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INTRODUCTION: Shunt surgery in pediatric patients still bears a significant risk of infection, in addition to mechanical complications of the shunt system. Antibiotic-impregnated systems and perioperative antibiotics have been extensively studied for their potential to reduce shunt infections. We examined the effectiveness of intrawound application of vancomycin powder during shunt surgery. PATIENTS AND METHODS: Patient records of 78 primary shunt implantations at a mean age of 40 months were reviewed. In total, 52 patients (mean age 50 months) had been treated according to standard surgical and perioperative procedures (Std), whereas 26 patients (mean age 20 months) additionally had received topical application of vancomycin powder before wound closure (Vmc). Overall infection rate was 3.8%, in Std patients 5.8%, and in Vmc patients 0%. The rates of CSF fistula and revision surgery were similar in both groups (5.8% vs 8% and 23.1% vs. 30%, respectively). CONCLUSION: To the best of our knowledge, this is the first report on topical vancomycin instillation, indicating its efficacy for the prevention of shunt infection in pediatric patients. Further studies with a higher number of patients are needed to verify this finding.
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Antibacterianos/uso terapéutico , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Hidrocefalia/cirugía , Infección de la Herida Quirúrgica/prevención & control , Vancomicina/uso terapéutico , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Vancomicina/administración & dosificaciónRESUMEN
INTRODUCTION: The ciliopathy "Joubert syndrome" was first described in 1969 by Dr. Marie Joubert and most subtypes follow an autosomal recessive inheritance. The complex disorder shows typical clinical features, such as hyperventilation, abnormal eye movements, and retardation. A pathognomonic midbrain-hindbrain malformation, the molar tooth sign, can be found on magnetic resonance imaging of the brainstem. There are a little more than 200 reports of Joubert syndrome in the literature. CASE PRESENTATION: We report a case of a 9-year-old boy who developed a progressive hydrocephalus starting from the age of 4. He underwent VP shunt placement at 8 years, which relieved hydrocephalus-related clinical symptoms and put development of the macrocephalus to a halt. CONCLUSION: Neonatal hydrocephalus due to the altered anatomy of the posterior fossa has been reported earlier, but to our knowledge, this is the first case of a delayed onset of hydrocephalus in a patient with Joubert syndrome.
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Cerebelo/anomalías , Anomalías del Ojo/complicaciones , Hidrocefalia/etiología , Enfermedades Renales Quísticas/complicaciones , Retina/anomalías , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/genética , Cerebelo/diagnóstico por imagen , Niño , Anomalías del Ojo/diagnóstico por imagen , Anomalías del Ojo/genética , Estudios de Seguimiento , Humanos , Hidrocefalia/diagnóstico por imagen , Enfermedades Renales Quísticas/diagnóstico por imagen , Enfermedades Renales Quísticas/genética , Imagen por Resonancia Magnética , Masculino , Mutación/genética , Proteínas/genética , Retina/diagnóstico por imagenRESUMEN
Protein tyrosine phosphatase interacting protein 51 (PTPIP51) is upregulated in glioblastoma multiforme (GBM) and expression levels correlate with the grade of malignancy in gliomas. A similar correlation was reported for its interacting partner 14-3-3ß, which has been shown to facilitate the interaction of PTPIP51 with cRAF (Raf1). Since the interaction of these signalling partners stimulates growth factor signalling downstream of the epidermal growth factor receptor (EGFR), a major drug target in GBM, we here investigated the impact of EGFR inhibition by small molecule inhibitors or monoclonal antibody on PTPIP51. The effect of EGFR inhibition on PTPIP51 mRNA, protein expression and its interaction profile in GBM was analyzed using the U87 cell line as model system. The transferability of the results to in vivo conditions was evaluated in cultured tumour cells from GBM patients. Cells were treated either to the small molecule tyrosine kinase inhibitor of EGFR Gefitinib or the monoclonal antibody Cetuximab in a time and dose dependent manner. Gefitinib treatment decreased the proliferation rate and induced apoptosis in U87 and primary tumour cells. The PTPIP51 interaction profile changed in correlation to the applied Gefitinib. Despite unchanged mRNA levels PTPIP51 protein was reduced. In contrast, treatment with Cetuximab had no effects on PTPIP51 expression. In conclusion, our results demonstrate the impact of EGFR inhibition by Gefitinib on PTPIP51 protein expression, a downstream regulator of MAPK signalling. These data will serve as a basis to unravel the precise role of PTPIP51-mediated signalling in GBM and its potential implications for Gefitinib-mediated therapy in future studies.
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Receptores ErbB/antagonistas & inhibidores , Glioblastoma/metabolismo , Proteínas Mitocondriales/metabolismo , Inhibidores de Proteínas Quinasas/farmacología , Proteínas Tirosina Fosfatasas/metabolismo , Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Western Blotting , Proliferación Celular/efectos de los fármacos , Receptores ErbB/genética , Receptores ErbB/metabolismo , Glioblastoma/tratamiento farmacológico , Glioblastoma/genética , Glioblastoma/patología , Humanos , Técnicas para Inmunoenzimas , Proteínas Mitocondriales/genética , Fosforilación/efectos de los fármacos , Proteínas Tirosina Fosfatasas/genética , ARN Mensajero/genética , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Transducción de Señal/efectos de los fármacos , Células Tumorales CultivadasRESUMEN
INTRODUCTION: Even though shunt surgery has been an established and widely accepted treatment for congenital hydrocephalus for five decades, long-term follow-up and functional outcome data is rare. PATIENTS AND METHODS: Sixty-nine patients were examined after congenital hydrocephalus had been treated between 1971 and 1987 at the Department of Pediatric Surgery (University of Leipzig) within the first 12 months of life. Median age of patients was 32 years (range 25-42 years). Patients agreed to undergo a contemporary hydrocephalus assessment. RESULTS: Seven patients (10.1%) became shunt-independent before adulthood. By the age of 20, 82% of the patients had needed at least one shunt revision, 100% by the age of 30. 21.7% of the primary valves (Spitz-Holter) remained intact without revision until today up to 35 years (mean functional intactness 23 years). Shunt infections occurred in 4.3% of primary implantations. 48% of the patients had a good functional outcome (mRS = 0-1). 40.9% of the patients attended regular school. In summary, 75% patients work on a daily basis. 44.6% live an independent life, 35.4% rely on parental supervision, and 20% depend on professional care institutions. CONCLUSION: Compared to the pre-shunt era, surgery within the first year of life is advantageous regarding visual function, educational progress, and social results. The outcome achieved throughout childhood remains stable during adult life as long as catastrophic events of shunt malfunction can be prevented. Epilepsy, motor deficits, acute shunt dysfunction, and problems of social integration as well as aging parental caregivers seem to be prominent factors of morbidity in adulthood.
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Hidrocefalia/cirugía , Resultado del Tratamiento , Derivación Ventriculoperitoneal/métodos , Adolescente , Adulto , Falla de Equipo , Femenino , Humanos , Estimación de Kaplan-Meier , Estudios Longitudinales , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Disfunción Ventricular/etiología , Derivación Ventriculoperitoneal/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: Many reports on glioblastoma multiforme discuss the prognostic impact of anatomical features such as cysts, necrotic changes, extent of edema or subependymal spread of tumor cells. In the present study, we examined different growth patterns and their possible relations to patient survival. METHODS: To analyze whether anatomical characteristics are related to prognosis, we reviewed the prospectively collected pre- and postoperative MRIs of 83 patients in the 5-ALA study, provided by the 5-ALA Glioma Study Group. Following a standardized analytic work flow, the tumor volume and site, presence of necrosis or cysts, and perifocal edema were assessed preoperatively. In the same way, postoperative MRI and the MRI at first recurrence were analyzed. In addition, survival time of the patients was documented. RESULTS: Median survival time of all 83 patients was 15.1 months (range 1.5 to 70.1, mean 18). The site or volume of glioblastoma, as well as the presence of intratumoral necrosis or cysts, did not exert a significant effect on survival time; 96.4 % of recurrences occurred within the former resection margin. Tumors with initial contact with the subependymal zone had multifocal or ventricular recurrences significantly more often. In patients with residual tumor on early postoperative MRI, the follow-up images displayed enlargement of the remnants in 91.9 % of these cases. CONCLUSIONS: A merely anatomical analysis of the glioblastoma growth pattern cannot reliably provide prognostic information. The occurrence of most recurrences next to the resection margin and the high percentage of growing residual tumors underline the importance of complete resections.
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Neoplasias Encefálicas/patología , Glioblastoma/patología , Recurrencia Local de Neoplasia/patología , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/cirugía , Quistes/patología , Glioblastoma/mortalidad , Glioblastoma/cirugía , Humanos , Imagen por Resonancia Magnética , Necrosis/patología , Recurrencia Local de Neoplasia/mortalidad , Neoplasia Residual/patología , Pronóstico , Tasa de Supervivencia , Carga TumoralRESUMEN
A case of an 8-year-old-boy with shunt-dependent occlusive hydrocephalus after resection of a cerebellar medulloblastoma is presented, who experienced repeated episodes of severe neurologic deterioration with signs and symptoms of raised intracranial pressure after spinal tapping. However, intracranial pressure was recorded within low ranges, only up to the opening pressure of the implanted adjustable shunt valve. Multiple shunt revisions were performed, until the condition was recognized as acute normal pressure hydrocephalus. Either enforced recumbency and downadjustment of the valve system to 0 cm H(2)O alone or external ventricular drainage seems to be successful to resolve the critical condition, depending on severity of the symptoms. The case illustrates that acute pathologic enlargement of the ventricular system is not always associated with increased intracranial pressure, even when typical signs and symptoms are present. The very rare entity of acute normal pressure hydrocephalus by two separated compartments is postulated based on the pulsatile vector force theory of brain water circulation.
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Hidrocéfalo Normotenso/fisiopatología , Enfermedad Aguda , Neoplasias Cerebelosas/cirugía , Niño , Humanos , Masculino , Meduloblastoma/cirugía , Punción Espinal/efectos adversos , Derivación VentriculoperitonealRESUMEN
INTRODUCTION: Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments. PATIENTS AND METHODS: In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3-18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations. RESULTS: The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection. CONCLUSION: The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.
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Ácido Aminolevulínico , Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Fármacos Fotosensibilizantes , Cuidados Preoperatorios/métodos , Adolescente , Neoplasias Encefálicas/cirugía , Niño , Preescolar , Femenino , Glioma/clasificación , Glioma/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Cirugía Asistida por ComputadorRESUMEN
Walker-Warburg syndrome is a very rare autosomal recessive disorder with congenital muscular dystrophy, brain malformations on the basis of a neuronal migration defect and ocular abnormalities. We report our experience in treating two cases of Walker-Warburg syndrome complicated by hydrocephalus with shunting and endoscopic techniques.
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Anomalías Múltiples , Encéfalo/anomalías , Hidrocefalia , Distrofias Musculares/complicaciones , Síndrome , Derivación Ventriculoperitoneal , Encéfalo/patología , Endoscopía , Femenino , Estudios de Seguimiento , Humanos , Hidrocefalia/complicaciones , Hidrocefalia/patología , Hidrocefalia/cirugía , Recién Nacido , Imagen por Resonancia Magnética , Masculino , Distrofias Musculares/congénito , Procedimientos NeuroquirúrgicosRESUMEN
We present the case of a 13-month-old girl with a right occipital cortical alteration on MRI that proved to be a growing lesion. Tumor growth had been observed over a period of 15 months before total resection was performed, revealing a dysembryoplastic neuroepithelial tumor WHO grade I. This case shows that dysembryoplastic neuroepithelial tumors can present as growing neoplasias. It underlines the importance of obtaining histologic diagnosis and close follow-up examinations using MRI, even in so-called stable lesions that are only unveiling through epileptic seizures.
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Neoplasias Encefálicas/patología , Imagen por Resonancia Magnética , Neoplasias Neuroepiteliales/patología , Biopsia , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/cirugía , Progresión de la Enfermedad , Epilepsia/etiología , Femenino , Humanos , Lactante , Neoplasias Neuroepiteliales/complicaciones , Neoplasias Neuroepiteliales/cirugíaRESUMEN
Cerebral cavernous malformations occur in 0.5% of the population. They consist of thin-walled vessels and can be found as congenital or sporadic lesions. Most of them are asymptomatic, however, due to their anatomical features blood leakage into the surrounding tissue can cause severe neurological symptoms. Although risk of bleeding is low, symptomatic lesions should be treated, with microsurgical resection being the therapy of choice for surgically accessible cavernomas. Intraventricular cavernous malformations are a rare subtype, and due to their anatomical localization, they are eligible for endoscopic surgery. However, there are only a few reports on endoscopic resection of intraventricular cavernomas to be found in the literature. We report the case of a 48-year-old woman who suffers from multiple cerebral cavernous malformations. Since the first diagnosis, several of these cavernomas had been removed in open microsurgical interventions. Most recently, a new lesion arose intraventricularly, adjacent to the ependymal wall of the right lateral ventricle. In follow-up, cranial MR imaging microbleeding and an increasing size were detected. Eventually, the lesion was endoscopically removed. Presurgery the patient suffered from right-sided sensibility loss and gait disturbances as a consequence of prior surgeries. Postsurgery, no new neurological symptoms could be found. We here present MR images and intraoperative pictures as well as a short video of the resection itself. In our opinion, endoscopic resection of intraventricular cavernomas should be considered in selected cases.
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In this review of the literature we discuss the rare occurrence of metastatic tumours mimicking bilateral vestibular schwannoma and present an own case with pancreatic signet-ring cell carcinoma as primary tumour.
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Carcinoma de Células en Anillo de Sello/diagnóstico , Carcinoma de Células en Anillo de Sello/secundario , Neoplasias del Oído/diagnóstico , Neoplasias del Oído/secundario , Oído Interno , Neuroma Acústico/diagnóstico , Neoplasias Pancreáticas/patología , Carcinoma de Células en Anillo de Sello/patología , Ángulo Pontocerebeloso , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Coloración y EtiquetadoRESUMEN
The reported liponeurocytoma of the left lateral ventricle in a 35-year-old man represents the fifth recorded case of a supratentorial intraventricular liponeurocytoma. In this location, liponeurocytomas are very exceptional, whereas it is the typical site for classic central neurocytomas. Conversely, neurocytomas of the cerebellum are predominantly liponeurocytomas with until now more than 25 reported cases. Thus, cerebellar liponeurocytoma is the most frequent neuroepithelial CNS tumor with adipose-like cells followed by ependymomas with a lipid component and supratentorial intraventricular liponeurocytoma. Adipose-like cells in neurocytomas may originate by lipidization of tumor cells, metaplastic transformation of neuroectodermal cells into fat cells or by true adipocytic differentiation. The present case showed also focal glial differentiation with GFAP-positivity of some tumor cells as often seen in cerebellar liponeurocytomas but much rarer in central neurocytomas. Pathogenetic and nosologic implications of supratentorial intraventricular liponeurocytomas are discussed. Future WHO tumor classification should consider that liponeurocytomas are not restricted to the cerebellum. Reports on cerebellar liponeurocytomas with a less favorable clinical course suggest a WHO grade II for liponeurocytomas.
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Neoplasias del Ventrículo Cerebral/patología , Lipoma/patología , Neurocitoma/patología , Adulto , Neoplasias Cerebelosas/patología , Neoplasias del Ventrículo Cerebral/metabolismo , Neoplasias del Ventrículo Cerebral/cirugía , Diagnóstico Diferencial , Proteína Ácida Fibrilar de la Glía/metabolismo , Humanos , Inmunohistoquímica , Lipoma/metabolismo , Lipoma/cirugía , Masculino , Neurocitoma/metabolismo , Neurocitoma/cirugíaRESUMEN
We present the case of a patient with an endolymphatic sac tumour (ELST). This rare tumour entity has only recently been defined and despite a well characterized clinical appearance misdiagnosis as jugular paraganglioma is frequent. A 68-year-old woman was admitted to our Neurosurgical Department with a mass lesion extending from the left temporal bone to the cerebello-pontine angle (CPA). Radiological features were high vascularization, contrast enhancement and destruction of the os petrosum. After preoperative angiographic embolization the tumour was removed in two surgical interventions, first via a lateral suboccipital approach and second by petrosectomy. The lesion proved to be a typical endolymphatic sac tumour by a synopsis of histological, radiological and clinical features. ELST should be taken into consideration in patients with mass lesions in the cerebellopontine angle destroying the petrous bone and resembling paraganglioma. Since slow growth rate and lack of metastases are particular features of ELST, complete resection of the tumour results in long survival times without adjuvant chemo- or radiotherapy.
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Adenocarcinoma Papilar/patología , Adenocarcinoma Papilar/cirugía , Hueso Petroso , Neoplasias Craneales/patología , Neoplasias Craneales/cirugía , Adenocarcinoma Papilar/irrigación sanguínea , Adenocarcinoma Papilar/diagnóstico por imagen , Anciano , Embolización Terapéutica , Femenino , Humanos , Procedimientos Neuroquirúrgicos , Cuidados Preoperatorios , Neoplasias Craneales/irrigación sanguínea , Neoplasias Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Glioblastoma multiforme (GBM) is the most common and most malignant primary brain tumour. Protein tyrosine phosphatase interacting protein 51 (PTPIP51) is an interaction partner of 14-3-3ß, which correlates with the grade of malignancy in gliomas. In this study PTPIP51 and its interacting partners 14-3-3ß, PTP1B, c-Src, Raf-1 as well as EGFR were investigated in human glioblastoma. Twenty glioblastoma samples were analyzed on transcriptional and translational level by immunohistochemistry, in situ hybridization and RT-PCR. To compare PTPIP51 expression in gliomas of different malignancies, quantitative RT-PCR for grade II astrocytoma and GBM samples was employed. Additionally, we analyzed the correlation between PTPIP51 and 14-3-3ß transcription, and checked for in situ interaction between PTPIP51 and 14-3-3ß and PTP1B, respectively. PTPIP51 and 14-3-3ß mRNA showed a tumour grade dependent upregulation in gliomas. Glioblastoma cells displayed a strong immunoreaction of PTPIP51, which co-localized with 14-3-3ß and PTP1B. The duolink proximity ligation assay corroborated a direct in situ interaction of PTPIP51 with both proteins, known to interact with PTPIP51 in vitro. The in vitro interacting partners Raf-1 and c-Src showed a partial co-localization. Besides, immune cells located in capillaries or infiltrating the tumour tissue and endothelial cells of pseudoglomerular vessels revealed a high PTPIP51 expression. The upregulation of PTPIP51 and its connection with the EGFR/MAPK pathway by 14-3-3ß via Raf-1 and by PTP1B via c-Src, argue for a functional role of PTPIP51 in the pathogenesis of human glioblastoma.
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Proteínas 14-3-3/análisis , Neoplasias Encefálicas/enzimología , Quinasas MAP Reguladas por Señal Extracelular , Glioblastoma/enzimología , Sistema de Señalización de MAP Quinasas , Proteínas Mitocondriales/análisis , Proteína Tirosina Fosfatasa no Receptora Tipo 1/análisis , Proteínas Tirosina Fosfatasas/análisis , Proteínas 14-3-3/genética , Adulto , Anciano , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patología , Femenino , Alemania , Glioblastoma/genética , Glioblastoma/patología , Humanos , Inmunohistoquímica , Hibridación in Situ , Masculino , Persona de Mediana Edad , Proteínas Mitocondriales/genética , Clasificación del Tumor , Proteína Tirosina Fosfatasa no Receptora Tipo 1/genética , Proteínas Tirosina Fosfatasas/genética , Proteínas Proto-Oncogénicas c-raf/análisis , ARN Mensajero/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Regulación hacia Arriba , Adulto Joven , Familia-src Quinasas/análisisRESUMEN
T-cell lymphoblastic lymphoma is a rare form of non-Hodgkin lymphoma, which shows preponderance for young men. Most common symptoms are painless swelling of lymph nodes, accompanied by B symptoms and large mediastinal masses. Most often, an involvement of the nervous system is due to paraneoplastic symptoms or side effects of treatment. In a literature research, we could not find a case with affection of a cervical nerve root as the first symptom for T-cell lymphoblastic lymphoma. A 39-year-old man presented with right-sided C8 radiculopathy, including pareses and paresthesia. Since the magnetic resonance image disclosed a right-sided mass lesion in the region of the neuroforamen C8, compressing the corresponding nerve root, a schwannoma was suspected. The tumor was removed using a dorsal approach. Neuropathological examination revealed the diagnosis of T-cell lymphoblastic lymphoma. The patient underwent diagnostic staging and received further treatment. He experienced a very grim course and succumbed to his disease 12 months after surgery. T-cell lymphoblastic lymphoma is a rare disease, and tropism of lymphoma cells to neural structures is seldom encountered. However, the presence of radiculopathy, together with signs, referring to B symptoms, should prompt the physician to consider this coincidence in the differential diagnosis of schwannoma.
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Linfoma de Células T/patología , Neurilemoma/patología , Neoplasias del Sistema Nervioso Periférico/patología , Raíces Nerviosas Espinales/patología , Anciano , Biopsia , Complejo CD3 , Vértebras Cervicales , Diagnóstico Diferencial , Ganglios Espinales/patología , Humanos , Inmunohistoquímica , Antígenos Comunes de Leucocito/inmunología , Linfoma de Células T/cirugía , Imagen por Resonancia Magnética , Masculino , Neurilemoma/cirugía , Neoplasias del Sistema Nervioso Periférico/cirugía , Radiculopatía/etiología , Radiculopatía/cirugía , Raíces Nerviosas Espinales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJECT: Early physiotherapeutic exercises after lumbar discectomy have been shown to be helpful for pain control and in reducing the delay until the return to work. Many strategies exclude sitting body positions during the first weeks, because raised intradiscal pressure and an increased motion range in the lower lumbar disc levels have been found in unoperated individuals when seated. To evaluate whether these results can be extrapolated to the situation of an operated patient, we examined the feasibility of an intracranial pressure sensor for measuring intradiscal pressure after lumbar discectomy. PATIENT AND METHOD: An otherwise healthy patient underwent lumbar discectomy for a right-sided lumbar disc herniation at the level L4/5. Before surgery he had agreed voluntarily to the implantation of a pressure sensor and the manufacturer had provided data on the safe use of the sensor in the disc space. Intraoperatively the sensor was positioned in the disc space from the right side. Measurements were performed by means of individual readings by three different examiners at different time points. Before removal of the sensor its correct position was demonstrated by X-ray and computed tomography. RESULTS: The patient tolerated surgery very well, recovery and wound healing were un-eventful, and symptoms improved. The pressure monitoring system showed reproducible results without any signs of technical problems. The intradiscal pressure values were about ten times lower than the values known from unoperated individuals (lying: up to 130 mmHg, sitting: up to 50 mmHg, standing: up to 450 mmHg. 100 mmHg=0.013332 MPa). CONCLUSION: We present an easy to perform and technically safe technique for the measurement of intradiscal pressure after lumbar discectomy using an intracranial sensor. To assess the impact of intradiscal pressure on recovery after lumbar microdiscectomy a study with a larger cohort of patients and with long-term follow-up will be needed.
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Discectomía , Disco Intervertebral/fisiología , Adulto , Humanos , Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Movimiento/fisiología , Presión , Tomografía Computarizada por Rayos XAsunto(s)
Neoplasias Encefálicas/cirugía , Glioblastoma/cirugía , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Recurrencia Local de Neoplasia/cirugía , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiología , Comorbilidad , Resultado Fatal , Glioblastoma/diagnóstico , Glioblastoma/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/epidemiología , Meningioma/diagnóstico , Meningioma/epidemiología , Persona de Mediana Edad , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Procedimientos Neuroquirúrgicos , Resultado del TratamientoRESUMEN
BACKGROUND: Most primary intracranial tumors occur as solitary lesions; multiple locations of one tumor, the occurrence of two different tumors or even collision tumors have been described only in a few patients. From a statistical point of view, in less than 100 glioblastoma cases will a meningioma be simultaneously present in the brain. We report three cases with this coincidence and display the results of CGH and chromosome analysis in two patients, in whom the tumors arose in very close spatial correlation to each other. PATIENTS: We describe three case histories with simultaneous occurrence of meningioma and glioblastoma as shown by MRI on admission. After neurosurgical removal of mass lesions, specimens from two patients were cultivated in cell culture and the cells were examined for chromosomal aberrations by conventional karyotyping as well as comparative genomic hybridization (CGH). RESULTS: Examinations disclosed characteristic genetic aberrations for one meningioma and two glioblastomas. In one patient it was possible to compare the data for the meningioma and the glioblastoma; in this case we did not find a common genetic aberration in tumor cells with a different histology. CONCLUSION: Genetic testing of tumor cells should be performed routinely when different histological types of brain tumors are present in a close spatial relationship. We favor the hypothesis of statistical coincidence for the simultaneous occurrence of the two tumors rather than a common pathway giving rise to two tumor entities.