New application of diffusion tensor imaging in neurosurgery.

Diffusion tensor imaging is a MRI technique that enables the measurement of the diffusion of water in tissue in order to produce neural tract images. Advanced methods such as color coding and tractography (fiber tracking) have been used to investigate the directionality. The localization of tumors in relation to the white matter tracts (infiltration, deflection), has been one the most important initial applications. A non invasive technique for assessing tumor tissue characteristics, like tumor cell density, is required to assist preoperative surgical planning for malignant brain tumors and help better define the target for tumor biopsy, resulting in more accurate diagnosis and grading of malignant brain tumors. One possible source of this information is diffusion tensor imaging. Date studies have focused on its ability to delineate white matter fiber tracks by fiber tracking and to detect tumor infiltration around the tumor and normal white matter interface. Relationships between cell density and the two key values that diffusion tensor imaging provides, fractional anisotropy and mean diffusivity, still need to be investigated. Mean diffusivity has a good negative correlation and fractional anisotropy has a good positive correlation with tumor cell density within the tumor core. Similar correlation was observed between the Ki-67, on the one hand and fractional anisotropy and mean diffusivity, on the other hand. Thus, measurement of both fractional anisotropy and mean diffusivity within the tumor core has a potential to provide detailed information on tumor cell density within the tumor.

Traumatic brain injury in infants and toddlers, 0-3 years old.

OBJECT: Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma. METHODS: We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. RESULTS: We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases. CONCLUSION: Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome.

Isolation and partial characterization of a new human glioblastoma cell line.

Although significant progresses were made in the field of molecular biology of malignant cerebral gliomas, the prognostic of these tumors continues to be reserved. One of the therapeutic failure reasons is the incomplete knowledge regarding the origin of these tumors and cells features, which in fact represent an obstacle in developing a cell and molecular therapy guided against malignant cells responsible for the tumor development and for the therapeutic resistance. Initiation and characterization of glioblastoma cell lines represents an essential step in order to obtain a better in vitro and in vivo experimental model for glioblastoma. We describe here a new glioblastoma line, named T11, which was successfully isolated in our laboratories starting with a tumor sample obtained intraoperative from a 58 years-old female patient. The histopathological evaluation showed a grad IV WHO glioma (glioblastoma). The sample was prepared by manual fragmentation, followed by enzymatic digestions using different concentration of trypsin. The cell line has been cultivated for more than 150 passages. The characterization of the glioblastoma line consisted in the evaluation of cells proliferation capacity (growth curve), morphological features, karyotyping and identification of specific markers. We found that T11 expressed specific markers for glial progenitors and astrocytes (glial fibrillary acidic protein-GFAP); oligodendrocites (A2B5; O4), and microglia (CD45, CD 11b). Cells were negative for neuronal lineage markers like beta3-tubulin and NCAM. In order to evaluate the differentiation grade of T11 cell line, the presence of stem cell markers (nestin, CD133) was explored. T11l cells expressed higher level of nestin and lower level of CD133 comparing with standard glioblastoma cell line U87. T11 cell line expressed VEGF and Bcl-2, but not EGFR and Mdrl and Bax. This new line has distinct and unique characteristics when compared with standard glioblastoma cell line (e.g., U87) and may become a new and useful in vitro model for glioblastoma.

A life threatening problem in infants: supratentorial epidural hematoma.

Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. Authors present a study on 30 infants with epidural hematoma (EDH) admitted in the Pediatric Department of Neurosurgery of the "Bagdasar-Arseni" Clinical Hospital in the period of 1990-2007 (17 years). The most common symptom was irritability, which occurred in 16 cases (53.3%), of our patients. Pallor in all cases (100%) and subgaleal hematoma in 20/30 (66.6%) of the patients. These were the most common clinical signs that occurred upon admission; both of them represent signs of significant clinical importance. Surgical evacuation via craniotomy was required in 26/30 (86.6%) of our patients, while 4/30 (13.3%) of the patients were managed conservatively. The mortality rate was 6.6% in our series, whilst the long-term morbidity rate was 3.3%. EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, the size of EDH, and the presence ofa midline structure shift on the head's CT scan.

Supratentorial epidural hematoma of traumatic etiology in infants.

INTRODUCTION AND BACKGROUND: Traumatic epidural hematoma (EDH) represents a rare head injury complication in infants. Its diagnosis can be quite challenging because its clinical presentation is usually subtle and nonspecific. In our current communication, we present our data regarding the presentation of infants with EDH, their management, and their long-term outcome. MATERIALS AND METHODS: In a retrospective study, the hospital and outpatient clinic charts and imaging studies (head CT and skull X-rays) of 31 infants with pure, supratentorial EDH of traumatic origin were meticulously reviewed. Children Coma Scale score and Trauma Infant Neurologic Score (TINS) were also reviewed. The most common presenting symptom was irritability, which occurred in 18/31 (58.1%) of our patients. Pallor (in 30/31 patients) and cephalhematoma (in 21/31 patients) were the most commonly occurring clinical signs upon admission; both signs represent signs of significant clinical importance. Surgical evacuation via a craniotomy was required in 24/31 of our patients, while 7/31 patients were managed conservatively. The mortality rate in our series was 6.5% (2/31 patients), and our long-term morbidity rate was 3.2% (1/31 patients). CONCLUSIONS: EDH in infants represents a life-threatening complication of head injury, which requires early identification and prompt surgical or conservative management depending on the patient's clinical condition, size of EDH, and presence of midline structure shift on head CT scan. Mortality and long-term morbidity are low with early diagnosis and prompt treatment.