How I do it: optic canal unroofing in surgery for tuberculum sellae meningiomas with compression of the optic nerve.

BACKGROUND: Tuberculum sellae meningiomas are challenging to treat when accompanied with altered vision due to compression of the optic nerve. These tumors mostly refer to be benign; therefore, gross total removal and excellent functional recovery are desired. METHOD: We describe the microsurgical treatment of tuberculum sellae meningioma with altered vision function on the left eye. Intradural unroofing of the optic canal with gross total resection of the tumor led to immediate excellent recovery. Intraoperative video highlights key steps of our surgical approach. CONCLUSION: Optic canal unroofing is in our opinion safe and mandatory when treating tuberculum sellae meningiomas with compression of optic nerve.

Neurenteric cysts, incidence and surgical treatment.

OBJECTIVES: Neurenteric cysts (NCs) of the central nervous system (CNS) are cystic congenital lesions that may occur anywhere along the neural tube. They are most common in the spinal region, in the lower part of the cervical and upper thoracic spine. Intracranial NCs occur rarely and there are only small series of patients published in literature worldwide. Microsurgical resection is the treatment of choice. We present our experience in treatment of NCs and review of literature. METHODS: Seven patients with NC of CNS who were operated at the Department of Neurosurgery of Comenius University at University Hospital Bratislava within nine years (2010-2018) were included in the study. The series was retrospectively evaluated with an emphasis on symptomatology, surgery and postoperative course. RESULTS: In three of the seven patients, NC was localized intracranially, in the other four, NC was in the spinal canal. In three patients, a complete removal of NC was achieved (2 intracranial NC, 1 spinal NC). In other patients, a portion of the cyst wall was left to prevent the development of a postoperative neurological deficit. After surgery, the neurological symptoms were completely resolved in six patients, while in one patient, they were alleviated. In one patient, a complication occurred during the postoperatove course. There was no recurrence during the follow-up (3-111 months, mean duration 39 months). CONCLUSION: In our series of patients with intracranial and intraspinal tumors, the incidence of NC was higher than presented in the published data. Our own surgical experience has shown that complete tumor resection is not always possible for intimate adherence to the surrounding structures. Leaving a tiny portion of the cyst wall allowed us to achieve good clinical results with no recurrence. Long-term follow-up of patients is required due to the risk of recurrence. However, it can already be stated that an adequate extent of resection leads to good clinical results (Tab. 1, Fig. 4, Ref. 33).

Pineal region teratomas in children.

Immature or mixed mature/immature teratomas of the pineal region were removed radically in three children. After a period of 26 and 25 months, two patients with immature teratomas are alive and well, whereas in the third patient a mixed teratoma locally recurred and caused a fatal rise of intracranial pressure 11 months after the operation. Regular examinations of tumor markers and neuroradiological investigations are mandatory after radical surgery and adjuvant radio- and chemotherapy.

Establishment, morphological, growth and cytoskeletal properties of 135-BCA carcinoma cell line derived from lung brain metastasis.

Many cell lines have been established from lung cancer but carcinoma cell lines derived from brain metastases occur rarely. The carcinoma cells growth relatively slowly in comparison with brain cells which often overgrow the tumor cells in early passages. The origin of these rapidly dividing brain cells in carcinoma cultures is discussed with respect to the previous studies on adult human brain tissue cultures. It was found that the majority of cells in adult human brain cultures derived from brain biopsies of patients with non-cancer diseases do not express glial markers. Based on the previous studies we suggest that they are glial precursor cells. The high proliferative capacity and non-glial phenotype of these brain cells may lead to the suggestion that they are of cancer origin. In this study the establishment and characterization of a new carcinoma cell line 135-BCA is described. The tissue cultures were derived from brain metastasis of lung large cell carcinoma. The cell line is specific by the epithelial cell morphology and evident cytokeratins expression during the whole subcultivation. All tumor cells were strongly immunoreactive for vimentin and negative stained for glial fibrillary acidic protein (GFAP). The new cell line may prove of value in biological and therapeutic studies of lung cancer. In addition, the further comparative analysis may reveal the environmental influence of brain tissue on carcinoma cells.

Co-expression of GFAP, vimentin and cytokeratins in GL-15 glioblastoma cell line.

Glial fibrillary acidic protein (GFAP), vimentin (Vi) and cytokeratin (CK) intermediate filament (IF) proteins were studied in glioblastoma cell line GL-15. The immunofluorescence staining revealed strong positive staining for vimentin in all cultured cells. Approximately 20% of analyzed cells showed strong and 50% moderate intensity of staining for GFAP. About 3% of all cells were positively stained with a mixture of anti-CK monoclonal antibodies. The expression of all IF was not in relation to the cell density or days in vitro after passage. The double immunofluoresce revealed that all CK-positive cells express GFAP and vimentin. This study demonstrates the heterogeneity of the clonal GL-15 glioma cell line which consists in three immunocytochemically distinct cell types: Vi+/GFAP-/CK-, Vi+/GFAP+/CK-, and Vi+/GFAP+/CK+. These findings give further evidence about the expression of non-glial IF in cultured glioma cells.

Characterization of two new permanent glioma cell lines 8-MG-BA and 42-MG-BA.

The establishment and characterization of two permanent glioma cell lines (8-MG-BA and 42-MG-BA) are described. Both cell lines were derived from the human glioblastoma multiforme. Analyzed cells were within the passage 200 to 220. The cells in both cultures showed similar morphology. In majority they consisted from flat polygonal cells. Growth kinetic studies demonstrated a population doubling time of 20 to 24 h in cell line 8-MG-BA and 48 to 54 h in cell line 42-MG-BA. The cell lines showed different hyperdiploid karyotypes. The immunofluorescence staining was performed for glial fibrillary acidic protein (GFAP) and vimentin. In the culture 8-MG-BA only a small amount of cells showed the GFAP-positive staining. At confluent 42-MG-BA culture the GFAP-positive cells reached 50 to 70% of all cells. Vimentin was found in all glioma cells in both cultures.

Heterogeneity of keratin intermediate filaments expression in human glioma cell lines.

Keratin intermediate filaments (Ifs) are specific for epithelial cell differentiation. This study demonstrates the presence of keratin in two recently established human glioblastoma cell lines 8-MG-BA and 42-MG-BA. Immunofluorescence staining was performed on cells within passage 230 to 235 using monoclonal pan-cytokeratin antibodies. The cells were analyzed during several DIV at different cell density. Keratin-positive stained cells reached 5 to 7% in 8-MG-BA and less than 0.1% in 42-MG-BA cell line. The presence of keratin-positive cells was independent on cell density and days in vitro. Keratin-positive cells appeared unevenly distributed in both cell lines. They were observed as single or areas of keratin-positive cells. The morphological features of keratin-positive and keratin-negative cells were similar. The results are discussed with respect to previous studies on glial fibrillary acidic protein (GFAP) and vimentin to show the heterogeneity of IFs expression in glioma cell lines.

[Concurrent cavernous and venous cerebral angiomas]. / Koincidentálne kavernózne a venózne angiómy mozgu.

Presence of venous angioma (VA) in a close vicinity of cavernous angioma (CA) of the brain enhances the risk of bleeding from CA. However, VA drains the venous blood from surrounding brain tissue and should be left in place during surgical removal of CA. Coincidence of CA and VA was found in 6 of 44 patients operated on for 45 CA during a six years period (1993-1998). Coincidental VA were found more often with the CA located in the deep structures of the brain, in the thalamus and the brainstem (5 of 15 cases) than with the superficial CA (1 of 30 cases). The most valuable diagnostic method was T1 weighted MR imaging with contrast enhancement, less reliable was nonenhanced T1 or proton density weighted imaging. Finding of the VA may positively influence the decision making concerning the indication for surgery and the selection of the most appropriate surgical tactics. (Tab. 1, Fig. 2, Ref. 15.)

[Microsurgical treatment of tumors and vascular lesions in the brain stem]. / Mikrochirurgické liecenie nádorových a cievnych lézií mozgového kmena.

The authors present their experience with microsurgical replacement of brainstem lesions within the period 1989-1999. They operated on 35 patients with tumors and with KM? at age ranging from 2 to 65 years. The children suffered prevailingly from gliomas. KM was more frequent in adults. Ten adults were treated for tumors (4 gliomas, 3 haemangioblastomas, 2 primary lymphomas and 1 epidermoid). A correct surgical technique by use of microsurgical technology can replace relatively safely replace the tumor and vascular lesions even from the inside of the brainstem.

[Meningioma of the clivus]. / Meningeómy klivu.

Clivus meningeoma is a relatively rare tumor with difficult surgical accession. Large and giant tumors acquire a very close relation to the brain stem, cranial nerves and brain vessels. In 10 our of 13 patients, the large tumor diameter exceeded 4 cm, and in half of them it was larger than 5 cm (max. 6.5 cm). Small and medium-sized tumors were removed by means of simple neurosurgical approaches. All of the 10 large and giant tumors were removed by a combined supra-infratentorial presigmoid approach which enabled the approach to the whole tumor. Three recurrent tumors were removed subtotally, the primary surgical intervention removed 5 tumors radically, 4 subtotally and 1 partially. The entire removal was precluded due to infiltrative growth of the tumor localized in the cavernous sinus, firm adherence of tumor to the brain stem or to the vertebrobasillar vessels. Authors' own experience support the data from literature dealing with the relationship of unfavourable results to the size of tumor. Permanent impairment of cranial nerves (38.5%) occurred mostly in large and giant tumors. One death (7.7%) during the peri-operative period (up to one month following operation), as well as the second that occurred in later period succeeded the removal of a giant tumor. Regarding the character of the relationship of large clivus meningeoma to the surrounding nerve and vascular structures, the future improvement of functional results can be expected especially owing to early diagnosis. (Tab. 2, Fig. 2, Ref. 19.)

[Epidural hematomas in the posterior cranial fossa]. / Epidurálne hematómy v zadnej lebecnej jame.

In the course of twenty years 92 patients with intracranial epidural haematomas (EH) were operated. In five these patients, i.e. 5.4%, the EH was in the posterior cranial fossa (EHPF). Focal symptoms of compression of the cerebellum and the lower cranial nerves developed only in subacute EHPF. In acute EHPF it was masked by manifestations of an affection of the brain stem. Direct evidence of EHPF was produced by AG. The best diagnostic method is computed tomography. Attention to EHPF can be however, drawn also clinical sings of injury of the bask of the skull or the finding of a fracture of the occipital bone on an X-ray picture of the skull. Evacuation of the EHPF provides favourable perspectives of a normal future life even on patients who are in a poor condition incl. signs of and impaired respiration.

[Undiagnosed primary Boerhaave syndrome]. / Primárne nepoznaný Boerhaave syndrom.

Spontaneous rupture of the oesophagus (Boerhaave syndrome) is a rare acute condition. Successful treatment of this life threatening condition depends on early diagnosis, the patient's general condition and subsequent treatment. The authors describe two cases of successful treatment of patients with primarily unrecognized spontaneous perforation of the oesophagus.

Radiation-induced meningioma with a long latency period: a case report.

Multiple meningiomas were diagnosed in a 43-year-old man previously treated with high-dose craniospinal radiotherapy at the age of 7 years for medulloblastoma. We suggest that surveillance MRI after high-dose craniospinal radiotherapy should be extended to several (3-5) decades.