1/54. glioblastoma multiforme at the site of metal splinter injury: a coincidence? Case report.The authors report the case of a man who had suffered a penetrating metal splinter injury to the left frontal lobe at 18 years of age. Thirty-seven years later the patient developed a left-sided frontal tumor at the precise site of the meningocerebral scar and posttraumatic defect. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar and metal splinters. In addition, a chronic abscess from which propionibacterium acnes was isolated was found within the glioma tissue. The temporal and local association of metal splinter injury with chronic abscess, scar formation, and malignant glioma is highly suggestive of a causal relationship between trauma and the development of a malignant brain tumor.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
2/54. Obstetric emergencies precipitated by malignant brain tumors.OBJECTIVE: Our goal was to present a case series of pregnancy-associated malignant brain tumors. STUDY DESIGN: A review was conducted from 1978-1998 at 5 hospitals. RESULTS: Ten women were diagnosed with a malignant brain tumor during pregnancy (n = 8) or post partum (n = 2). patients diagnosed antenatally exhibited severe symptoms, manifest between 27 and 32 weeks' gestation. Six were emergently delivered of their infants because of maternal deterioration, and 2 were delivered electively in the early third trimester after documentation of fetal pulmonary maturity. There were 4 maternal deaths and 1 neonatal death; all of the other infants maintained viability. CONCLUSIONS: Malignant brain tumors rarely occur in pregnancy. In contrast to reports that describe an indolent course, each of the 8 antenatal patients experienced a neurologic crisis. If symptoms are amenable to pharmacologic control, we advocate delivery in the early third trimester after documentation of fetal pulmonary maturity. To minimize temporal lobe or cerebellar herniation in neurologically unstable patients, a consideration should be made for cesarean delivery with the patient under general anesthesia, followed by immediate neurosurgical decompression.- - - - - - - - - - ranking = 5.5010842409978keywords = mater (Clic here for more details about this article) |
3/54. case reports of symptomatic metastases in four patients with primary intracranial gliomas.Four patients with primary intracranial high-grade gliomas are reported. Three of them developed spinal symptoms and signs generated by spinal metastases a few months after first diagnosis, the last patient developed an extraspinal metastasis in cervical lymph nodes. The spinal metastasis of a 30 years old patient was located intradurally at L5/S1, in the second patient at level L3, the third patient presented with multiple metastases in the cervical, thoracic and lumbar spine. Previously reported cases are reviewed, are discussed in the light of our own observations and analysed for the various therapeutic options.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
4/54. Redifferentiation therapy in brain tumors: long-lasting complete regression of glioblastomas and an anaplastic astrocytoma under long term 1-alpha-hydroxycholecalciferol.PURPOSE: Classical and new therapies in anaplastic astrocytomas and glioblastomas do not yield sufficient results. Agents able to redifferentiate neoplastic cells in vitro are known. We proposed alfacalcidol, a vitamin d analog able to bind to nuclear receptors regulating mitotic activity, in the treatment of malignant gliomas. patients AND methods: patients with glioblastomas and anaplastic astrocytomas were enrolled in a phase II trial involving surgery or biopsy, radiotherapy (64 Gy), chemotherapy with VM26-CCNU or fotemustine, and alfacalcidol at the daily dose of 0.04 microg/kg. MRI took place every 6 months. RESULTS: Eleven patients were included and completed the study. The series involved 10 glioblastomas and 1 anaplastic astrocytoma. Three patients out of 11 patients (27%), 2 glioblastomas and 1 astrocytoma grade III, exhibited a particular response, consisting in the progressive regression of the radiological lesion, with a decrease of the gadolinium-enhanced area. Simultaneously, the patients showed a complete clinical remission, observed respectively for 7, 5 and 4 years. In the series of 10 patients with glioblastomas, 2 cases showed this response; after 4 years, 2 of 10 patients with glioblastomas (20%) were alive; the median survival time is 21 months. Normal or subnormal calcemia was observed, at the dose proposed, so that no interruption of the drug was necessary. CONCLUSIONS: Alfacalcidol, an in vitro agent of redifferentiation, is safe and seems able to induce in some patients, in synergy with classical surgery-radiotherapy-chemotherapy treatments, a particular progressive and durable regression of the tumor. The responders might represent about 20% of malignant gliomas.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
5/54. Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review.BACKGROUND: We present a case of spinal leptomeningeal metastasis from an intracranial glioblastoma multiforme that presented with radicular pain.CASE DESCRIPTION: A 55-year-old man with a previously treated supratentorial glioblastoma multiforme presented with a 12-month history of thoracic radicular pain. MRI of the thoracic spine demonstrated an intradural extramedullary metastatic tumor deposit at the levels of T8-T10. External beam radiotherapy to the thoracic spine provided a minimal decrease in the intensity of the radicular pain. The lack of appreciation of the metastatic potential of the primary intracranial tumor resulted in delayed diagnosis and treatment.CONCLUSION: Spinal leptomeningeal metastasis needs to be suspected in patients with a past history of intracranial glioblastoma multiforme, who present with the clinical features of radiculopathy or myelopathy. awareness of this condition will facilitate appropriate intervention.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
6/54. Epidural metastasis of a glioblastoma after stereotactic biopsy: case report.Tumor seeding along the biopsy tract is a rare complication in stereotactic biopsy. We present the unique case of a 42-year-old male with epidural tumor seeding along the needle tract after computer tomography-guided stereotactic biopsy of a glioblastoma in the right basal ganglia. Three months after the biopsy and one week following fractionated radiation therapy, the patient died of brain edema and cardiac dilatation. Besides further tumor growth at the primary site, autopsy revealed a right frontal epidural, nodular metastatic tumor at the site of dura incision of the stereotactic biopsy. Histological examination showed a glioblastoma that spread epidurally along the needle tract. This is the first report of an epidural intracranial implantation metastasis of a glioblastoma after stereotactic biopsy.- - - - - - - - - - ranking = 9keywords = dura (Clic here for more details about this article) |
7/54. Impact of brain shift on intraoperative neurophysiological monitoring with cortical strip electrodes.BACKGROUND: intraoperative neurophysiological monitoring has become the standard procedure for locating eloquent regions of the brain. Such continuous electrical stimulation of motor pathways is usually applied by means of flat silicon-embedded electrodes placed directly on the motor cortex. However, shifting of the silicon strip on the cortical surface as well as electrode displacement due to brain shift underneath the electrode can lead to inaccurate recordings not directly caused by intraoperative impairment of the motor cortex or the motor pathways. METHOD: This prospective study was conducted to quantify cortical brain shift during open cranial surgery and to assess its impact on electrode positioning in 31 procedures near the precentral gyrus. Three groups of different lesion volumes were distinguished. movement of the cortex between opening of the dura and completion of tumor removal as well as cortical electrode shifting were digitally measured and analyzed. FINDINGS: Cortical surface structures evidenced a significantly larger shift (up to 23.4 mm) in comparison to the electrode strips (up to 4.2 mm) in lesions with a volume of over 20 ml. Cortex shifting highly correlated with lesion volume, whereas strip electrode movement was almost unidirectional and did not differ significantly among the three groups. However, the way they were placed (completely on the cortex vs. partly underlying or overlapping the craniotomy borders) affected the magnitude of their intraoperative displacement. As a consequence, 3 of the 31 cases (9.3%) showed a significant change in the recorded motor responses due to intraoperative dislocation of the stimulating electrode. INTERPRETATION: Changes in the location of cerebral structures due to intraoperative brain shift may exert a marked influence on intraoperative neurophysiological monitoring if cortical strip electrodes are used. Therefore, long-term monitoring of the central region requires continuous checking of the position of stimulating electrodes and, if necessary, correction of their location.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
8/54. Occupational head injury and subsequent glioma.We report the case of a policeman who suffered a severe head injury to the right temporoparietal lobe while driving a police car. Four years later, the patient developed a neoplasm at the precise site of the meningocerebral scar. Histological examination confirmed a glioblastoma multiforme adjacent to the dural scar. Radiological documentation of the absence of tumor at the time of injury, exact localization of the neoplasm in the injured cerebral area, and latency of the cancer supported the hypothesis of a causal relationship with brain trauma. physicians faced with brain neoplasms in adults should carefully investigate the patient's personal history of head trauma. When a relationship with occupational head injury is probable, reporting of suspect occupational illness is compelling.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
9/54. glioblastoma multiforme of the pineal region: case report.PURPOSE: pineal region tumors are uncommon, and comprise more frequently three categories: germ cell, parenchymal cell and glial tumors. Most pineal gliomas are low-grade astrocytomas. glioblastoma multiforme, the most aggressive and common brain tumor, is extremely rare at this location with only few cases reported. CASE DESCRIPTION: a 29-year-old woman with a two month history of headache, nuchal pain, fever, nausea and seizures and physical examination showing nuchal rigidity, generalized hypotony, hypotrophy and hyper-reflexia, Babinski sign and left VI cranial par palsy. CT scan examination revealed a ill-defined hypodense lesion at the pineal region with heterogeneous contrast enhancement. MRI showed a lesion at the pineal region infiltrating the right thalamic region. The patient underwent a right craniotomy with partial resection of the mass. The histological examination of paraffin-embedded material defined the diagnosis of glioblastoma multiforme. Post-operative radiotherapy was indicated but the patient refused the treatment and died two months afterwards. CONCLUSION: in spite of its rarity at this location, glioblastoma multiforme should be considered in the differential diagnosis of aggressive lesions at the pineal region.- - - - - - - - - - ranking = 2.7505421204989keywords = mater (Clic here for more details about this article) |
10/54. Development of glioblastoma multiforme following traumatic cerebral contusion: case report and review of literature.BACKGROUND: Diagnostic criteria for posttraumatic brain tumors were formulated in the pre-CT (computerized tomography) era. We propose that radiologic criteria incorporating imaging data be added to the existing criteria. CASE DESCRIPTION: We report a case of a 56-year-old man who presented with history of raised intracranial pressure of 20 days' duration. Imaging showed a large left frontal intra-axial mass lesion. He had history of head injury 5 years prior with CT evidence of bilateral basifrontal contusions. There was no contrast enhancement at the site of the contusions in an intervening CT scan done 18 months after the trauma. He underwent radical excision of the mass, and the histopathology was reported as glioblastoma multiforme. We formulated additional radiologic criteria for tumors that may present following trauma. A review of the literature of posttraumatic gliomas is also presented. CONCLUSION: Fulfillment of the additional radiologic criteria proposed by us will help distinguish a tumor that developed following trauma from that which was present before the occurrence of the injury.- - - - - - - - - - ranking = 1keywords = dura (Clic here for more details about this article) |
| | Next -> |