Supratentorial recurrences of gliomas. Morphological studies in relation to time intervals with astrocytomas

Summary We report 137 recurrent supratentorial astrocytomas. The primary tumours diagnosed on the basis of a grading system with three stages were 72 astrocytomas I and 65 astrocytomas II. In the first group 14% of the recurrences were not changed, 55.5% became astrocytomas II, and 30.5% became glioblastomas. In the second group 55.4% were unchanged, and 44.6% became glioblastomas. The postoperative intervals until reintervention or death were statistically examined. It seems that the recurrence time chiefly depends on the nature of the primary tumour. The transformation of an astrocytoma I to a glioblastoma takes longer than the transformation of an astrocytoma II into a glioblastoma. In about two thirds of all astrocytomas an increase of malignancy is to be expected. From the histological picture it is not possible in an individual case to predict the likelihood or speed of malignant change. With regard to the effect of irradiation the authors conclude that radiotherapy most probably does not produce malignancy.The authors wish to express their gratitude to the founder and organizer of the Institute of Neurosurgery in Budapest, Prof. Dr. L. Zoltán (), for his promotion of these investigations.     

额颞枕顶超大骨瓣减压术对幕上恶性脑梗塞的临床疗效研究

目的：评估额颞枕顶超大骨瓣减压术对幕上恶性脑梗塞（ supra－tentorial malignant in－farcts,STMBI）的临床疗效。方法：采用前瞻性研究的方法,将临床和放射学诊断为STMBI的患者分为手术组和对照组,比较两组的术后死亡率;随访1年后比较两组患者的格拉斯哥预后评分（ GOS）、Bar－thal指数。结果：本次研究共纳入共26例研究对象,其中手术组13例,对照组13例。术前两组年龄、GCS比较差异无统计学意义。随访1年结果显示,手术组和对照组1年生存率分别为为84．6％和69．2％（p＞0．05）。格拉斯哥预后评分（GOS）、Barthal 指数在手术组更好（p＜0．05）。结论：STMBI 患者早期行额颞枕顶超大骨瓣减压术与保守治疗相比,不仅降低了死亡率,还改善了预后。     

Supratentorial pressures: Part II: Intracerebral pulse waves

Intracerebral pulse waves were recorded in cat and monkey while intracranial pressure (ICP) manipulations were performed. The intracerebral pulse waves appeared comparable to cerebrospinal fluid (CSF) pulsations. The wave forms were divided into multiple smaller waves, designated P₁ to P₄. The P₁ component was primarily of arterial origin and was accentuated by increasing ICP unrelated to increased venous pressure, most commonly from a mass lesion. Bilateral carotid occlusion resulted in decreased amplitude of P₇. Venous hypertension from jugular venous or sagittal sinus occlusion, on the other hand, accentuated waves P₂ and P₃ more than P₇. This is consistent with a Starling resistor model of the cerebral venous system in which mass lesions may compress low-pressure veins and accentuate the arterial pressure-dependent P₁ wave, whereas venous hypertension causes increased prominence of the later P₂ and P₃ waves.     

Remote cerebellar hemorrhage following supratentorial craniotomy

Abstract

Objective: Cerebellar hemorrhage remote from the site of surgery may complicate neurosurgical procedure. The exact pathophysiology of this type of hemorrhage is poorly understood. We retrospectively compared 16 patients who had remote cerebellar hemorrhage (RCH) with a case-matched control cohort, to determine the significance of perisurgical and surgical factors that may predispose patients to such bleeding events.

Methods: From 1 June 2005 to 31 December 2008, postoperative routine head computed tomographic (CT) scan was performed in our institution and 16 patients with RCH after supratentorial neurosurgical procedure were identified. The medical charts of these 16 cases and a control cohort of 64 patients were recorded. All parameters were analyzed with regards to various variables.

Results: The incidence RCH after supratentorial craniotomy increased after postoperative computed tomographic scan. The mechanism of cerebellar hemorrhage in this series of patients is most likely multifactorial. Several variables showed a significant association with the occurrence of RCH. Multivariate analysis indicated that the following two factors independently correlated with occurrence of RCH: (1) postoperative epidural drainage amount; and (2) history of previous cerebrovascular accident (CVA) with cerebral atrophy. All cases with RCH underwent medical treatment and no neurological sequelae associated with RCH.

Conclusions: Postoperative epidural drainage amount and history of previous CVA with cerebral atrophy can reliably predict the occurrence of cerebellar hemorrhage after supratentorial craniotomy. One of the most important strategies to minimize hazardous complications is to be aware of these potential risk factors and to take action to prevent them.     

A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a Pourfour du Petit Syndrome and review of the literature

Objective

This report illustrates the rare rapid spontaneous redistribution of an acute intracranial supratentorial subdural hematoma (AISSDH) to the entire spinal subdural space (SSS). The study is also unique in that the spinal subdural hematoma (SSH) manifested by the extremely rare Pourfour du Petit Syndrome (PPS).

Methods

A 66-year-old man sustained blunt head trauma. On admission to the regional hospital, he scored 6 on GCS and his pupils were of equal size reacting to light. Initial computed tomography (CT) scan showed a unilateral AISSDH. The patient was referred to our department and arrived 16 h following the accident, at which time a repeat CT scan revealed almost complete resolution of the AISSDH without clinical improvement. On the 9th postinjury day transient anisocoria and tachycardia without spinal symptomatology developed. Since neither neurological examination nor follow-up CT scans showed intracranial pathology explaining the anisocoria, the patient was treated further conservatively. During the next 3 days circulatory instability developed and the patient succumbed to primary traumatic injury. Autopsy revealed a SSH occupying the entire SSS.

Conclusion

This case calls attention to the unique combination of the displacement of an AISSDH to the SSS and the presentation of this clinical entity by the PPS.     

幕上皮质下梗死后进展性运动功能缺损的预测因素

目的探讨幕上皮质下梗死后进展性运动功能缺损（PMD）的相关预测因素。方法前瞻性纳入142例幕上皮质下梗死患者,根据病情特点及美国国立卫生研究院卒中量表（NIHSS）中运动项目评分,将患者分为PMD组（39例）与稳定组（103例）。比较两组一般临床资料、实验室指标、神经功能评分及影像学特点,采用多因素Logistic回归分析,分析幕上皮质下梗死后PMD的独立危险因素。结果①PMD组患者进展时间平均为（31±11）h,33例（84.6%）病情进展出现在夜间。②单因素分析显示,PMD组中女性（P=0.045）、基线收缩压≥180mm Hg（P=0.000）、放射冠部位梗死（P=0.000）、梗死灶直径15～30 mm（P=0.003）、不稳定性斑块（P=0.001）及大脑中动脉狭窄或闭塞（P=0.015）患者所占的比例明显高于稳定组。而稳定组基底核部位梗死（P=0.000）、梗死直径〈15 mm（P=0.000）比例显著高于PMD组。③多因素Logistic回归分析显示,女性（OR=2.837,95%CI：1.076～7.485;P=0.035）、基线收缩压≥180 mm Hg（OR=3.509,95%CI：1.349-9.124;P=0.010）、放射冠部位梗死（OR=6.807,95%CI：2.446～18.944;P=0.000）、不稳定性斑块（OR=3.137,95%CI：1.019～9.657;P=0.046）、大脑中动脉病变（OR=4.027,95%CI：1.160～13.976;P=0.028）是发生PMD的独立危险因素。结论幕上皮质下梗死后PMD的发病率较高,女性、基线收缩压≥180mmHg以及放射冠部位梗死、不稳定性斑块和大脑中动脉病变均为PMD重要的预测因素。     

Cranial CT in the Sjogren-Larsson syndrome

Summary Cranial CT in a case of Sjögren-Larsson syndrome (SLS) showed a striking loss of attenuation of supratentorial white matter. This is in accordance with the myelin loss found at microscopic brain examination of patients with SLS, but not with the only report on five patients examined by cranial CT. The considerable myelin loss may be detected only by more recent generations of CT scanners and seems to be stationary during lifetime.     

Treatment and survival of supratentorial and posterior fossa ependymomas in adults

Ependymoma is a rare primary brain or spinal cord tumor that arises from the ependyma, a tissue of the central nervous system. This study analyzed a large cohort of adult supratentorial and posterior fossa ependymoma tumors in order to elucidate factors associated with overall survival. We utilized the USA National Cancer Database to study adult World Health Organization grade II/III supratentorial and posterior fossa ependymoma patients treated between 1998 and 2011. Overall survival was estimated by the Kaplan–Meier method and factors associated with survival were determined using a multivariate Cox proportional hazards model. Among 1318 patients, 1055 (80.0%) had grade II and 263 (20.0%) anaplastic tumors located in the posterior fossa (64.3%) and supratentorial region (35.7%). Overall average age was 44.3 years, 48.0% of patients were female, 86.5% were Caucasian, and 36.8% underwent near/gross total surgical resection. Radiotherapy was given to 662 patients (50.8%) and 75 (5.9%) received chemotherapy. Older age at diagnosis (hazard ratio [HR] 1.51, p < 0.0001), high tumor grade (HR 1.82, p = 0.005), and large tumor size (HR 1.66, p = 0.008) were associated with poor survival. Females compared to males (HR 0.67, p = 0.03) and patients with posterior fossa tumors versus supratentorial (HR 0.64, p = 0.04) had a survival advantage. Our study showed that older patients, with supratentorial tumors, and high histological grade had an increased risk of mortality. A survival benefit was captured in females and patients with posterior fossa tumors. Adjuvant radiotherapy and chemotherapy did not confer a survival benefit among all patients, even after stratification by tumor grade or anatomical location.     

成人幕上原始神经外胚层肿瘤的影像学特征

目的探讨成人幕上原始神经外胚层肿瘤(primitive neuroectodermal tumors,PNET)的影像学特点,以提高对本病的认识。方法回顾性分析经手术病理证实的6例成人幕上PNET的CT及MRI表现(其中CT检查2例、MRI检查4例)。结果 6例PNET中,位于幕上大脑半球颞叶3例、额顶叶2例及基底节区1例。肿瘤实质CT平扫2例均呈稍高密度;4例经MRI扫描,T1WI呈等、稍低信号,T2WI呈等、稍高信号,增强扫描肿瘤实质明显强化2例、轻度强化2例。病灶体积较大,内含囊变/坏死4例、出血2例及流空血管1例,边界较清,瘤周无或轻度水肿5例,大片水肿1例。结论充分认识成人幕上PNET的影像学表现特征,有助于提高术前诊断率。     

Remote Cerebellar Hemorrhage and Iliofemoral Vein Thrombosis After Supratentorial Craniotomy

Introduction  Cerebellar hemorrhage following supratentorial craniotomy is rare. Its clinical symptoms are often mild and transient. Discussion  Here, we report a case of cerebellar hemorrhage associated with iliofemoral vein thrombosis as a complication of anterior temporal lobectomy and amygdalohippocampectomy for refractory medial temporal epilepsy.