Neurosurg Focus
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Brain tumor stem cells (TSCs) hypothetically drive the malignant phenotype of glioblastoma multiforme (GBM), and evidence suggests that a better understanding of these TSCs will have profound implications for treating gliomas. When grown in vitro, putative TSCs grow as a solid sphere, making their subsequent characterization, particularly the cells within the center of the sphere, difficult. Therefore, the purpose of this study was to develop a new method to better understand the proteomic profile of the entire population of cells within a sphere. ⋯ This study is the first to show that cryosectioning of neurospheres derived from glioma models in mice and GBM in humans is a feasible method of better defining the stem cell profile of a glioma.
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Review Case Reports
Peroneal intraneural ganglia. Part I. Techniques for successful diagnosis and treatment.
The common peroneal nerve is the peripheral nerve most often affected by intraneural ganglion cysts. Although the pathogenesis of these cysts has been the subject of controversy in the literature, it is becoming increasingly evident that they are of articular origin. Recent recognition of this fact has proven to be significant in reducing recurrences and improving treatment outcomes for patients. The authors present a stepwise method of assessing and treating peroneal intraneural ganglion cysts.
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In an attempt to elucidate the pathophysiology and clinical significance of global cerebral edema (GCE) following aneurysmal subarachnoid hemorrhage (SAH), the authors explored potential mechanisms and reviewed findings associated with this phenomenon. Admission computed tomography (CT) scans show GCE in up to 20% of patients experiencing aneurysmal SAH. ⋯ Clinically, GCE on CT after aneurysmal SAH is predictive of a poor outcome. Further investigation is needed to gain a full understanding of edema development following SAH, with the hope that the knowledge can be used to influence treatment positively and improve outcome.
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Whole-brain radiotherapy (WBRT) after resection of a single brain metastasis can cause long-term radiation toxicity. The authors evaluated the efficacy of resection and placement of 125I seeds (without concomitant WBRT) for newly diagnosed single brain metastases. ⋯ Permanent 125I brachytherapy applied at the initial operation without WBRT provided excellent local tumor control. Local control and patient survival rates were at least as good as those reported for resection combined with WBRT. Although the authors noted a higher incidence of distant metastases compared with that reported in other studies of initial WBRT, these metastases were generally well controlled with a combination of surgery, stereotactic radiosurgery, and, less often, WBRT. Twenty-four patients (92%) never required WBRT, thus avoiding potential long-term radiation-induced neurotoxicity.
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Surgical approaches to treat orbital disease should provide a good exposure of intraorbital anatomical structures, allow their functional preservation, and provide good cosmetic results. The authors describe a minimally invasive, combined transconjunctival-eyebrow approach to all orbital quadrants in a step-wise manner. The indications, advantages, and limitations of the technique are highlighted. ⋯ The combined transconjunctival-eyebrow approach provides an excellent orbital exposure, with minimal damage to the circumjacent structures. It requires less operative time than other approaches and yields good cosmetic results. Intracranial or intrafacial tumor extension and tumors located purely in the orbital apex are limitations for the use of this technique.