Stromelysin-3 is expressed by aggressive meningiomas

BACKGROUND: Stromelysin-3 (ST3) that belongs to the metalloproteinase family is proposed to play a role in tumor invasion. The purpose of this work was to study the variation of ST3 expression in meningiomas. METHODS: Twenty atypical meningiomas were retrieved from the Pathology Department's files at Hopital de Bellevue, Saint-Etienne, France. They were compared with 20 benign meningiomas randomly selected from the same file. The tumors were classified using standard histologic criteria. Frozen sections of the tumors were immunostained for ST3 and MIB-1 to evaluate the proliferative activity of tumor cells. RESULTS: The study included 5 fibrous meningiomas, 10 transitional meningiomas, 20 syncitial meningiomas, 2 secretory meningiomas, 2 microcystic meningiomas, and 1 angiomatous meningioma. Stromelysin-3 was expressed within the stromal and neoplastic cells of only 1 benign meningioma and 13 atypical meningiomas. The MIB-1 proliferation index was significantly higher in the meningiomas expressing ST3 (Student t test: P < 0.001). The invasion of bone, muscle, and brain by meningiomas as well the recurrence were statistically correlated with their ST3 expression (Kruskal-Wallis nonparametric correlation test, P = 0.001 and P = 0.008, respectively). CONCLUSIONS: Stromelysin-3 might play an important role in the invasiveness of meningiomas. Therefore, considering, ST3 in association with evaluation of the MIB-1 proliferating index may be an useful tool to assess the behavior of meningiomas.     

Lumbar discal hernia after 65 years of age

The authors make a retrospective study of a series of 200 patients who had been surgically treated, within a period of 26 months, for a lumbar discal pathology. Twenty of these (20%) were over 65 years old. A similar study was carried out in a rheumatological unit over a period of three years, and has included 266 patients, 21 of whom (7,8%) were older than 65. The comparison of both these series permits us to make some considerations concerning the frequency of this pathology after the age of 65, its clinical presentation and its treatment, which, as for the younger adult, must be surgical when the correct treatment fails and when a complication appears.     

Intra operative embolization of unresectable cerebral arterio-venous malformations. Occlusion attempt by means of a delayed polymerization mixture. Report of two cases (author's transl)

Two cases of unresectable intra-cranial arterio-venous malformation (AVM) are reported, treated by direct intra-operative embolization. A 50% mixture of Butyl-2-Cyano-Acrylate and Mono-Iodo-Stearate of Ethyle (Duroliopaque) was used after catheterization of some of the feeding cortical arteries. No intra-operative angiography was performed. The first patient, admitted after subarachnoid hemorrhage and presenting with a mild transient right hemiparesia and aphasia, showed evidence of a left temporal AVM with a left middle cerebral artery supply and contribution from the left cerebral posterior artery. The AVM was embolized with 3 cc of the mixture. A mild aphasia occurred after surgery and completely recovered after two weeks. Roughly half of the AVM was occluded on the postoperative angiograms. The second patient suffering from a long history of seizures had a huge right frontal AVM, with a right middle cerebral artery and right anterior cerebral artery supply, and contribution from a right lenticulostriate artery, the left anterior cerebral artery and the right posterior cerebral artery. The AVM was embolized with 7 cc of the mixture. A complete palsy of the left upper limb occurred after surgery, with complete recovery after two weeks. On the post-operative angiograms, more than three fourth of the AVM was occluded.     

Anterior sacral meningocele. Apropos of 11 cases

The authors report 11 cases of anterior sacral meningocele, cystic mass connected with lumbar sac through a sacral bony defect: 2 children and 9 adults. Clinic presentations are analysed. Examination including, X ray, ultrasonography, scanner is discussed. The authors believe that these lesions must be treated surgically because a risk of rupture in the rectum with important meningitis exists. There is also a septic risk if an error of diagnosis ends at a puncture. The transacral approach is easy and it gives the best results.     

Peroperative spinal cord ultrasonography in neurosurgery

Intraoperative spinal sonography is a new method of investigation. We are reporting 14 observations. The results of these explorations permit to describe the normal spinal sonography and a spinal ultrasonic semeiology. We underline the advantage of this technic in the neurospinal surgery particularly to locate the tumors and to facilitate the removal.     

Ultrasonically guided biopsy of cerebral tumors

The authors have not an installation for stereotaxic neurosurgery. In this condition they have used for 3 years real-time ultrasonography to guide the biopsy of deep-seated brain lesions. For adopting finally their method, a preliminary study of 31 patients has been performed. This method is not available for superficial lesions (two failures) which are in the blind area of the probe. In 29 cases the lesion has been clearly identified and biopsed. Histologic diagnosis has been correct in 26 cases (90 percent), incorrect in 3 cases (lesion too necrotic in 2 cases, non specific gliosis in 1 case). The simplicity of this method, its innocuity and its low cost (versus sterotaxy) and its others applications prove its high interest for neurosurgery.     

Spontaneous rhinorrhea disclosing intranasal meningoencephalocele and ependymoma of the 4th ventricle

The authors report a case of a spontaneous rhinorrhea due to an intranasal meningoencephalocele associated with a benign, perhaps congenital, ependymoma of the floor of the fourth ventricle. The tumour was initially unknown, because clinical symptoms suggested a congenital aqueductal stenosis (macrocrania, no neurological signs, association with a congenital defect of the cranial base). This observation, which belongs to "hypertensive spontaneous rhinorrhea" suggests that the C.S.F. fistula is possible only when hydrocephalus coexists with a congenital abnormality of the cranial base. Therapeutic problems are discussed: the direct approach of the fistula alone is most often insufficient, the treatment of the hydrocephalus alone is possible, but may induce a tension pneumocephalus, the best attitude is the treatment in the same stage, of the fistula and the hydrocephalus. But, in case of chronic non communicant hydrocephalus, aqueductal tubing or ventriculocisternostomy can be insufficient and permanent internal C.F.S. derivation may be performed.     

Phase II study of a radiotherapy/etoposide combination for patients with newly malignant gliomas

Purpose: Etoposide, a semisynthetic derivative of podophyllotoxine, is a topoisomerase II inhibitor. This drug is currently used in several types of human cancer. The aim of this study was to evaluate the efficacity and tolerance of a near-concurrent association of radiotherapy and etoposide for newly malignant gliomas. Methods: From May 1995 to December 1996, 30 malignant glioma patients were included in this phase II study; 16 patients underwent surgical tumor resection, and a stereotactic biopsy was performed in 14 patients. Standard cranial irradiation and six courses of etoposide (100 mg/m², ×days 1–3) were administered. The first course of etoposide was administered on days 1–3 of radiotherapy and was resumed in the week following the end of radiotherapy. Treatment was consolidated by further courses of etoposide every 4 weeks. Results: Only 26 patients could be evaluated for the purpose of our study. The median age was 60.1 years, and the median Karnofsky performance score (KPS) was 80.2. The rate of objective response for evaluable patients was 34.6%, and four complete responses (CR) and five partial responses (PR) were noted. The median survival (MST) was 12 months, and the average overall survival was 12.5 months. Hematological toxicity was mild, and grade 3 or 4 neutropenia (white blood cell count <1500/ml) was noted in three patients, without any sepsis or bleeding. Conclusions: The results obtained in this study are comparable to the best reported results on the combination of radiotherapy and nitrosoureas. The near-concurrent combination of radiotherapy and etoposide seems to be effective and well tolerated in the treatment of newly malignant gliomas. Received: 7 December 1998 / Accepted: 5 February 1999