[Treatment possibilities in patients with glioblastoma multiforme].

Glioblastoma multiforme is the most common primary malignant brain tumor in adults. The actual treatment approach includes surgical excision of the lesion followed by radio- and chemotherapy in standard doses and regimens. In most cases, in spite of aggressive treatment, the survival does not exceed 12-16 months after the initial diagnosis. The present survey provides systematic information about the current treatment modalities for control of the disease as well as the perspectives of introduction of some experimental methods in clinical practice.

[Characteristics and prognosis of visual deficit caused by parasellar meningiomas].

UNLABELLED: Meningiomas are the most common slow growing tumors of the central nervous system which arise from the arachnoid cells. One certain group of them--tuberculum sellae (TS), cavernous sinus (CS), anterior clinoid (AC), and planum sphenoidale (PS) meningiomas, a group often called "parasellar", present with monocular or binocular visual deterioration, which is often unrecognized by patients until visual loss is severe and the tumor has reached a significant size. AIM: To describes the type of visual deficit, severity of the symptoms and surgical treatment of tumors with the above mentioned localization. MATERIAL AND METHODS: During the period 2003-2007 year, 93 patients (31 man, 62 women) diagnosed with meningiomas of the TS (31 cases), CS (16 cases), AC (21 cases), PS (17 cases), (see text) - 8, were diagnosed and operated on in the Department of Neurosurgery, University Hospital "St. Ivan Rilsky", Sofia, Bulgaria. Retrospective analysis was done. RESULTS: Age at diagnosis ranged from 12 to 74 years, but the majority of cases were in the 5th and 6th decade of life. Localization of was: TS 33%, CS 17%, AC 24%, PS 18% and with more than one area affected in 8 %. The most common symptom was slowly progressing loss of monocular visual acuity (81% of cases). 68% of patients presented with already severely deteriorated vision (0.1-0). Neuro-ophthalmological examination (see text) the patients. Computed tomography and magnetic resonance imaging were the main diagnostic methods. "Gross" total resection was achieved in 62%, subtotal in 12%, partial in 26% of the cases. There was early improvement in 57% of the patients. Death due to cardio-respiratory insufficiency occurred in one case. CONCLUSION: the progressive monocular visual deficit is often the first clinical symptom of the parasellar menigiomas. The early diagnosis is important for the success of surgery. Close collaboration between different specialists (ophthalmologists, neurologist and neurosurgeons) is essential for treatment of these tumors and prevention of the visual deterioration.

[Malignant progression of an anaplastic ganglioglioma into a glioblastoma multiforme--report on two cases and review of the literature].

INTRODUCTION: Ganglioglioma is an uncommon type of primary brain tumors. In most of the cases the tumor demonstrates benign clinical behaviour with long-term patients' survival. We present two cases ofhistologically confirmed anaplastic ganglioglioma in which malignant progression into a glioblastoma multiforme was seen. CASE 1: A 36 year-old female with known Turner syndrome and recent history of single generalized seizure. The contrast-enhanced magnetic resonance imaging (MRI) showed an infiltrating lesion of the left frontal lobe. The tumor was excised partially and the histological result was anaplastic ganglioglioma (World Health Organization - WHO. gr. III). No additional neurological deterioration occurred after the procedure. A postoperative radiotherapy was performed with total dose of 60 Gy. The patient was symptom-free for one year taking her anticonvulsant medications. Control neuroimaging studies (computer tomography - CT, and MRI) were made because of progressive headache, right limbs weakness and speech disturbances. A local tumor recurrence was found and the patient underwent second operative intervention with gross total tumor resection. The histological result was glioblastoma multiforme (WHO gr. IV glioma). The patient improved after the procedure. An involvement of the contralateral cerebral hemisphere was found on control CT-scan ten months later. The patient died after one month, 23 months after her initial diagnosis. CASE 2: A 17 year-old female with recent history of progressive headache and three generalized seizures preceded by involuntary movements of the right limbs. MRI data for large, heterointense tumor lesion in the left frontal lobe was found. A subtotal tumor removal was made. The histological result was anaplastic ganglioglioma (WHO gr. ILL). The patients' headache and right side hemiparesis improved after the intervention. She was seizure-free taking her anticonvulsant medications. Thirty-day-long fractionated radiotherapy was performed with total dose of 60 Gy. The patient remained symptom-free for thirteen months after initial surgical procedure. During the next month the patients, partial motor seizures relapsed. Progressive headache, diplopia, and visual acuity impairment also developed. The ventriculoperitoneal shunt was implanted with neuroimaging data for internal hydrocephalus development. The patients' headache and visual disturbances improved after the procedure. Data for additional local tumor growth was found on control CT-scan one month later. The patient underwent subtotal excision of the lesion and the actual histological result was glioblastoma multiforme. The patient deteriorated after the intervention according to her right limbs paresis and died one month and half later. 20 months after the initial diagnosis. CONCLUSION: The gangliogliomas are uncommon in clinical practice. The tumor behaviour may vary between the patients in spite of the similar histological characteristics which indicates the possible presence of different tumor subtypes.

[Clinical, histopathological and cytogenetical findings in six cases with primary glioblastoma multiforme].

INTRODUCTION: Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor. There is an increasing amount of data demonstrating that the routine histological examination has limited value to predict the tumor biological behaviour. AIM: To compare the clinical, histological and cytogenetical findings in a group of six patients with primary GBM surgically treated in the Department of Neurosurgery at University Hospital "St. Ivan Rilski"- Sofia, Bulgaria. MATERIAL AND METHODS: The studied group consisted of three women and three men with average age of 51 years and 6 months. In all patients the diagnosis was histologically confirmed. A microarray comparative genomic hybridization (CGH) analysis of fresh-frozen tumor tissue samples was also made. RESULTS: In two of the patients the tumor was localized in frontotemporal region, in another two- in frontoparietal, and in the other two- in parietal and occipital respectively. The onset was with headache in three of the cases. The median time between the onset and admission in the clinic was 70 days. Gross-total tumor removal was performed in one patient. In the other five subtotal excision was made. Three of the patients improved after the intervention. One patient deteriorated after the surgery. All patients demonstrated typical histological findings except one who had giant cell subtype of GBM. The microarray CGH analysis determined chromosome 10 monosomy in five patients, trisomy 7 - in four, trisomy 20 - in three, 3q23 deletion - in three, and Yp11.2 deletion - in three. CONCLUSION: GBMs are genetically heterogeneous tumors with different clinical response to standard multimodal treatment regimens. The microarray CGH analysis is a powerful method which can demonstrate the presence of a number of molecular markers with possible predictive value.