Asunto(s)
Fusión Vertebral , Insuficiencia Vertebrobasilar , Humanos , Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/cirugía , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/etiología , Insuficiencia Vertebrobasilar/cirugía , Fusión Vertebral/efectos adversos , Vértebras Cervicales/diagnóstico por imagenRESUMEN
OBJECT: The authors reviewed angiograms obtained in patients with cavernous malformations to identify and characterize coexisting venous drainage. METHODS: Fifty-seven patients with cavernous malformations treated at the authors' institutions between 1994 and 2002 were classified into three groups according to the venous system adjacent to the malformation on angiography studies. In Group A patients (23 patients) the malformations had no venous drainage; in Group B patients (14 patients) the lesions were associated with typical venous malformations; and in Group C patients (20 patients) the lesions had atypical venous drainage (AVD). The risk of hemorrhage based on the type of associated venous drainage was analyzed, and the usefulness of magnetic resonance (MR) imaging compared with digital subtraction (DS) angiography in demonstrating associated AVD was determined. Fifty-seven patients harbored 67 cavernous malformations: Group A patients had 29 cavernous malformations with no associated venous drainage; Group B patients had 17 lesions associated with venous malformations; and Group C patients harbored 21 lesions, 20 of which manifested AVD. Symptomatic hemorrhage was present in 10 (43.5%) of 23 Group A patients and in 28 (82.4%) of 34 Groups B and C patients. Although high-resolution MR imaging revealed the presence of associated venous malformations in 11 (78.6%) of 14 Group B patients, such studies demonstrated AVD in only two (10%) of 20 Group C patients. CONCLUSIONS: Patients harboring cavernous malformations plus venous malformations or AVD are more likely to present with symptomatic hemorrhage than are patients with cavernous malformation alone. The actual incidence of associated venous drainage may be underestimated when MR imaging alone is used rather than combined with DS angiography.
Asunto(s)
Seno Cavernoso/patología , Malformaciones Arteriovenosas Intracraneales/patología , Adulto , Angiografía de Substracción Digital , Seno Cavernoso/diagnóstico por imagen , Femenino , Humanos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Estudios RetrospectivosRESUMEN
A 7-year-old boy presented with acute onset of left hemiparesis and headache, followed by disturbance of consciousness. Neuroimaging studies showed pontine hemorrhage. Surgery was performed to remove a massive hematoma. Histological examination of the wall revealed anaplastic astrocytoma. Postoperative radiation therapy and several types of chemotherapy were administered. However, the tumor recurred and he died 9 months after onset. Hemorrhagic onset of pontine glioma is rare and carries an extremely poor prognosis.
Asunto(s)
Astrocitoma/complicaciones , Astrocitoma/diagnóstico , Neoplasias del Tronco Encefálico/complicaciones , Neoplasias del Tronco Encefálico/diagnóstico , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/etiología , Astrocitoma/terapia , Neoplasias del Tronco Encefálico/terapia , Niño , Humanos , Hemorragias Intracraneales/terapia , MasculinoRESUMEN
Tissue factor (TF) is a cell-surface glycoprotein responsible for initiating the extrinsic pathway of coagulation; this is inhibited by tissue factor pathway inhibitor (TFPI). As TF reportedly regulates tumor growth and angiogenesis, we investigated the role of TF in meningioma. Using immunohistochemical methods, we studied the expression of TF, TFPI, MIB-1 labeling index in 44 meningiomas to determine whether those factors reflect histological grade and proliferative ability. CD31 and CD68 immunostaining was used to assess vascular density and macrophage infiltration, respectively. Additionally we assessed the influence of TF on meningioma cell proliferation by MTT assay. TF was expressed in 1 of 34 (2.9%) benign, 1 of 5 (20%) atypical, and all of 5 anaplastic meningiomas. TFPI was detected in 2 benign (5.9%), 1 atypical (20%), and 3 (60%) anaplastic meningiomas. Both TF and TFPI expression was significantly correlated with the MIB-1 labeling index (LI). However, neither TF nor TFPI showed a correlation with vascular density. The density of tumor-associated macrophages was not correlated with TF or TFPI immunoreactivity. MTT assay revealed that TF increased the proliferation of meningioma cells. Although some macrophages expressed TF, a great number of the TF immunopositive parenchymal cells in the meningiomas were tumor cells. The present study suggest that the TF system reflects the proliferative ability and malignancy of meningiomas.