Intraparenchymal meningioma in a 14-month-old infant: case report

The authors report a 14-month-old infant with an intraparenchymal meningioma. At this age, intracranial tumor is an unusual cause of hemiconvulsions, and an intraparenchymal tumor localisation is even more unusual.     

Apoptosis in cerebral astrocytic tumours and its relationship to expression of the bcl-2 and p53 proteins

Apoptosis is an important determinant of tumour growth which can be regulated by the bcl-2 and p53 genes. This study examines the relationship between apoptosis, growth fraction (Ki-67 immunolabelling index), and accumulation of the bcl-2 and p53 proteins in a spectrum of cerebral astrocytic tumours (n=81). including fibrillary astrocytomas (n=16), anaplastic astrocytomas (n=19), and glioblastomas (n=46). Median apoptosis indices (AIs) increased across this spectrum of tumours, and a significant (P<0.0001) correlation was demonstrated between A1 and Ki-67 labelling index (LI). Immunolabelling with the bcl-2 antibody was found in 44% of fibrillary astrocytomas, 42% of anaplastic astrocytomas, and 28% of glioblastomas. It was also found in the vascular endothelial proliferation typically seen in glioblastomas, and in the giant, multinucleated cells of some glioblastomas. No clear relationship between AI and bcl- 2 accumulation was evident. Immunolabelling with the p53 antibody was found in 56% of fibrillary astrocytomas, 79% of anaplastic astrocytomas, and 50% of glioblastomas. No clear relationship between AI and patterns of p53 immunolabelling was evident. Equal proportions of p53-positive tumours were bcl- 2 positive and bcl- 2 negative, but a small proportion of p53-negative tumours was bcl- 2 positive. The correlation between A1 and Ki-67 LI is in line with findings in other malignant tumours. We suggest that the regulation of apoptosis in astrocytic tumours is too complex for a clear association between A1 and bcl- 2 and p53 protein expression to be demonstrated.     

New embolization method using estrogen for dural arteriovenous malformation and meningioma

For the treatment of dural arteriovenous malformations, conjugated estrogens were infused continuously through a cannula inserted into the external carotid artery. In 6 of 8 patients, therapeutic effects such as total or partial disappearance of the nidus were observed. The same method was employed to occlude the feeders of meningiomas in 3 patients to reduce bleeding during the operations. The histological findings from the surgically extirpated meningioma are described.     

Intracranial meningiomas. Analysis of 344 surgically treated cases

The authors present 344 (230 females, 114 males) surgical cases of intracranial meningioma. A total of 370 interventions (344 primary procedures, 10 reexplorations for neurologic deterioration, 16 operations for recurrence) were made. Mean follow-up was 38 months. The overall evaluation revealed that 306 (88.95%) patients were completely normal or in a better condition than before operation. 18 (5.23%) were in a worse condition after operation and 20 (5.81%) died. Results suggested that complications and mortality were mostly related to localization and large volume; we also still have problems with aggressive and malignant meningiomas.     

Acute extradural hematoma associated with silastic dural substitute: Case report

The author reports the occurrence of an acute extradural hematoma associated with a silastic dural substitute, originally implanted 13 years previously. A recurrent malignant meningioma also arose at the site of the previous surgery.     

Dumbbell Type Jugular Foramen Meningioma Extending Both into the Posterior Cranial Fossa and into the Parapharyngeal Space: Report of 2 Cases with Vascular Reconstruction

Summary Two cases with huge dumbbell type jugular foramen meningioma with extension into the parapharyngeal space are reported. A well co-ordinated surgical strategy for total resection to this high risk tumour with neurosurgeons, otolaryngologists and plastic surgeons is mandatory to minimise operative complications. Both of our patients presented with a cervical mass and lower cranial nerve palsies, and had huge dumbbell type masses extending from the posterior cranial fossa through the jugular foramen to the parapharyngeal space, encasing the cervical internal carotid artery. Gross total resection of the tumours was successfully achieved by basically a 2-stage operation. In the first stage, posterior fossa tumours were removed by the transjugular approach, combined with the petrosal approach in one case. In the second stage, cervical tumours were removed along with the cervical carotid artery by the transcervical and/or transmandibular approach, followed by vascular reconstruction from the ipsilateral carotid artery to the middle cerebral artery using saphenous vein graft. From these experiences, we recommend this 2-stage operation for large dumbbell type meningiomas extending to the infratemporal/parapharyngeal space. The intracranial tumour is removed at the first operation. The extracranial portion is resected at the second, and if necessary, the involved cervical carotid artery is resected and simultaneous revascularisation using saphenous vein graft is performed with a vascularised free muscle graft. This strategy could maximise the functional preservation on the one hand, and minimise the surgical risk, such as postoperative infection, on the other.     

侧脑室脑膜瘤的CT和MRI诊断

目的 报道24例侧脑室内脑膜瘤并总结其CT和MRI的特点。方法 回顾24例经手术和病理证实的侧脑室脑膜瘤的CT和MRI资料，分析其影像学表现。其中9例CT检查，15例MRI检查，5例同时做CT和MRI检查。结果①侧脑室脑膜瘤好发于中青年女性。②好发部位为侧脑室三角区，占87．5％(21／24)。③肿瘤大多为类圆形，占83．3％，体积较大，边界清晰。④CT多表现为平扫呈均匀略高密度影，增强呈均匀显著强化，占77．8％(7／9)；MRI多表现为T1W1呈现等信号占80％(12／15)，T2W1呈略高信号占73．3％(11／15)，增强呈均匀强化占73．3％(11／15)。结论侧脑室脑膜瘤的CT和MRI表现典型，其发病年龄、性别及发病部位等特殊，据此可以提高诊断正确率。     

Differences between the concentrations of antiepileptic drugs in normal and pathological human brain

Summary The concentrations of antiepileptic drugs in histologically normal and pathological brain tissues were investigated in 6 patients submitted to surgery. No significant difference for phenobarbital and phenytoin was found between normal and scar tissue, whereas there was a trend to concentration in tumour tissue (meningioma and glioma) of phenobarbital, phenytoin and carbamazepine. Alteration in the vascular supply and pathological changes at cellular and subcellular levels could be responsible for the differences in the distribution of the drugs. The possible clinical relevance of the preferential concentration of the drugs in tumour tissue is discussed.     

Bestimmung des regionalen Blutvolumens (rBV) in Meningeomen:Vergleich von Echoplanar- und Gradientenechosequenzen

The purpose of this study was to evaluate relative regional blood volume (rCBV) in meningioma and compare the utility of reconstruction using both gradient-echo sequence and echo-planar-imaging (EPI) sequence. Eighteen patients with meningiomas were studied on a Siemens 1.5-T scanner.During the gradient-echo sequence (n= 12) and EPI sequence (n=6), a bolus (0.2 mmol/kg) of GdDTPA was injected mechanically with a flow rate of 5 ml/second. Image processing of dynamic data was performed on a pixel-by-pixel basis. The ratio of tumor rCBV/gray matter rCBV was 3.01 ±1.18(3.07 ± 1.39 in gradient sequence and 2.84 ± 0. 94 in EPI sequence). The ratio of gray matter/white matter as the reference tissue had a mean of 2.79 ± 0.76 using the FLASH sequence, and a mean of 3.04 ± 1.31 using EPI. These differences were not statistically signifcant (P＞0.5, t-test).According to the ratio of tumor rCBV/gray matter rCBV, a mean value, 14.5 ml/100 g, of rCBV in meningiomas was calculated. Compared with gray matter, increased inhomogeneous rCBV was observed in meningioma. Based on the two different sequences, no bias can be observed in our rCBV reconstruction.     

蝶骨翼脑膜瘤81例临床回顾分析

目的 总结蝶骨翼脑膜瘤的诊断、分型及手术治疗的经验和体会。方法 回顾性分析了经显微手术和病理证实的蝶骨翼脑膜瘤81例，其中内侧型43例，外侧型36例，扁平型2例，巨大型7例，大型63例，小型11例。采用改良翼点入路53例；额下翼点联合入路7例；经颧弓翼点入路15例；额颢眶颧入路6例。结果 Simpson Ⅰ级切除45例，Ⅱ级切除17例，Ⅲa级切除9例，Ⅲb级6例，Ⅳa级3例。术后本组患者颅高压、视力下降及眼球突出等临床症状均有不同程度的改善和恢复。术后随访9个月～6年，复发5例，3例行二次于术。结论 充分全面的术前评估，正确选择手术入路，熟练掌握术区显微解剖及显微手术操作，可以提高肿瘤全切率，减少术后并发症，以降低术后致残率和复发率。