scholarly journals Stereotactic Transcerebellar Approach to Pontine Lesions through the Middle Cerebellar Peduncle

1999 ◽  
Vol 5 (1) ◽  
pp. 19-25 ◽  
Author(s):  
F. Parker ◽  
M.F. Levesque ◽  
J. Bittoun ◽  
D. Doyon ◽  
M. Tadie
Keyword(s):  
Clinical Outcome ◽  
Mr Studies ◽  
Neurological Deficits ◽  
High Yield ◽  
Low Grade ◽  
High Grade ◽  
Inappropriate Therapy ◽  
Middle Cerebellar Peduncle ◽  
Cerebellar Peduncle ◽  
Pontomedullary Junction

A stereotactic approach to the pons through the middle cerebellar peduncle based on MR studies was used to biopsy 18 patients. The stereotactic coordinates and angles were defined with reference to three orthogonal planes (mid-sagittal, IVth ventricular floor and pontomedullary junction). The pathological diagnoses were in keeping with clinical outcome and comprised five high-grade astrocytomas, three low-grade astrocytomas, two glioblastomas multiforme, two oligodendrogliomas, two primitive neuroectodermic tumours, two lymphomas, one medulloblastoma, and one tuberculosis. This approach provides a high yield of positive histological diagnoses with little morbidity (transient neurological deficits in two cases) and thereby avoids inappropriate therapy.

scholarly journals Stereology in Grading and Prognosis of Canine Cutaneous Mast Cell Tumors

2021 ◽  
pp. 030098582098513
Author(s):  
Mafalda Casanova ◽  
Sandra Branco ◽  
Inês Berenguer Veiga ◽  
André Barros ◽  
Pedro Faísca
Keyword(s):  
Mast Cell ◽  
Clinical Outcome ◽  
Prognostic Value ◽  
Histological Grade ◽  
Intraobserver Variability ◽  
Low Grade ◽  
High Grade ◽  
Mast Cell Tumors ◽  
Cutaneous Mast Cell ◽  
Grade Iii

Canine cutaneous mast cell tumors (ccMCTs) are currently graded according to Patnaik and Kiupel grading schemes. The qualitative and semiquantitative parameters applied in these schemes may lead to inter- and intraobserver variability. This study investigates the prognostic value of volume-weighted mean nuclear volume ([Formula: see text]), a stereological estimation that provides information about nuclear size and its variability. [Formula: see text] of 55 ccMCTs was estimated using the “point-sampled intercept” method and compared with histological grade and clinical outcome. The clinical history of dogs treated with surgical excision alone was available for 30 ccMCTs. Statistical differences in [Formula: see text] were found between grade II ([Formula: see text]= 115 ± 29 µm3) and grade III ccMCTs ([Formula: see text]= 197 ± 63 µm3), as well as between low-grade ([Formula: see text]= 113 ± 28 µm3) and high-grade ccMCTs ([Formula: see text]= 184 ± 63 µm3). An optimal cutoff value of [Formula: see text] ≥ 150 µm3 and [Formula: see text] ≥ 140 µm3 was determined for grade III and high-grade ccMCTs, respectively. In terms of prognosis, [Formula: see text] was not able to predict the clinical outcome in 42% of the cases; however, cases with [Formula: see text]<125 µm3 had a favorable outcome. These results indicate that, despite having limited prognostic value when used as a solitary parameter, [Formula: see text] is highly reproducible and is associated with histological grade as well as with benign behavior.

scholarly journals Stereotactic Brainstem Biopsy: Technical Aspects with Emphasis on Role of Awake Craniotomy

2020 ◽  
Vol 9 (02) ◽  
pp. 080-084
Author(s):  
Reddy Kanala Ramnadh ◽  
Krishna Yerramneni Vamsi ◽  
Thirumal Yerragunta ◽  
Kumar Vupuloori Arvind ◽  
Varshesh Shah
Keyword(s):  
Stereotactic Biopsy ◽  
Tissue Sample ◽  
Low Grade ◽  
Middle Cerebellar Peduncle ◽  
Brainstem Lesions ◽  
Pediatric Age Group ◽  
Technical Modifications ◽  
Cerebellar Peduncle ◽  
Brainstem Biopsy

Abstract Introduction The role of frame-based stereotactic biopsy in brainstem lesions has been well established in literature. Transfrontal, transtentorial, and transcerebellar routes are used to access various targets within the brainstem. While the transfrontal approach is preferable in midbrain lesions, a transcerebellar approach via the middle cerebellar peduncle forms the shortest possible trajectory for pontine and medullary lesions. Objective Authors to describe the technical nuances of frame-based stereotactic biopsy of lower brainstem lesions to increase the procedural safety and efficacy. Materials and Methods Technical modifications in frame fixation were done to acheive the desired trajectory to the target. In adult cases biopsy was performed with patient awake during the procedure. Results Total of five patients underwent biopsy with the technical modifications. Three patients were adults and two were in pediatric age group. Their age ranged from 12 to 50 years. No complications were encountered. Two of the biopsies showed demyelination and the other three turned out to be low-grade glioma, pilocytic astrocytoma, and lymphoma, respectively. Conclusion Despite obvious inherent risks, the transcerebellar biopsy in semi-sitting position is a well-tolerated and effective method of obtaining a diagnostic tissue sample in brainstem lesions. We have noted that adoption of the technical modifications described in this article has aided in improving the safety and ease of the procedure.

scholarly journals Endovascular Treatment of Acute Embolism of the Major Cerebral Arteries

2004 ◽  
Vol 10 (3) ◽  
pp. 213-223 ◽  
Author(s):  
S. Ota ◽  
T. Ota ◽  
K. Goto ◽  
I. Inoue ◽  
T. Ota
Keyword(s):  
Clinical Outcome ◽  
Intracranial Haemorrhage ◽  
Cerebral Arteries ◽  
Favorable Outcome ◽  
Low Grade ◽  
High Grade ◽  
Timi Grade ◽  
Grade 3 ◽  
The Relationship ◽  
Control Angiography

This study evaluated: 1) the effect of recanalization on changing clinical outcome, 2) the relationship between dose of Urokinase (UK) and incidence of recanalization and intracranial haemorrhage, and 3) the efficacy and feasibility of balloon disruption (BD) in the treatment of acute cerebral embolism. Sixty-one patients with acute embolism of the major cerebral arteries treated by endovascular approaches over the past nine years were retrospectively evaluated. Among them, 30 cases were treated by BD alone or in conjunction with intra-arterial fibrinolysis in the last five years. The other 31 cases, mostly treated in the first four years, were treated with intra-arterial fibrinolysis alone and were used as controls to evaluate the efficacy of BD. Control angiography was performed just after the reperfusion procedure to evaluate the degree of recanalization. Angiographic responses were graded using modified Thrombolysis in Myocardial Infarction (TIMI) criteria. Clinical outcome was evaluated using modified Rankin Scale (mRS) score at the time of discharge. Thirty-six of the 61 patients (59.0%) achieved high-grade recanalization (TIMI grade 3). Significantly more patients attained favorable outcome (mRS score 0–1) in the high-grade recanalization group than the low-grade recanalization group (41.7% vs. 16.0%, p< 0.05). Concerning patients treated with BD, significantly more patients attained good recanalization and significantly more patients were ambulatory (mRS score 0–3) than those treated with intra-arterial fibrinolysis alone (76.7% vs. 41.9%, p<0.01; 70.0% vs. 41.9%, p< 0.05, respectively). A significantly lower dose of UK was used, and relatively less intracranial haemorrhage was seen in patients treated with BD than those treated with intra-arterial fibrinolysis (194,000 ± 191,000 units vs. 388,000 ± 231,000 units, p=0.001; 16.7% vs. 38.7%, p = 0.055, respectively). Concerning morbidity and mortality of BD, there was one death caused by dissection of the M2 portion of the middle cerebral artery (MCA) that happened during BD on a distally migrated embolus. Although no conclusions can be drawn from our study, a favorable outcome for acute embolism of the major cerebral arteries is expected by attaining good recanalization. In addition, BD is an effective technique that can achieve high-grade recanalization alone, or reducing the dose of fibrinolytic agent.

Non-Hodgkin's lymphoma involving the tonsil: An immunohistochemical study

1991 ◽  
Vol 105 (6) ◽  
pp. 445-450 ◽  
Author(s):  
M. G. Watson ◽  
J. Crocker
Keyword(s):  
Clinical Outcome ◽  
Hodgkin’S Lymphoma ◽  
Immunohistochemical Study ◽  
Hodgkin's Lymphoma ◽  
Prognostic Indicators ◽  
Low Grade ◽  
High Grade ◽  
Non Hodgkin’S Lymphoma ◽  
Morphological Criteria ◽  
Non Hodgkin's Lymphoma

AbstractTwenty-one patients with non-Hodgkin's lymphoma involving the palatine tonsil were studied in an attempt to relate pathological data to clinical outcome. Eleven tumours were classified as low-grade and ten as high-grade on morphological criteria. The results of immunohistochemical investigations are presented; all tumours but one were of B-cell origin. None of the pathological factors studied were found to be useful prognostic indicators.

scholarly journals Claudins and Ki-67

2011 ◽  
Vol 59 (11) ◽  
pp. 1022-1030 ◽  
Author(s):  
Péter Törzsök ◽  
Péter Riesz ◽  
István Kenessey ◽  
Eszter Székely ◽  
Áron Somorácz ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcome ◽  
Expression Pattern ◽  
Cell Cancer ◽  
Urothelial Cell ◽  
Low Grade ◽  
High Grade ◽  
Specific Expression ◽  
Ki 67 ◽  
Normal Tissues

Updated classification of urothelial cell cancer differentiates low-grade and high-grade cancers, which determines potential clinical outcome. Substantial interobserver variability necessitates new biomarkers to ensure classification. Claudins’ specific expression pattern characterizes normal tissues, different tumor types, and defined grades of tumor differentiation. The aim of this study was to examine the expression pattern of claudins and proliferation marker Ki-67 in low-grade and high-grade urothelial cell cancers compared with independent control samples of non-tumorous urothelium, as well as to reveal the predictive usefulness of claudins. The expression of claudins-1, -2, -3, -4, -5, -7, and -10 and Ki-67 was studied with quantitative immunohistochemistry and real-time RT-PCR with relative quantification in 103 samples: 86 urothelial cell cancers (27 low grade, 59 high grade) and 17 non-tumorous urothelia. Results were analyzed regarding overall survival and recurrence-free period as well. High-grade tumors overall showed significantly higher claudin-4 and Ki-67 and significantly lower claudin-7 expression when compared with low-grade ones. High-grade tumors revealed significantly shorter overall survival in Kaplan-Meier analysis. Claudin-4, claudin-7, and Ki-67 might be used as potential markers to differentiate low-grade and high-grade urothelial cell cancers, thereby possibly enhancing accuracy of pathological diagnosis and adding further information to clinical outcome.

Brainstem and Cranial Nerves: Pons

2021 ◽  
pp. 82-91
Author(s):  
Kelly D. Flemming ◽  
Paul W. Brazis
Keyword(s):  
Blood Supply ◽  
Basilar Artery ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Middle Cerebellar Peduncle ◽  
Corticospinal Tracts ◽  
Imaginary Line ◽  
Cerebellar Peduncles ◽  
Cerebellar Peduncle ◽  
Pontomedullary Junction

The pons extends from the pontomedullary junction to an imaginary line drawn from the exit of cranial nerve IV. Dorsal to the pons lies the cerebellum, which receives information and projects information back to the brainstem through the inferior, middle, and superior cerebellar peduncles. Important structures at this level include the corticospinal tracts, corticopontocerebellar fibers traveling through the middle cerebellar peduncle, the cerebellum, and cranial nerves V through VIII. Blood supply to the pons is from the basilar artery and its perforating vessels.

Subtemporal Transtentorial Approach in Mesencephalic and Perimesencephalic Lesions in Children—A Series of 20 Patients

2019 ◽  
Author(s):  
Pietro Spennato ◽  
Carmela Chiaramonte ◽  
Carmela Russo ◽  
Nicola Onorini ◽  
Giuseppe Mirone ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Neurological Deficits ◽  
Direct Access ◽  
Low Grade ◽  
Superior Cerebellar Peduncle ◽  
High Grade ◽  
Subtemporal Approach ◽  
Advantages And Disadvantages ◽  
Neoplastic Lesions ◽  
Surrounding Areas

Abstract BACKGROUND Midbrain and surrounding areas are among the most difficult regions to surgically approach in neurosurgery. The subtemporal approach is a well-known neurosurgical approach that is rarely described in children. OBJECTIVE To assess the feasibility, advantages, and disadvantages of subtemporal approach in children. METHODS A total of 20 pediatric patients with intra-axial tumors involving the lateral midbrain or superior cerebellar peduncle or with extra-axial tumors in the middle incisural space/Meckel cave underwent subtemporal transtentorial approaches with the aim to remove (16 cases) or biopsy (4 cases) their lesions. These cases were retrospectively reviewed and the surgical approach described. RESULTS Total resection was achieved in 11 patients. In the 4 patients who underwent biopsies, a diagnosis was obtained. A total of 5 patients presented non-neoplastic lesions (dermoid tumors or cavernomas). A total of 9 patients harbored low-grade tumors and 6 high-grade tumors. Patients with low-grade tumors and non-neoplastic lesions are all alive with no evidence of disease or stable residue. Four patients affected by high grade tumors died. No patient suffered permanent neurological deficits related to the surgical approach. Three patients presented temporary neurological deficits following the procedure: one case of strabismus, one case of aphasia and hemiparesis, secondary to delayed, transient thrombosis of the Labbé vein, and 1 case of trigeminal neuralgia. CONCLUSION The subtemporal approach represents a feasible approach for mesencephalic and perimesencephalic lesions in children. It provides an ample and direct access, with excellent outcomes and acceptable postoperative morbidity.

Parotid Cancer: Treatment and Results

1993 ◽  
Vol 72 (12) ◽  
pp. 787-793 ◽  
Author(s):  
David W. Roberson ◽  
Felix W. K. Chu ◽  
C. Thomas Yarington
Keyword(s):  
Radiation Therapy ◽  
Clinical Outcome ◽  
Neck Dissection ◽  
Residual Disease ◽  
Late Recurrence ◽  
Low Grade ◽  
High Grade ◽  
Parotid Cancer ◽  
High Incidence ◽  
Age And Sex

The records of 74 consecutive patients with primary parotid malignancy were reviewed. The age and sex incidence was comparable to that described in previous studies; we observed a high incidence of adenocarcinoma not reported by other investigators. Stage at the time of examination and histologic grade of tumor were independent statistically significant predictors of clinical outcome. Long survival with low grade disease and late recurrence were common. Radiation therapy has been shown to increase survival in a number of studies; however, it had no demonstrable benefit in our series. Parotid cancer should be managed aggressively and early surgery is indicated for all parotid neoplasms. Neck dissection is indicated for clinically positive nodes and high grade cancers; radiation therapy is indicated for high grade cancers and residual disease.

scholarly journals The Promising IgSF11 Immune Checkpoint Is Highly Expressed in Advanced Human Gliomas and Associates to Poor Prognosis

2021 ◽  
Vol 10 ◽  
Author(s):  
Amina Ghouzlani ◽  
Soumaya Rafii ◽  
Mehdi Karkouri ◽  
Abdelhakim Lakhdar ◽  
Abdallah Badou
Keyword(s):  
T Cell ◽  
Clinical Outcome ◽  
Immune Checkpoint ◽  
High Grade Glioma ◽  
Immune Checkpoint Blockade ◽  
Immune Checkpoints ◽  
Low Grade ◽  
High Grade ◽  
Human Gliomas ◽  
Poor Overall Survival

Glioma is the most prevalent primary brain tumor. Immune checkpoint blockade has made a great stride in mending patient’s clinical outcome for multiple types of cancers. However, PD-1, CTLA-4, or VEGF blockade exhibited only poor outcome in glioma patients. This study aimed to explore the expression and role of IgSF11, an emerging immune checkpoint and a ligand of VISTA, in human gliomas. IgSF11 mRNA expression was assessed in human glioma patients at different grades using 2 independent cohorts, a set of 52 Moroccan samples, including 20 glioma tissues, 22 PBMC samples taken before and 10 PBMC samples taken after surgery; and a series of 667 patients from TCGA. In parallel, immunohistochemistry was performed to evaluate IgSF11 protein staining. IgSF11 gene expression was significantly upregulated in high grade glioma tissues, compared to low grade. IgSF11 protein also showed a significant expression in low and high-grade gliomas. Interestingly, IgSF11 expression seemed to correlate positively with other critical immune checkpoints such as PD1, PDL-1, VISTA, and surprisingly negatively with CTLA-4. Although, T cell markers appeared higher in advanced gliomas, T cell-produced pro-inflammatory genes showed similar expression levels, highly likely because of the potent immunosuppressive microenvironment. Indeed, increased expression of IgSF11 in advanced human gliomas associated with a poor overall survival. Our data strongly suggest that IgSF11 is an immune checkpoint, which is upregulated in advanced human gliomas and contributes to the immunosuppressive state resulting in a poor clinical outcome in glioma patients. IgSF11 could be considered as a possible promising therapeutic target in advanced human gliomas.

scholarly journals Magnetic resonance–guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 13-21
Author(s):  
Elsa V. Arocho-Quinones ◽  
Sean M. Lew ◽  
Michael H. Handler ◽  
Zulma Tovar-Spinoza ◽  
Matthew Smyth ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Tumors ◽  
Adjuvant Treatment ◽  
Pediatric Brain Tumors ◽  
Tumor Location ◽  
Neurological Deficits ◽  
Low Grade ◽  
High Grade ◽  
Pediatric Brain

OBJECTIVEThis study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors.METHODSData from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed.RESULTSA total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3–72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created.CONCLUSIONSSLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.

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