Motives for sports participation as predictions of self-reported outcomes after anterior cruciate ligament injury of the knee.

Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study, a randomized controlled trial. At baseline, 121 patients recorded in an initial questionnaire that their motives for sports participation fell into four categories: achievement, health, social integration, or fun and well-being. These four categories were used as variables in the analyses. All 121 subjects completed the 2-year follow-up. The largest improvement was seen in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale sports and recreation function, with an effect size of 2.43. KOOS sports and recreation function was also the subscale score best predicted by the motives for sports participation. Baseline motives achievement and fun and well-being predicted worse levels of pain and function 2 years after the injury, even after adjusting for age, gender, treatment and baseline scores. Psychological aspects, such as motives for participation in sport, can be factors in predicting of patient-reported outcomes 2 years after injury. Evaluating motives for sports participation may help predict the outcome 2 years after ACL injury.

Does work-site physical activity improve self-reported psychosocial workplace factors and job satisfaction? A randomized controlled intervention study.

PURPOSE: To investigate whether a work-site strength-training program has a positive effect on self-reported psychosocial workplace factors and job satisfaction. METHODS: We conducted a randomized controlled trial among laboratory technicians implementing neck and shoulder exercises for pain relief, with 199 participants in the training group and 228 in the control group. Influence at work, sense of community, time pressure, and job satisfaction were measured with the Copenhagen Psychosocial Questionnaire at baseline and post-intervention after 20 weeks. RESULTS: There was no statistically significant change in any of the four variables in the training group from baseline to follow-up (all p ≥ 0.39). When we used MANOVA to test for between-group effects over time, we did not find any statistically significant result (all p > 0.14). CONCLUSIONS: This study does not provide evidence for an effect of a work-site strength-training program on self-reported psychosocial workplace factors and job satisfaction.

Microsurgical treatment of cranial and spinal dural arteriovenous fistulas for acute occlusion: a single institution's experience.

OBJECTIVES: To determine the success rate of primary microsurgical treatment of both cranial and spinal dural arteriovenous fistulas (cdAVFs and sdAVFs). METHODS: Data of 40 consecutive patients (mean age, 64.5 years; range, 35-88 years) who underwent microsurgical treatment for a diagnosed cdAVF/sdAVF at a single academic institution were retrospectively obtained. General patient information, such as age on the day of surgery and sex, patient charts, admission protocols, operating reports, and discharge protocols were reviewed. Outcomes, including modified Rankin Scale (mRS) scores and the rate of complete occlusion confirmed by a postoperative angiography were analyzed. RESULTS: The overall post-treatment occlusion rate was 100% in sdAVFs and 92% in cdAVFs. The most common presentation of cdAVFs was intracerebral hemorrhage (67%), followed by headache (53%) and vertigo (33%). The main symptoms of sdAVFs were sensory deficits, paresis, gait abnormalities, and incontinence. Additional endovascular treatment after primary surgery was needed in seven (47%) patients with cdAVF and one patient (4%) with sdAVF. All sdAVFs were classified as Cognard grade V, while six (40%) cdAVFs were Cognard grade III, eight (54%) were grade IV and one (6%) was grade V. Complications included cerebrospinal fluid (CSF) fistulas, CSF circulation disorders, meningitis, and epidural and intracerebral hemorrhages. Furthermore, sdAVF showed higher rates of clinical improvement than cdAVF (56% vs. 47%). DISCUSSION: Microsurgery resulted in complete occlusion in most cases of sdAVFs. However, additional endovascular treatment was necessary in nearly 50% of patients with cdAVF. Therefore, combined treatment in cranial cdAVF seems to be the desired strategy.

Successful talent development in track and field: considering the role of environment.

Track and field includes a number of high-intensity disciplines with many demanding practices and represents a motivational challenge for talented athletes aiming to make a successful transition to the senior elite level. Based on a holistic ecological approach, this study presents an analysis of a particular athletic talent development environment, the IFK Växjö track and field club, and examines key factors behind its successful history of creating top-level athletes. The research takes the form of a case study. Data were collected from multiple perspectives (in-depth interviews with administrators, coaches and athletes), from multiple situations (observation of training, competitions and meetings) and from the analysis of documents. The environment was characterized by a high degree of cohesion, by the organization of athletes and coaches into groups and teams, and by the important role given to elite athletes. A strong organizational culture, characterized by values of open co-operation, by a focus on performance process and by a whole-person approach, provided an important basis for the environment's success. The holistic ecological approach encourages practitioners to broaden their focus beyond the individual in their efforts to help talented junior athletes make a successful transition to the elite senior level.

FRED Flow Diverter: A Study on Safety and Efficacy in a Consecutive Group of 50 Patients.

BACKGROUND AND PURPOSE: Endovascular flow diverters are increasingly used for the treatment of cerebral aneurysms. We assessed the safety and efficacy of the Flow-Redirection Endoluminal Device (FRED) in a consecutive series of 50 patients. MATERIALS AND METHODS: Inclusion criteria were wide-neck, blister-like, or fusiform/dissecting aneurysms independent of size, treated with the FRED between February 2014 and May 2015. Assessment criteria were aneurysm occlusion, manifest ischemic stroke, bleeding, or death. The occlusion rate was assessed at 3 months with flat panel CT and at 6 months with DSA by using the Raymond classification and the O'Kelly-Marotta grading scale. RESULTS: Fifty patients with 52 aneurysms were treated with 54 FREDs; 20 patients were treated with the FRED and coils. Aneurysm size ranged from 2.0 to 18.5 mm. Deployment of the FRED was successful in all cases. There were no device-associated complications. One patient developed mild stroke symptoms that fully receded within days. There have been no late-term complications so far and no treatment-related mortality. Initial follow-up at 3 months showed complete occlusion in 72.3% of the overall study group, Six-month follow-up showed total and remnant-neck occlusion in 87.2% of patients, distributed over 81.5% of the FRED-only cases and 95.0% of the cases with combined treatment. CONCLUSIONS: The FRED flow diverter is a safe device for the treatment of cerebral aneurysms of various types. Our data reveal high occlusion rates at 3 and 6 months, comparable with those in other flow diverters. Long-term occlusion rates are expected.

Detection of tumor necrosis factor-alpha protein and messenger RNA in human glial brain tumors: comparison of immunohistochemistry with in situ hybridization using molecular probes.

Tumor necrosis factor-alpha (TNF alpha) protein and messenger (m)RNA distribution was studied in biopsy samples of glial brain tumors, using immunohistochemistry and in situ hybridization with molecular probes, to investigate the role of this cytokine in tumor proliferation and immunological host defense. Focal expression of TNF alpha was detected in four of four glioblastomas, one of two anaplastic astrocytomas, and four of five low-grade astrocytomas, regardless of their subtype or grade of malignancy, but in none of the normal peritumoral brain tissues used as controls. The TNF alpha protein and mRNA were present in reactive astrocytes and protoplasmic tumor cells, confined to areas of leukocyte or T-lymphocyte infiltrating, and less pronounced in tumor cells at the edge of necrosis. Additionally, TNF alpha reactivity was found in infiltrating macrophages and perivascular microglia. Immunohistochemistry and in situ hybridization for TNF alpha showed comparable reaction patterns and numbers of TNF alpha-positive cells, even though the sensitivity of in situ hybridization was significantly higher. Quantitative evaluation of TNF alpha protein, TNF alpha mRNA, and leukocyte infiltration revealed a significant positive correlation between the TNF alpha-positive reactive astrocytes and the number of lymphocytes present in corresponding areas. Together, these data lead to the conclusion that TNF alpha in reactive astrocytes and monocytic cells within tumor areas of high leukocyte infiltration and in tumor cells at the border of necrosis may represent one defense pathway of the immune system against tumor proliferation.

Frameless stereotactic lesion contour-guided surgery using a computer-navigated microscope.

BACKGROUND: The Zeiss MKM System is a recently developed computerized operating microscope for image-guided neurosurgery. The clinical advantages, reliability, accuracy, and limitations of this technique were investigated. METHODS: Since February 1995, 78 consecutive frameless stereotactic image-guided procedures were performed in 73 patients (30 males, 43 females; mean age, 46.9 years; range, 16-77 years) for tumor surgery (50/64.1%), cavernoma removal (16/20.5%), and functional procedures (12/15.4%). Skin markers (74 cases) or bone markers (4 cases) and a standard imaging protocol (2-mm cranial computed tomography (CCT) in 59 cases/1.5-mm magnetic resonance imaging (MRI) in 19 cases) were used. RESULTS: The main advantages were pre-operative skin incision, craniotomy and corticotomy planning, and determination of lesion boundaries. Useful registration and system reliability were noted in 97% (76/78) of the procedures. A significant improvement in registration accuracy was observed over the test period from a mean of 4.8 mm (SD = 3.36; Cases 1-25) to a mean of 2.2 mm (SD = 0.86; Cases 26-78). This resulted in an improvement in application accuracy from <5 mm in 71% (Cases 1-25) to <2 mm in 95% (Cases 26-78) of cases, and the accuracy led to successful localization of the lesion in every case. Accuracy was reliable at the beginning of every procedure, but degraded to values >5 mm by the end of the procedure in 29% (22/78) of cases. MRI cases achieved higher application accuracy values (2.1 mm mean) than CT cases (3.7 mm mean). CONCLUSIONS: The system offers a reliable alternative to frame-assisted stereotactic craniotomies in lesion targeting, but would need an intraoperative image update for resection guidance.

Intra-operative marking of neuroanatomical details--helpful for radiosurgery?

This report is a list of simple but effective techniques for marking important structures intra-operatively. During the last 2 years in 52 patients intra-operative marking techniques have been used. In 37 cases a small piece of fat has been taken. In 10 patients it was done by a radiopaque Barium impregnated silicon sphere and in 5 patients with a piece of a monofilament suture. Postoperative checks were done by conventional X-ray, computer tomography and Magnetic Resonance Imaging. The indication in all cases was to offer landmarks helpful for planning postoperative radiosurgery. In case of fat and radiopaque Barium impregnated silicone spheres the markings were always well defined and clear in contrast. In those cases where a piece of monofilament suture was used it was impossible to get clear postoperative information. In general there were no intra- or post-operative complications. All markers were well tolerated and no side effects have been observed so far. The advantages and disadvantages of each of these possibilities are described and discussed.

Evaluation of big endothelin-1 concentrations in serum and ventricular cerebrospinal fluid after early surgical compared with nonsurgical management of ruptured intracranial aneurysms.

OBJECT: Whereas the removal of subarachnoid blood is possible during early-stage aneurysm surgery, this cannot be achieved in aneurysms treated by endovascular means. The levels of potential spasmogens in the cerebrospinal fluid (CSF) in patients receiving endovascular treatment might therefore be higher, with the potential for more severe post-subarachnoid hemorrhage (SAH) vasospasm. METHODS: Serum and CSF concentrations of big endothelin (ET)-1 were serially measured in patients with SAH receiving one of the following treatments: 1) early (within 72 hours of SAH) aneurysm surgical treatment (15 patients), 2) early endovascular treatment (17 patients), or 3) no intervention in the acute phase (12 patients). In patients suffering delayed infarctions higher levels of big ET-1 CSF were demonstrated than in those without infarctions (p = 0.01). In patients in whom surgery was performed in the acute phase lower big ET-1 CSF concentrations were demonstrated than in those who received embolization treatment or no treatment (p = 0.02). Subgroup analysis demonstrated that in patients receiving early endovascular treatment, higher big ET-1 CSF concentrations were revealed than in those undergoing early aneurysm surgery; this was true for patients with (microsurgerytreated, 1.84 +/- 0.83 pg/ml; and embolization-treated 2.19 +/- 0.54 pg/ml) and without (microsurgery-treated 1.76 +/- 0.61 pg/ml; and embolization-treated 2.01 +/- 0.48 pg/ml) delayed infarctions. CONCLUSIONS: Among patients with SAH who received treatment during the acute phase, those undergoing early aneurysm surgery were shown to have lower big ET-1 CSF levels than those receiving embolization and no treatment (that is, the nonsurgical treatment groups). The clinical significance of this finding remains to be established in future clinical trials, because in the present study the trend toward lower levels of big ET-1 CSF in the microsurgically treated group was not paralleled by a lower delayed stroke rate or an improvement in neurological outcome.

Radiation stability of organic matter in liquid and frozen H2O, NH3 and water-ammonia mixtures.

The redox properties of irradiated liquid and frozen H2O, NH3 and H2O/NH3 mixtures at 298 K and 77 K, resp., towards some simple organic molecules have been checked by injecting carrierfree 11C atoms and analyzing their chemical state by means of radiochromatography. The reactions and the stability of organic products versus radiation dose (in this study by MeV protons) depend on temperature, phase state, mobility of radicals, their concentration and reactivity. Especially dangerous are the reactive OH and O2H radicals which oxidize organic material to inorganic CO2. Highest stability has been found at low temperatures (solid state, reduced mobility of radicals) and for systems containing H-donors (H2O/NH3 mixtures), which reduce the concentration of oxidizing radicals. The fact that many bodies in space consist of H2O-ice with NH3 and CH4 additives at temperatures between 10 and 150 K is promising in view of the survival of organic matter under high doses of radiation.

Optimized angiographic CT using intravenous contrast injection: a noninvasive imaging option for the follow-up of coiled aneurysms?

BACKGROUND AND PURPOSE: Because recanalization of coiled cerebral aneurysms is reported to occur, follow-up imaging is mandatory, ideally noninvasively. Our study aimed to evaluate the accuracy of an optimized angiographic CT by using intravenous contrast material injection in the assessment of coiled cerebral aneurysms, compared with MR angiography and digital subtraction angiography, the criterion standard. MATERIALS AND METHODS: We included 69 patients with 76 coiled cerebral aneurysms. In each patient, we performed an angiographic CT with intravenous contrast material injection with a dual rotational acquisition, a time-of-flight MR angiography, and a DSA. The angiographic CT with intravenous contrast material injection data was postprocessed by using newly implemented reconstructions modes and a dual-volume technique. An aneurysm occlusion rate was assessed in angiographic CT with intravenous contrast material injection and MRA; remnants were measured and correlated with DSA, respectively. RESULTS: Twenty-eight remnants were revealed by DSA with a mean size of 3.1 × 3.1 mm. Angiographic CT with intravenous contrast material injection demonstrated a sensitivity of 93% and a specificity of 96% in remnant detection. MRA showed almost identical accuracy (sensitivity of 93%, specificity of 100%). Assessment of remnant size by angiographic CT with intravenous contrast material injection and by MRA revealed a high significant correlation with DSA, respectively (P < .001). CONCLUSIONS: Optimized angiographic CT with intravenous contrast material injection and MRA demonstrated accuracy comparable with that of DSA in the follow-up of coiled aneurysms, respectively. The assessment of remnant size showed a high correlation with DSA for both techniques. Due to the lack of radiation exposure, MRA seems to be the preferred technique. However, angiographic CT with intravenous contrast material injection can be considered a reliable, noninvasive alternative in patients with MR imaging contraindications or in cases of compromising artifacts due to metal implants (ie, clips).

Surgical target selection in cerebral glioma surgery: linking methionine (MET) PET image fusion and neuronavigation.

OBJECTIVE: The objective of this study was to investigate the histological correlate of (11)C-methionine (MET) PET uptake of brain gliomas by image fusion for navigated surgery. METHODS: Twenty-seven patients (18 male, 9 female; mean age 42 years; range 11-77 years; 8 low-grade and 11 high-grade astrocytomas or mixed gliomas, 8 oligodendrogliomas) underwent MET PET studies preoperatively. RESULTS: MET PET tumor uptake was detected in 26 of 27 patients (96.3%). The quantitative MET tumor standardized uptake value (SUV) ratio was significantly higher in malignant gliomas and oligodendrogliomas than in low-grade gliomas (2.76/2.62 vs. 1.67, p=0.03). Generally, qualitative visual grading of MET uptake revealed 2 main patterns: focal MET uptake in 12 and uniform global MET uptake in 11 patients. Focal uptake corresponded to malignant glioma histology in 66.7%, and uniform global uptake to oligodendroglial histology in 72.7%. In oligodendrogliomas, global MET uptake constituted 81.5% (range 53.8-135%) of the MRI T(1) tumor volume on average and was limited to the MRI FLAIR tumor volume in 86% (7/8) of patients. Tissue samples of focal MET uptake areas correlated with histological anaplasia in 66.6% (8/12 glioma patients), although 62.5% (5/8 patients) lacked MRI contrast enhancement. CONCLUSION: MET PET image fusion may facilitate the targeting of anaplastic foci in homogeneous MRI non-enhancing gliomas for biopsy, may identify oligodendroglial histology preoperatively as well as characterize biologically active tumor volumes within MRI T(1)/FLAIR tumor areas of candidate patients for resection.

Evaluation of preoperative high magnetic field motor functional MRI (3 Tesla) in glioma patients by navigated electrocortical stimulation and postoperative outcome.

OBJECTIVES: The validity of 3 Tesla motor functional magnetic resonance imaging (fMRI) in patients with gliomas involving the primary motor cortex was investigated by intraoperative navigated motor cortex stimulation (MCS). METHODS: Twenty two patients (10 males, 12 females, mean age 39 years, range 10-65 years) underwent preoperative fMRI studies, performing motor tasks including hand, foot, and mouth movements. A recently developed high field clinical fMRI technique was used to generate pre-surgical maps of functional high risk areas defining a motor focus. Motor foci were tested for validity by intraoperative motor cortex stimulation (MCS) employing image fusion and neuronavigation. Clinical outcome was assessed using the Modified Rankin Scale. RESULTS: FMRI motor foci were successfully detected in all patients preoperatively. In 17 of 22 patients (77.3%), a successful stimulation of the primary motor cortex was possible. All 17 correlated patients showed 100% agreement on MCS and fMRI motor focus within 10 mm. Technical problems during stimulation occurred in three patients (13.6%), no motor response was elicited in two (9.1%), and MCS induced seizures occurred in three (13.6%). Combined fMRI and MCS mapping results allowed large resections in 20 patients (91%) (gross total in nine (41%), subtotal in 11 (50%)) and biopsy in two patients (9%). Pathology revealed seven low grade and 15 high grade gliomas. Mild to moderate transient neurological deterioration occurred in six patients, and a severe hemiparesis in one. All patients recovered within 3 months (31.8% transient, 0% permanent morbidity). CONCLUSIONS: The validation of clinically optimised high magnetic field motor fMRI confirms high reliability as a preoperative and intraoperative adjunct in glioma patients selected for surgery within or adjacent to the motor cortex.

Expression of BCL-2 oncoprotein on tumor cells and tumor-infiltrating lymphocytes (TIL) in meningiomas.

The Expression of the antiapoptotic oncoprotein BCL-2 and its correlation to tumor grade in 62 meningiomas (48 classic, 9 atypical, and 5 anaplastic) using single and double immunohistochemistry was investigated. BCL-2 expression was found in two different cell populations identified as lymphocytes (BCL-2+CD3+) and tumor cells (BCL+/CD3-). Tumor-infiltrating lymphocytes (TIL) (CD3+) were found within classic (9.5% of cells), atypical (2.4% of cells), and anaplastic (1.8% of cells) meningiomas. In classic meningiomas, 66.5% of TIL were BCL-2-positive, in atypical meningiomas 79.2%, and in anaplastic meningiomas 37.9%. In 33 (68.8%) of the classic meningiomas, medium to high counts of BCL-2+ tumor cells were detected. Atypical meningiomas showed nearly equal percentages of high (two patients), medium (five patients), and low (two patients) BCL-2+ tumor cell counts, whereas anaplastic meningiomas showed only medium (two patients) and low (three patients) BCL-2 tumor cell counts or were BCL-2-negative (one patient). In summary, a significant inverse correlation between the number of BCL-2-positive tumor cells and tumor grade in meningiomas was found. These findings support the hypothesis of cell survival prolongation by the antiapoptotic ability of BCL-2 proto-oncogenes and demonstrate the prognostic relevance of BCL-2 immunoreactivity in meningiomas.

Histological heterogeneity of neuroradiologically suspected adult low grade gliomas detected by Xenon enhanced computerized tomography (CT).

Xenon-enhanced computerized tomography (XeCT) was performed on 14 consecutive adult patients presenting with seizures showing supratentorial non-enhancing radiologically uniform appearing low grade gliomas on CT/MR images. Pre-operative XeCT patterns were compared with postoperative histological diagnosis, grading and Ki67 proliferation indices (PI). After gross-total, subtotal resection or biopsy, 11 astrocytomas, 2 oligodendrogliomas and 1 oligo-astrocytoma were diagnosed and graded: Grade I: 2 patients (Ki67-PI = 0.5-0.8), Grade I-II: 4 patients (Ki67-PI = 0.3-1.5), Grade II: 3 patients (Ki67-PI = 0.5-3.5), Grade II-III: 4 patients (Ki67-PI = 3.8-6.8) and Grade III: 1 patient (Ki67-PI = 5.2), (Kernohan Classification). Xenon CT studies revealed different flow patterns, correlating with the postoperative histological diagnosis, grading and proliferation indices: A tumour group with well defined, delayed, only minimally enhancing tumour area (5 patients, Grade I, I-II or II), a second group with less well defined low-flow-area borders and inhomogenous, strong enhancement within the tumour (4 patients, Grade II-III, III) and a third group with fast enhancing tumours was identified. The third pattern was exclusively shown in the 2 oligodendrogliomas (Grade I and II-III) and 1 oligo-astrocytoma (Grade II). The preliminary report identifies the Xenon enhance CT as a beneficial pre-operative investigation for patients with radiologically uniform appearing suspected adult supratentorial low-grade gliomas, which may give information about the presence of anaplastic foci or oligodendroglial components.

Endoscopic exploration of the IVth ventricle.

Regarding to the upcoming techniques in neuroendoscopy the IVth ventricle was examined. First in a series of 30 fresh and fixed anatomical specimens-the vessels injected with LATEX-the fourth ventricle was investigated endoscopically. There are three possibilities to reach the IVth ventricle: coming from the IIIrd ventricle via the aqueductus cerebri, using the basal cisterns through the apertura lateralis Luschkae and coming via the cerebellomedullar cistern through the foramen of Magendi. Using different kinds of endoscopes (rigid, flexible and steerable flexible)-diameter ranging from 5 to 9 french-with different optical systems (0 degree, 5 degrees, 30 degrees, 75 degrees) and different light sources (Halogen, Xenon) the anatomical details seen under the endoscope and the topographical landmarks of the approaches were investigated, presented and discussed. Based on the experience at the end of the cadaver work a short comment on which kind of equipment seems the best was given. A series of 14 clinical cases was presented as the second part of the study (7 cases with a tumor in the IVth ventricle-2 metastasis, 3 gliotic tumors, 1 ependymoma, 1 medulloblastoma, 3 patients with an occluded aqueduct because of meningo-ventriculitis and 4 patients with cystic malformations). The neuroendoscopic approaches, the neuroanatomical details relevant for surgery and the clinical data will be given and discussed. In general no intraoperative or postoperative complications were seen. In conclusion our experience from the theoretical neuroanatomical and the clinical part as well as the advantages and disadvantages from the different kind of endoscopes and approaches are discussed.

Xanthogranuloma of the anterior skull base: a case report.

A case of a xanthogranuloma arising in the anterior skull base involving the bone of the left orbital roof, the dura mater, and the periorbit is presented. The lesion was completely removed by a supraorbital "eyebrow" skin incision using frameless stereotactic image guidance. A reconstruction of the orbital roof was performed using a titanium mesh graft. The neuropathological investigation revealed all the characteristics of a xanthogranuloma. Intracranially, xanthogranulomas appear as rare tumors of the dura or choroid plexus, usually arising in association with histocytosis X or familial hyperlipoproteinemia. One case not associated with these diseases is discussed.

Gamma knife radiosurgery of recurrent central neurocytomas: a preliminary report.

OBJECTIVES: A series of three recurrent central neurocytomas treated by gamma knife radiosurgery (GKRS), which were initially totally resected, are described. Up to now, no reports exist on this treatment modality for this rare tumour entity. METHODS: Three male patients, aged between 20 and 25 years, presented with large intraventricular tumours. Total tumour removal was achieved by a single surgical procedure (one patient) or two operations (two patients). Neuropathological investigation showed a central neurocytoma, immunohistochemically all three tumours expressed a neuronal antigenic profile typical for neurocytomas, and the MIB-1 proliferation index ranged from 2.4% to 8.7%. Each patient experienced a tumour recurrence after 5 to 6 years. The recurrence was multifocal in two and a singular tumour mass in one patient. Gamma knife radiosurgery was performed. The tumours were enclosed within the 30% to 60% isodoseline, and delivered a tumour marginal dose of 9.6 to 16 Gy. During the follow up period, the patients were tested clinically and the volume of the tumours was measured on MRI. RESULTS: Within follow up periods of 1 to 5 years, control MRI showed a significant decrease of the tumour mass in all cases. None of the patients developed new neurological symptoms after GKRS. Two patients returned to work in their previous employment, whereas one patient remained permanently disabled due to a pre-existing visual impairment and abducens palsy. CONCLUSION: GKRS proved to be a useful tool in the treatment of recurrent central neurocytomas. Tumour control and even tumour shrinkage can be achieved with a single procedure and a low risk of morbidity.

Multiple spinal "miliary" hemangioblastomas in von Hippel-Lindau (vHL) disease without cerebellar involvement. A case report and review of the literature.

We report on a 57-year-old male presenting with radicular pain in the nerve roots of L5 and S1 on the right side and dysuria. Magnetic resonance imaging (MRI) of the lumbar spine showed multiple (up to 20) small, intradural enhancing nodules attached to the cauda equina down to the sacrum, the largest 1 cm in diameter at the level Th12/L1 compressing the conus. Additionally, small nodules in the cervico-thoracal region adjacent to the cord, but no cerebellar or cerebral abnormalities, were detected in a consecutive MRI of the remaining neuroaxis. The histology of a resected lesion at Th12/L1 revealed hemangioblastoma of the reticular type. Together with a history of left eye enucleation performed 17 years ago for angiomatosis of the retina and the immunohistochemical detection of von Hippel-Lindau (vHL) protein within the removed spinal hemangioblastoma, a diagnosis of vHL disease was established. Family history and screening for visceral manifestations of vHL disease were negative. In contrast to cerebellar or solitary spinal hemangioblastomas, multiple spinal hemangioblastomas without cerebellar involvement in vHL represent unusual manifestations. Unlike the case for solitary lesions in non-syndromic patients, a surgical cure does not seem feasible in this case. The role of treatment modalities is discussed.