Intraoperative MR Imaging in Neurosurgery.

Intraoperative magnetic resonance imaging (iMRI) has dramatically expanded and nowadays presents state-of-the-art technique for image-guided neurosurgery, facilitating critical precision and effective surgical treatment of various brain pathologies. Imaging hardware providing basic imaging sequences as well as advanced MRI can be seamlessly integrated into routine surgical environments, which continuously leads to emerging indications for iMRI-assisted surgery. Besides the obvious intraoperative diagnostic yield, the initial clinical benefits have to be confirmed by future-controlled long-term studies.

Vascular endothelial growth factor signals through platelet-derived growth factor receptor ß in meningiomas in vitro.

BACKGROUND: Vascular endothelial growth factor (VEGF)-mediated angiogenesis mediates tumour growth and metastasis. Meningiomas are primarily benign, slow-growing, highly vascularised tumours. Aside from VEGF, there is little data on the function of major angiogenic proteins in meningiomas. METHODS: The VEGFA, platelet-derived growth factor B (PDGFB), and their respective receptors - VEGF receptor 2 (KDR) and PDGF receptor ß (PDGFRß) - were quantified using real-time PCR and a TaqMan Protein Assay in meningiomas in vivo and in vitro. The effect of VEGFA and PDGFB on cell proliferation and the tyrosine phosphorylation of PDGFRß were examined. RESULTS: Most meningiomas displayed no KDR protein expression but elevated PDGFRß levels. Exogenous VEGFA stimulation significantly increased cell proliferation. The PDGFRß inhibition before stimulation with VEGFA abolished the proliferative stimuli. The VEGFA induced concentration-dependent PDGFRß tyrosine phosphorylation comparable to PDGFB-induced PDGFRß tyrosine phosphorylation. The PDGFRß inhibitors gambogic acid, sunitinib, and tandutinib equally impaired the migration of meningioma cells. In addition, gambogic acid suppressed the VEGFA-induced PDGFRß tyrosine phosphorylation. CONCLUSION: Collectively, our data suggest that VEGFA primarily regulates VEGF-mediated migration through PDGFRß in meningiomas. The inhibitory effect of gambogic acid and tandutinib against meningioma growth in vitro suggests that selective PDGFRß inhibitors, in combination with VEGF inhibitors, should be evaluated further as potential therapies for recurrent and malignant meningiomas.

Evaluation of quality of life parameters in patients who have syringomyelia.

Syringomyelia is a centromedullary syndrome that can be treated conservatively or with various neurosurgical procedures. We hypothesized that different clinical subgroups of patients exist, which would necessitate the need for individualised neurosurgical intervention and maintenance to achieve optimal quality of life (QoL). Using both the short-form 36-item (SF-36) questionnaire and the Syringomyelia Disability Index, clinical and QoL data was prospectively assessed in 142 patients with syringomyelia. Cluster analysis was then performed on the subscale results of the SF-36. The SF-36 scores of those with syringomyelia were significantly lower than those of the general German population, as well as when compared to those patients suffering from other chronic diseases. The SF-36 scores were independent of the syringomyelia patients' underlying syrinx pathology. Cluster analysis of the QoL patterns revealed four indicative patient groups. Syringomyelia is a chronic, progressive disease, and the syrinx itself appears to be the source of the symptoms, rather than the underlying pathology. The identified QoL subgroups in syringomyelia patients indicate the necessity of appropriate diagnosis and treatment of the pathology so that expansion of the syrinx cavity is reduced, maintaining QoL and functionality of these patients.

Management of skull based meningiomas in the elderly patient.

BACKGROUND: The demographic evolution of Western society together with availability of modern imaging techniques leads to an increasing diagnosis of meningioma patients over 70 years of age. This raises the question of appropriate management of this histologically benign tumour in a geriatric population. DESIGN: Forty-three patients aged over 70 years were analyzed and matched in a retrospective study with a younger group of 89 patients according to tumour size, histology, symptoms, recurrence and presence of neurofibromatosis II. RESULTS: Changes in postoperative Karnofsky scores were not statistically different between the two age groups. Neurological outcome was worse among the younger group (12% vs. 7% deterioration). Regarding surgical complications we noted only a statistically significant higher infection rate in the geriatric age group. There was no peri-operative mortality. CONCLUSIONS: Age alone is not a criterion to deny a priori skull base surgery, since well selected geriatric patients may benefit from a meningioma operation that may enhance future quality of life.

Microsurgical removal of a petrous apex meningioma after stereotactic radiation: technical case report.

OBJECTIVE AND IMPORTANCE: Stereotactic radiation is increasingly advocated as a primary treatment option for benign cranial base lesions. The clinical course of the patient reported herein raises questions regarding the rationale for initiation of radiotherapy to a petrous apex meningioma before microsurgery. CLINICAL PRESENTATION: We report a 50-year-old woman who experienced medically refractory trigeminal pain. She was diagnosed with a meningioma around the petrous apex and treated by fractionated stereotactic radiation. After a short period of alleviation accompanied by hypesthesia, the pain returned in a previously unknown and violent fashion. INTERVENTION: Complete tumor removal through a retrosigmoid intradural suprameatal approach resulted in immediate and permanent pain cessation. CONCLUSION: Radiotherapy should be withheld for benign and accessible tumors of the cranial base until the option of radical microsurgical treatment has been explored.

Congenital arthrogryposis associated with atlantoaxial subluxation and dysraphic abnormalities. Case report.

The authors report the case of a 27-year-old woman with an arthrogryposis multiplex congenita (AMC) associated with atlantoaxial subluxation. To the authors' knowledge, this is the first report of its kind. The authors review the literature with reference to dysraphic abnormalities associated with atlantoaxial subluxation and with AMC. The patient presented with severe tetraparesis following a minor traffic accident. She underwent a procedure in which transoral decompression and dorsal stabilization were performed and, postoperatively, made a good clinical outcome. The authors stress the need for diagnostic neuroimaging of the craniocervical junction in patients with AMC.