Clinical outcome of adult choroid plexus tumors: retrospective analysis of a single institute.

BACKGROUND: Choroid plexus tumors are rare brain tumors with clinical features that vary according to the histological grade. We reviewed the treatment outcomes of 15 adult patients with choroid plexus tumors, focusing on surgical outcomes and current therapeutic strategies. METHOD: Patient demographic and clinical characteristics, operative findings, adjuvant therapies, disease progression and survival rates were reviewed. RESULTS: The median age at diagnosis was 33.7 ± 10 years (19-59 years) for patients with choroid plexus tumors. Postoperative chemotherapy was given to 26.7 % of patients, and 13.3 % of patients received radiotherapy. The Ki-67 labeling index and mitotic index increased at higher histological grades. All of the choroid plexus papilloma and atypical choroid plexus papilloma patients have survived. The overall survival rate of patients with choroid plexus carcinoma was 50 % in the first year, but none of the patients survived to the second year. Five patients underwent permanent cerebrospinal fluid diversion surgery because of hydrocephalus or subdural effusion. CONCLUSIONS: Choroid plexus papilloma and atypical choroid plexus papilloma patients can be treated with complete surgical resection. Choroid plexus carcinoma has a poor prognosis, and aggressive multi-modal treatments are generally needed for treatment. Chemotherapy and radiotherapy are important adjuvant therapies for choroid plexus carcinoma. If hydrocephalus and/or subdural effusion occur, permanent cerebrospinal fluid (CSF) diversion should be added to the therapeutic strategy.

The protective effect of low-dose methotrexate on ischemia-reperfusion injury of the rabbit spinal cord.

Methotrexate was developed as a cytostatic agent, but at low doses, it has shown potent anti-inflammatory activity. Previous studies have demonstrated that the anti-inflammatory effects of methotrexate are primarily mediated by the release of adenosine. In this study, we hypothesized that low-dose methotrexate has protective effects in spinal cord ischemia-reperfusion injury. Rabbits were randomized into the following four groups of eight animals each: group 1 (control), group 2 (ischemia), group 3 (methylprednisolone) and group 4 (methotrexate). In the control group only a laparotomy was performed. In all the other groups, the spinal cord ischemia model was created by the occlusion of the aorta just caudal to the renal artery. Neurological evaluation was performed with the Tarlov scoring system. Levels of myeloperoxidase, malondialdehyde and catalase were analyzed, as were the activities of xanthine oxidase and caspase-3. Histopathological and ultrastructural evaluations were also performed. After ischemia-reperfusion injury, increases were found in the serum and tissue myeloperoxidase levels, tissue malondialdehyde levels, xanthine oxidase activity and caspase-3 activity. In contrast, both serum and tissue catalase levels were decreased. After the administration of a low-dose of methotrexate, decreases were observed in the serum and tissue myeloperoxidase levels, tissue malondialdehyde levels, xanthine oxidase activity and caspase-3 activity. In contrast, both the serum and tissue catalase levels were increased. Furthermore, low-dose methotrexate treatment showed improved results concerning the histopathological scores, the ultrastructural score and the Tarlov scores. Our results revealed that low-dose methotrexate exhibits meaningful neuroprotective activity following ischemia-reperfusion injury of the spinal cord.

Hydatid cyst of the ambient cistern radiologically mimicking an arachnoid cyst.

Hydatid cysts of the posterior fossa are extremely rare. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. A 7-year-old boy was admitted to the emergency department because of intense headache, nausea, vomiting, and progressive drowsiness that developed within the period of a week. On radiological examination a round, 2.5 × 2.5-cm cystic lesion appeared in the ambient cistern and caused hydrocephalus as a result of extrinsic aqueductal stenosis. The cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via an infratentorial-supracerebellar approach with the patient in the sitting position. The authors here described an unusual case of a hydatid cyst in the left ambient cistern with hydrocephalus due to extrinsic aqueductal stenosis, which seems to be the first such case in the literature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the quadrigeminal cistern to determine which surgical procedure to perform and to avoid unexpected complications.

Solitary lumbar osteochondroma presenting with foot-drop: a case report.

Although osteochondroma is the most common benign bone tumor, the lumbar spine is anuncommon localization for solitary osteochondroma. Solitary lumbar osteochondromas rarely affect the neurological structures, because most of the lesions grow out of the spinal canal. We report a 48-year-old patient suffering from right foot-drop due to acute compression of right L4 nerve root by a lesion expanding into the spinal canal, originating from the right inferior articular facet of the third lumbar vertebrae. The symptoms improved after surgical removal of the lesion and histopathological examination of the lesion confirmed the diagnosis of osteochondroma. To the best of our knowledge, this is a unique case report in the literature.

A retained wood penetrating the superior orbital fissure in a neurologically intact child.

Transorbital intracranial injuries due to a wooden foreign body traversing superior orbital fissure is an extremely rare condition. A 9-year-old boy was struck by a tree branch in the left eye while playing in the garden two months ago. On physical examination, the patient had only a hypertrophic scar on his medial side of left upper eyelid at the admission. A history of recurrent cutaneous fistula from the puncture site due to a retained foreign body was suspected, and the patient was hospitalized to evaluate and remove the object to prevent severe infection. Afterwards, the child was operated successfully via the left transcranial route to detect and remove the foreign body. The authors described an unusual case of wooden foreign body that traversed the superior orbital fissure yet caused no deficit and was associated with no fracture. Even if symptoms are absent, removal of a wooden foreign body should be immediately performed to prevent sight-threatening and life-threatening complications.

Effect of curcumin on lipid peroxidation, early ultrastructural findings and neurological recovery after experimental spinal cord contusion injury in rats.

AIM: After acute spinal cord injury (SCI), a large number of axons are lost by a cascade of pathophysiological events known as a secondary injury. The main aim of the current study was to investigate the potential neuroprotective effects of curcumin on lipid peroxidation (LPO), neurological function, and ultrastructural findings after SCI. MATERIAL AND METHODS: Forty adult Wistar albino rats were randomized into five groups: control, SCI alone (50 g/cm weight drop), methylprednisolone sodium succinate (MPSS) (30 mg/kg), curcumin + dimethyl sulfoxide (DMSO) (300 mg/kg), and DMSO alone (0.1 mg/kg). RESULTS: Administration of curcumin significantly decreased LPO in first 24 hours. However, there were no differences in the neurological scores of injured rats between the medication groups and the control group. Curcumin was more effective than DMSO and MPSS in reducing LPO, whereas DMSO was more effective than curcumin and MPSS in minimizing ultrastuctural changes. The results of this study indicate that curcumin exerts a beneficial effect by decreasing LPO and may reduce tissue damage. CONCLUSION: Since ultrastructural and neurological findings does not support biochemical finding, our findings do not exclude the possibility that curcumin has a protective effect on the spinal cord ultrastructure and neurological recovery after SCI. A combination of curcumin with other vehicle may also have a considerable synergy in protecting spinal cord.

Effects of darbepoetin-α in spinal cord ischemia-reperfusion injury in the rabbit.

BACKGROUND: Darbepoetin-alpha (DA) is a novel erythropoiesis-stimulating agent developed for treating anemia. In animal models, recombinant human erythropoietin has been reported to be beneficial for neuroprotection. In this study, we determined whether DA would protect the spinal cord against ischemia-reperfusion injury in a rabbit model. METHODS: Forty rabbits were randomized into five groups of eight animals each: group 1 (sham), group 2 (ischemia), group 3 (vehicle), group 4 (30 mg/kg methylprednisolone), group 5 (30 µg/kg DA). Only laparotomy was performed in the sham group. In all the other groups, the spinal cord ischemia model was created by a 20-min occlusion of the aorta just caudal to renal artery with an aneurysm clip. The drugs were administered immediately after the clamp was removed. The animals were killed 24 h later. Spinal cord segments between L2 and L5 were harvested for analysis. Neurological evaluation was performed with the Tarlov scoring system just before the animals were killed. Level of tissue malondialdehyde was analyzed as a marker of lipid peroxidation and tissue caspase-3 activity as a marker of apoptosis. Also, histopathological evaluation of the tissues was performed. RESULTS: Both malondialdehyde and caspase-3 levels were significantly decreased by DA administration. Histopathological evaluation of the tissues also demonstrated decrease in neuronal degeneration and infiltration parameters after DA administration. In the DA group, neurological outcome scores were statistically significantly better compared with the ischemia and the vehicle groups. CONCLUSIONS: Although further studies considering different dose regimens and time intervals are required, DA was shown to be at least as effective as methylprednisolone in spinal cord ischemia/reperfusion model.

Methothrexate attenuates early neutrophil infiltration and the associated lipid peroxidation in the injured spinal cord but does not induce neurotoxicity in the uninjured spinal cord in rats.

BACKGROUND: The goal of most acute therapies for spinal cord injury (SCI) in humans include attenuation of the early inflammatory response and may limit the extent of tissue injury and the consequent disability. OBJECTIVE: The purpose of this study was to investigate the early effects of methothrexate (MTX) treatment on myeloperoxidase (MPO) activity, malondialdehyde (MDA) level, and ultrastructural findings in the injured and uninjured spinal cords of rats. The effects of MTX treatment were also compared with methylprednisolone sodium succinate (MPSS) treatment. METHODS: Wistar rats were divided into seven groups: control; trauma alone (50 g/cm weight drop trauma); SCI + MPSS (30 mg/kg); SCI + low-dose (0.5 mg/kg) MTX (LDMTX); SCI + higher-dose (1 mg/kg) MTX (HDMTX); non-trauma + LDMTX; non-trauma + HDMTX. RESULTS: Administration of MTX and MPSS treatments significantly decreased MPO activity (p < 0.05) and MDA level (p < 0.05) in the first 24 h. The MTX treatments, particularly HDMTX, were more effective than MPSS in reducing MPO activity, and MTX treatments were also more effective than MPSS in reducing MDA level (p < 0.05). The MTX treatment was more protective on large- and medium-diameter myelinated axons in minimizing ultrastructural changes in the spinal-cord-injured rats, but did not induce neurotoxicity in normal spinal cord. CONCLUSION: The results of this study indicate that MTX treatment has a beneficial effect by reducing early neutrophil infiltration and the associated lipid peroxidation, and has significantly protective effects on the injured spinal cord tissue in the first 24 h after SCI. Given the anti-inflammatory properties of MTX, a single dose of MTX a week is used for non-neoplastic disease in humans, and MTX may have a beneficial role in the immediate management of acute SCI.

Orbital hydatid cyst.

Hydatid cysts rarely appear in the orbital cavity without the involvement of the other organs. Most of them are situated in the superolateral and superomedial angles of the orbit. Inferiorly located cysts are very uncommon. The authors report a case of a primary hydatid cyst of the orbit with inferolateral localization. The cyst was removed surgically via a frontotemporoorbitozygomatic approach combination with puncture-aspiration-injection-reaspiration technique. This case was considered as a primary infection, because there was no previous history of hydatid disease and no findings of liver and lung cysts on radiological examination. Physicians should include orbital hydatid cyst in the differential diagnosis of unilateral proptosis. To avoid complications that might occur during surgery, the cyst can be easily removed using the combination technique detailed in this report.

Intradural lipoma of the cervicothoracic spinal cord with intracranial extension.

INTRODUCTION: Intradural spinal lipoma is rare and seen about 1% of all tumors of the spinal cord. Lipomas of the cervical location with intracranial extension are extremely rare and are described as intramedullary or subpial location. CASE: A 12-year-old female with lipoma of the cervicothoracic spinal cord demonstrated progressive quadriparesis. The patient underwent surgery with decompression of the affected craniocervical location. DISCUSSION: In the reported case, we describe a rare intradural lipoma of the cervicothoracic spinal cord with posterior fossa extension in the child, and the relevant English medical literature is reviewed.

Unusual manifestations of primary Glioblastoma Multiforme: A report of three cases.

BACKGROUND: Brain tumors, especially high-grade gliomas, can present with focal or generalized signs due to mass effect, parenchymal infiltration and destruction. In general, at the time of diagnosis, tumors could cause common neurological symptoms and major clinical signs depending on their localization. In rare instances, brain tumors colud be manifested with unusual symptoms. CASE DESCRIPTION: WE DESCRIBE THREE CASES PRESENTING WITH UNUSUAL CLINICAL SYMPTOMS: ulnar neuropathy, vertigo and syncope attacks. Microscopic total tumor excision was done and histopathological analysis revealed that these tumors were glioblastoma multiforme. Both external beam radiotherapy and chemotherapy were given as adjuvant treatments. CONCLUSIONS: Physicians should keep brain tumors in mind in the case of patients who present with atypical symptoms such as those reported here. Brain imaging should be performed over a prolonged period following presentation if the patient's symptoms remain unresolved after adequate treatment.