperative tumor volume was associated with a trend of improved MFS (p = 0.072). The univariate analysis shows the statistical trend for the relationship between histological subtype and PFS and MFS (p = 0.079, p = 0.078, respectively). Multivariate analysis selected preoperative tumor volume and rCBV as independently associated with PFS (p = 0.009, p = 0.019, respectively) and MFS (p = 0.023, p = 0.035, respectively). EOR was associated with a trend of improved PFS, and MFS (p = 0.069, p = 0.094, respectively).

Conclusions

Tumor resection of LGG with the use of intraoperative monitoring and neuronavigation is associated with a low risk of new permanent deficits, but EOR significantly decreases with the size of the tumor and/or its location in/close to the eloquent areas. Smaller preoperative tumor volume and greater EOR are significantly associated with longer OS, PFS and MFS. Preoperative rCBV is one of the important prognostic factors significantly connected with survival. Prognosis in LGGs is still under discussion. Other factors such as age, histopathological subtype and KPS should not be underestimated.     

Synchronized finger exercise reduces surround inhibition

Objective

To investigate whether hand muscle repetitive use reduces surround inhibition (SI) as observed in patients with focal hand dystonia, we performed a transcranial magnetic stimulation (TMS) study in 15 healthy right-handed volunteers.

Methods

TMS was set to be triggered by self-initiated flexion of the index finger at 3 ms after movement onset. Motor evoked potentials (MEPs) of the abductor digiti minimi (ADM) were measured before and at 0, 10, 20 and 30 min after ‘single’ (little finger abduction) and ‘dual’ (both index finger flexion and little finger abduction) exercise at 0.5 Hz for 30 min. SI was calculated as (mean control MEP – mean self-triggered MEP) × 100/mean control MEP.

Results

Compared to single exercise, dual exercise produced significantly larger and longer-lasting enhancements of self-triggered MEPs, and greater reduction in calculated SIs.

Conclusions

This result demonstrates that synchronized finger exercise can reduce SI between the involved muscles possibly due either to the strengthening of the excitatory connections or to the weakening of the inhibitory connections between them, and may illustrate the association between hand muscle repetitive use and disturbed SI observed in FHD.

Significance

The operation of surround inhibition can be reduced by practicing synchronous movements.     

Mismatch negativity and low frequency oscillations in schizophrenia families

Objective

Theta-alpha range oscillations have been associated with MMN in healthy controls. Our previous studies showed that theta-alpha activities are highly heritable in schizophrenia patients’ families. We aimed to test the hypothesis that theta-alpha activities may contribute to MMN in schizophrenia patients and their family members.

Methods

We compared MMN and single trial oscillations during MMN in 95 patients, 75 first-degree relatives, 87 controls, and 34 community subjects with schizophrenia spectrum personality (SSP) traits.

Results

We found that (1) MMN was reduced in patients (p < 0.001) and SSP subjects (p = 0.047) but not in relatives (p = 0.42); (2) there were augmented 1–20 Hz oscillations in patients (p = 0.02 to <0.001) during standard and deviant stimuli; (3) theta-alpha (5–12 Hz) oscillations had the strongest correlation to MMN in controls and relatives (ΔR² = 21.4–23.9%, all p < 0.001), while delta (<5 Hz) showed the strongest correlation to MMN in schizophrenia and SSP trait subjects; and, (4) MMN (h² = 0.56, p = 0.002) and theta-alpha (h² = 0.55, p = 0.004) were heritable traits.

Conclusions

Low frequency oscillations have a robust relationship with MMN and the relationship appears altered by schizophrenia; and schizophrenia patients showed augmented low frequency activities during the MMN paradigm.

Significance

The results encourage investigation of low frequency oscillations to elucidate the neurophysiological pathology underlying MMN abnormalities in schizophrenia.     

Correlation between the arterial pulse wave of the cerebral microcirculation and CBF during breath holding and hyperventilation in human

Objective

To evaluate if relative changes in the amplitude of the arterial pulse wave of the cerebral microcirculation (APWCM) measured by near-infrared spectroscopy (NIRS) may provide information about relative changes of cerebral blood flow (CBF) in cerebral cortex.

Methods

In 10 healthy human volunteers, through simultaneous recording of the APWCM amplitude by means of NIRS and the mean blood flow velocity (MBFV) of middle cerebral artery by means of transcranial Doppler (TCD) at rest and during breath holding and hyperventilation, we evaluate a possible correlation between relative changes of the mean APWCM amplitude and relative changes of MBFV.

Results

We found a significant linear correlation: breath holding: R² 0.84, p < 0.001, hyperventilation: R² 0.81, p < 0.001.

Conclusion

The relative changes of the mean APWCM amplitude seem able to provide information about relative changes of CBF of cerebral cortex in healthy adult humans during breath holding and hyperventilation.

Significance

APWCM detected by NIRS, a safe, repeatable, inexpensive technology and at the bedside may improve the study of cerebral cortex microcirculation in neurological diseases.     

Clinical outcome of surgically treated low-grade gliomas: A retrospective analysis of a single institute

Objective

Low grade gliomas (LGGs) are slow-growing primary brain tumors with heterogeneous clinical behaviors. The aim of our study is to review the treatment outcome of 63 patients with LGGs focusing on surgical outcome and the current therapeutic strategy.

Methods

We retrospectively enrolled 63 patients surgically treated for LGGs. The gross total resection (GTR) was performed in 35 patients (60.3%), subtotal resection (STR) was performed in 19 patients (31.7%) and partial resection (PR) or biopsy was performed in 9 patients (14.3%). We analyzed their progression-free survival (PFS), overall survival (OS), and malignant transformation with regard to age, gender, Karnofsky performance score (KPS), clinical presentation, tumor location, radiologic pattern, contrast enhancement, extent of removal, pathologic subtype, chemotherapy (CT) and radiotherapy (RT) treatment.

Results

Among all LGGs, the 3-year OS rate was 80% and the 5-year OS was 76%. The 3-year PFS rate was 83.6% and the 5-year PFS was 25%. The non-eloquent area location showed a longer PFS than the eloquent area location (p = 0.05). Oligodendroglial pathology showed a longer PFS compared to oligoastrocytomas and astrocytomas (p = 0.02). Patients older than 60 years had poorer OS than younger patients (p < 0.05). Female gender had a shorter OS than male gender (p < 0.05), and a KPS of 90 or 100 had a longer OS than a KPS of 80 (p < 0.05). Oligodendroglial pathology statistically correlated with a longer OS (p < 0.05).

Conclusion

The findings from our study, which were confirmed by uni- and multivariate analyses, demonstrated that radical tumor resection was associated with better long-term outcomes and tumor progression for patients with LGG.     

Measures of small-fiber neuropathy in HIV infection

Introduction

Noninvasive methods are needed to detect distal sensory polyneuropathy in HIV-infected persons on antiretroviral therapy (ART).

Methods

Quantitative sudomotor axon reflex test (QSART) and Utah Early Neuropathy Scale (UENS), small-fiber sensitive measures, were assessed in subjects with and without clinical neuropathy. Pain was assessed by visual analog scale (VAS).

Results

Twenty-two subjects had symptoms and signs of neuropathy, 19 had neither, and all were receiving ART. Median sweat volume (μL) was lower at all testing sites in those with neuropathy compared to those without (p < 0.01 for all). UENS and VAS (mm) were higher in neuropathy subjects (p < 0.05 for each). Lower sweat volume at all sites correlated with higher pin UENS subscore, total UENS, and VAS (p < 0.05 for all). In multivariable analyses adjusting for age, CD4⁺ T cells, sex, and use of “d-drug” ART, QSART and UENS remained associated (p = 0.003).

Conclusion

QSART and UENS have not been previously studied in this patient population and may identify small-fiber neuropathy in HIV-infected, ART-treated persons.     

Clinicopathological review of patients with and without multiple sclerosis treated by partial sensory rhizotomy for medically refractory trigeminal neuralgia: a 12-year retrospective study

Background

Trigeminal nerve root entry zone demyelination has been implicated as a cause of trigeminal neuralgia (TN) in multiple sclerosis (MS) and patients with nerve root vascular compression. We have examined the relationship between pathology and treatment outcome in patients with and without MS, treated for intractable TN by partial sensory rhizotomy (PSR).

Methods

We reviewed the operative records, electron microscopic biopsy findings and post-operative satisfaction and pain scores of 23 MS and 47 non-MS patients who underwent PSR between 1992 and 2004.

Results

The MS and non-MS patients had similar ages of onset of TN, duration of symptoms, age at surgery and proportions with typical and atypical symptoms. Demyelination was present in 16 MS and 23 non-MS patients (p = 0.129), and a compressing vessel in 5 MS and 23 non-MS patients (p = 0.039). Of those with demyelination, vascular compression was documented in 3 MS and 15 non-MS patients (p = 0.008). Pain and satisfaction scores were similar in both groups. Recurrent TN was more commonly associated with a compressing vessel (p = 0.019).

Conclusions

TN is frequently associated with nerve root entry zone demyelination in MS and patients with nerve root vascular compression. The characteristics of the TN and response to PSR are similar in both groups. Persistent vascular compression increases the risk of recurrent TN after PSR.     

Multimodality language mapping in patients with left-hemispheric language dominance on Wada test

Objective

We determined the utility of electrocorticography (ECoG) and stimulation for detecting language-related sites in patients with left-hemispheric language-dominance on Wada test.

Methods

We studied 13 epileptic patients who underwent language mapping using event-related gamma-oscillations on ECoG and stimulation via subdural electrodes. Sites showing significant gamma-augmentation during an auditory-naming task were defined as language-related ECoG sites. Sites at which stimulation resulted in auditory perceptual changes, failure to verbalize a correct answer, or sensorimotor symptoms involving the mouth were defined as language-related stimulation sites. We determined how frequently these methods revealed language-related sites in the superior-temporal, inferior-frontal, dorsolateral-premotor, and inferior-Rolandic regions.

Results

Language-related sites in the superior-temporal and inferior-frontal gyri were detected by ECoG more frequently than stimulation (p < 0.05), while those in the dorsolateral-premotor and inferior-Rolandic regions were detected by both methods equally. Stimulation of language-related ECoG sites, compared to the others, more frequently elicited language symptoms (p < 0.00001). One patient developed dysphasia requiring in-patient speech therapy following resection of the dorsolateral-premotor and inferior-Rolandic regions containing language-related ECoG sites not otherwise detected by stimulation.

Conclusions

Language-related gamma-oscillations may serve as an alternative biomarker of underlying language function in patients with left-hemispheric language-dominance.

Significance

Measurement of language-related gamma-oscillations is warranted in presurgical evaluation of epileptic patients.     

Systemic arterial inflammation, measured with 18FDG-PET, is common amongst subjects with both recent and prior cerebrovascular disease

Objective

To compare systemic arterial inflammation in subjects with recent ischaemic stroke or TIA and controls with prior cerebrovascular disease.

Methods

Systemic arterial inflammation was prospectively measured by ¹⁸F-fluorodeoxygluose positron emission tomography in 11 cases with recent ischaemic stroke or TIA, and 11 sex matched controls with prior cerebrovascular disease.

Results

Hot spots (both carotid and non-carotid) of localised ¹⁸FDG uptake were found in more than half of all patients with either recent (n = 6) or prior (n = 8) cerebrovascular disease. There was no significant difference in the total number of hotspots, or hotspots at specific sites, in cases compared with controls. Mean standard uptake values (SUV) were similar in the carotid arteries and aorta of cases and controls, and showed a trend toward higher values in the femoral arteries of the controls (median 1.8; IQR 1.6–2.2) compared to cases (median 1.5; IQR 1.4–1.7).

Conclusion

Arterial inflammation was common, and appeared similar, in patients with recent stroke/TIA, and controls with stroke/TIA more than two years previously.     

Management of symptomatic intrathecal catheter-associated inflammatory masses

Objective

Intrathecal catheter-associated inflammatory masses (CIMs) are a serious complication of implanted drug pumps. The goal of this study was to review our experience with CIMs, including the pathology of all resected CIMs, and identify objective data which may guide management.

Methods

We performed a retrospective review of 13 patients who developed symptomatic CIMs during continuous intrathecal opioid therapy for chronic pain. Eight patients presented with pain plus neurologic deficit and 5 patients presented with pain alone.

Results

CIM resection via laminectomy and intradural exploration was ultimately performed in 8 patients, 3 of whom were initially treated with a non-resective surgical approach (catheter repositioning or pump removal) that failed.All 3 patients who experienced a failure with non-resective surgery had CIMs located in the thoracic spine with a maximum diameter ≥ 13 mm and 2 of these patients had neurologic deficits on presentation.

Conclusions

Our experience, with the largest reported single-surgeon series of patients harboring CIMs, favors early resection, especially in patients with neurologic deficit. Resection may also be a prudent first-line strategy for patients with larger thoracic masses (≥13 mm) regardless of neurologic status. Neurologic deficits engendered by CIM usually improve after resection and the majority of patients in our series would have still elected to have an intrathecal pump for pain control knowing a CIM would have developed.     

Treatment of sialorrhea in children with cerebral palsy: a double-blind placebo controlled trial

Objectives

To prospectively study the efficacy and safety of intraparotid gland injection of Botulinum neurotoxin serotype A (Dysport^®) for the treatment of sialorrhea (drooling) in children with cerebral palsy (CP).

Patients and methods

Twenty-four children, ages 21 months to 7 years, were recruited and randomized to receive either treatment with 100 U Botulinum toxin or placebo. Rating scales for the frequency and severity of drooling were performed at the time of injection, at 1 month, and at baseline prior to the second injection. A second set of injections of either 140 U of drug or placebo was given 4 months later, and the same rating scales were used. Eight patients declined the second injection. Due to high dropouts in the placebo group in second set of injections, statistical analysis was performed for the results of the initial injection only.

Results

Scores of the median frequency (p = 0.034) and severity (p = 0.026) of drooling were reduced in the treatment group. Median total score also declined in the treatment group (p = 0.027). After the second injection, five out of nine patients injected with the drug showed a decline in the total score; including three patients who did not respond to the first injection. Only two patients experienced transient increase in drooling after the treatment with the drug.

Conclusion

Botulinum toxin is an effective and safe treatment option for drooling in children with CP.     

No genetic association between NCAM1 gene polymorphisms and schizophrenia in the Chinese population

Background

The neural cell adhesion molecule 1(NCAM1, aliases NCAM and CD56) is a cell-surface molecule which makes homophilic adhesion between neural cells involved in cell migration, axon outgrowth and synaptic plasticity. Recent studies reported that NCAM1 might act as a candidate schizophrenia susceptibility gene.

Method

We genotyped five SNPs (rs1943620, rs1836796, rs1821693, rs686050, rs584427) within the NCAM1 gene and conducted a case-control study in 288 schizophrenic patients and 288 healthy subjects in the Chinese Han population. We compared allele and genotype frequencies and haplotype distributions between cases and controls.

Result

No significant differences in allele and genotype frequencies were found for each single SNP between schizophrenic patients and healthy subjects. Moreover, there were no significant differences in haplotype distributions between cases and controls (global χ² = 1.318, P = 0.725, df = 3).

Conclusion

Our study suggests that the five SNPs within NCAM1 gene we studied may not play a major role in the schizophrenia susceptibility in the Chinese Han population.     

Gamma knife radiosurgery for orbital tumors

Objective

This study was performed to investigate the radiological and functional outcomes of patients with orbital tumors treated by gamma knife radiosurgery (GKS).

Patients and methods

Fifteen patients with orbital tumors (7 meningiomas, 3 cavernous hemangiomas, 2 schwannomas, 2 metastatic tumors and 1 adenoid cystic carcinoma of the lacrimal gland) were treated. Seven patients with preserved vision and tumors located near the optic nerve were treated with multisession (3 or 4 fractions) radiosurgery. The mean tumor volume was 3695 mm³ (737–13,300). The median marginal dose was 14 Gy (13–20) in single-session radiosurgery, and the median cumulative marginal dose was 20 Gy (15–20) in multisession radiosurgery.

Results

After a mean follow-up of 20.9 months (6–50), tumor control was confirmed in 12 of 15 patients. Three patients with malignant lesions had to undergo another operation due to tumor progression. Of the 13 patients whose preoperative vision was preserved, 6 patients showed improvement in visual acuity and/or visual field, 4 patients showed no change in vision, and 3 patients showed deterioration (2 related to tumor progression).

Conclusions

As with intracranial tumors with similar pathologies, GKS may be an effective treatment option for orbital tumors. Multisession radiosurgery may be a good strategy for increasing the possibility of visual function preservation in selected cases in which the lesion is adjacent to the optic apparatus.     

Effectiveness of home rehabilitation program for ischemic stroke upon disability and quality of life: a randomized controlled trial

Background

To develop and examine the effectiveness of individual 6-month home rehabilitation program in ischemic stroke patients upon disability and quality of life at 2 years.

Methods

This is a prospective randomized controlled trial (RCT) in 60 patients with recent ischemic stroke. They were randomly assigned to receive either home rehabilitation program once a month for 6 months with audiovisual materials (intervention group) or usual care (control group). We collected outcome data after discharge from the hospital until 2 years. The Barthel index (BI), the modified Rankin Scale (mRS) and utility index (EQ-5D) were measured for function, disability and quality of life respectively.

Results

At 2 years, the BI was significantly improved in the intervention group more than the control group: 97.2 ± 2.8 vs. 76.4 ± 9.4, p < 0.001. The good outcome, defined as BI 95–100, or mRS 0 or 1. For BI, there were 29 patients (96.7%) in intervention group vs 12 patients (42.9%) in usual care group (95% CI, 42.0, 85.0, p = 0.03). For mRS, there were 28 patients (93.3%) in intervention group vs 9 patients (32.1%) in usual care group (95% CI, 38.2, 87.0, p = 0.02). Number needed to treat for good outcome in mRS was 2.0 (95% CI: 1.0, 1.3). The mean (SD) of utility index in intervention group and control group were 0.9 ± 0.02 and 0.7 ± 0.04 respectively (p = 0.03). There was no significant interaction in baseline characteristics and treatment outcome.

Conclusions

Early home rehabilitation program in the first 6 months period after ischemic stroke leads to more rapid improvement in function, reducing disability and increase quality of life than usual care.     

Outcome of Chlamydia pneumoniae associated acute ischemic stroke in elderly patients: a case-control study

Background

Limited data exists about the role of Chlamydia pneumoniae elderly patients with acute ischemic stroke.

Objective

To study the role of C. pneumoniae in elderly patients (age more than 65 years) with acute ischemic stroke and its impact on stroke out come.

Methods

We recruited 100 elderly patients with acute ischemic stroke and 100 age and sex matched controls over a period of 2 years. IgG and IgA anti C. pneumoniae antibodies were measured by microimmunofluorescence technique in patients and controls. Good outcome was defined as a Modified Rankin score (mRS) of ≤2.

Results

We found C. pneumoniae antibodies in 35% stroke patients and in 18% control subjects (p = 0.01). Good out come at 90 days follow up was found in 20/35(57.1%) seropositive stroke patients compared to 37/65(56.9%) seronegative stroke patients (p = 0.9).

Conclusions

C. pneumoniae antibody positivity was independently associated with ischemic stroke in elderly patients and its presence does not alter the stroke outcome.     

Impact of the per-operatory application of GLIADEL wafers (BCNU, carmustine) in combination with temozolomide and radiotherapy in patients with glioblastoma multiforme: Efficacy and toxicity

Purpose

For the last few years wafers of Gliadel have been inserted into the operation cavity in patients with glioblastoma multiforme. This is followed by concurrent radio-chemotherapy with temozolomide (TMZ) according to the Stupp protocol. Only a few studies have investigated this kind of treatment regimen and the impact in terms of survival and toxicity of the combination of Gliadel with TMZ and radiotherapy.

Methods and materials

From November 2006 to January 2010, 24 patients with a newly diagnosed glioblastoma have undergone a tumour resection which was considered to be macroscopically complete in 12 cases and with tumour residue in another 12 cases. The mean age at the moment of diagnosis was 60.25 years and the median age 63.Twenty-three patients underwent subsequently concurrent radio-chemotherapy with TMZ followed by cycles of elevated doses of TMZ as an adjuvant treatment. One patient had adjuvant radiotherapy alone followed by adjuvant chemotherapy. Thirteen were able to receive 6 or more cycles of adjuvant TMZ. Seven patients had received less than 6 cycles of TMZ as an adjuvant therapy. Two patients did not receive adjuvant TMZ at all.

Results

The median overall survival of our group was 19.2 months and the median progression free survival was 12.3 months. Overall survival for the macroscopically complete-resection patients was 14 months, and 12.85 months in subtotal-resection patients. The median OS was 14.25 months for patients PS 0 – 1 at the moment of diagnosis and 12.65 for PS 2 patients. Chemotherapy with TMZ had to be stopped prematurely in 10 cases due to haematotoxicity, digestive toxicity or early relapse.

Conclusions

The concomitant use of surgery with implantation of BCNU wafers and radio-chemotherapy seems to be well tolerated. Despite the small number of patients treated in our group, particular attention should be paid to the potential haematological consequences of this multimodal treatment regimen.     

Single brain metastasis: resection followed by whole-brain irradiation and a boost to the metastatic site compared to whole-brain irradiation plus radiosurgery

Objective

The most appropriate treatment for a single brain metastasis is still controversial. This matched-pair analysis compared whole-brain irradiation plus radiosurgery (WBI + RS) to neurosurgical resection followed by whole-brain irradiation and a boost to the metastatic site (NR + WBI + B).

Methods

The data of 46 patients treated with WBI + RS were matched 1:1 to 46 patients treated with NR + WBI + B with respect to age, gender, Karnofsky performance score (KPS), tumor type, extracerebral metastases, and interval from first diagnosis of cancer to treatment of the metastasis, RPA class, and GPA score. Both groups were compared for local control of the treated metastasis, intracerebral control, and survival.

Results

The 1-year local control rates were 85% after WBI + RS and 78% after NR + WBI + B (p = 0.35). The 1-year intracerebral control rates were 74% and 68% (p = 0.33), respectively. The 1-year survival rates were 64% and 58% (p = 0.70), respectively. A multivariate analysis was not performed for local and intracerebral control, because no factor achieved significance on univariate analyses for these endpoints. Improved survival was associated with KPS > 70 (p = 0.032), absence of extracerebral metastases (p = 0.003), RPA-class 1 (p = 0.014), and GPA score of 3.0–4.0 (p = 0.010).

Conclusion

Treatment outcomes were not significantly different after WBI + RS or NR + WBI + B. Because WBI + RS is less invasive, it may be preferable for many patients with a single brain metastasis.     

An analysis of related factors of surgical results for patients with craniopharyngiomas

Objective

The objective of this study was to retrospectively review the surgical results following gross total resection and partial resection with or without radiotherapy for craniopharyngiomas and analyze the related factors of surgical results.

Methods

From 1994 to 2009, 214 patients underwent 219 procedures for craniopharyngiomas. We retrospectively reviewed the pre- and postoperative data of patients, reported the perioperative and long-term surgical results and analyzed the influencing factors and the relationship between hypothalamic involvement and postoperative quality of life.

Results

Gross total resection was achieved in 154 procedures (70.3%). Perioperative mortality was 5%. Perioperative hyperpyrexia was the most significant risk factor for perioperative mortality. A total of 151 patients were followed from 6 months to 190 months. There were significant differences in recurrence rate and overall survival between gross total resection and limited resection (P < 0.05). There was significant difference in recurrence rate between limited resection and limited resection with radiotherapy (P < 0.01), but it did not reach statistical difference between gross total resection and gross total resection with radiotherapy. The factors strongly influencing overall survival include old patients, partial resection and recurrent tumors. The preoperative hypothalamic involvement negatively correlates with the postoperative quality of life in patients with craniopharyngiomas.

Conclusion

The preoperative CT/MR imaging provides clues of the relationship between tumor and surrounding structures. Gross total resection should be achieved in the treatment of craniopharyngiomas on the condition that hypothalamus is preserved. The patients who undergo limited resection should receive conventional radiotherapy or gamma knife surgery.