Successful radical removal of an intracranial meningioma in 1835 by Professor Pecchioli of Siena

1984 ◽  
Vol 60 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Renato Giuffrè
Keyword(s):  
Dura Mater ◽  
Intracranial Meningioma ◽  
Content Type ◽  
Bone Surgery ◽  
Radical Removal ◽  
University Of Paris ◽  
The Right ◽  
The University ◽  
Fine Print

✓ In 1835, Pecchioli, Professor of Surgery and Operating Medicine at the University of Siena, removed a “fungus of the dura mater” (meningioma). The lesion was a large ulcerated cranial outgrowth at the level of the right sinciput, which at operation proved to originate from the dura mater and to be eroding the bone. Surgery was radical. The patient recovered and attended for follow-up review several times in the course of 30 months, always fit and with no sign of recurrence. This procedure was later selected for the competition for the chair of Surgery at the University of Paris in 1840. In 1847, Pecchioli summarized his surgical material spanning 16 years' activity, including neurosurgical operations.

Significance of proliferating cell nuclear antigen in predicting recurrence of intracranial meningioma

1996 ◽  
Vol 84 (1) ◽  
pp. 85-90 ◽  
Author(s):  
Mark A. Cobb ◽  
Muhammad Husain ◽  
Bruce J. Andersen ◽  
Ossama Al-Mefty
Keyword(s):  
Proliferating Cell Nuclear Antigen ◽  
Statistical Significance ◽  
Tumor Biology ◽  
Nuclear Antigen ◽  
Intracranial Meningioma ◽  
Content Type ◽  
Tumor Histology ◽  
Proliferating Cell ◽  
Fine Print

✓ It is well known that the histological appearance of meningiomas often fails to predict accurately the clinical behavior of the tumor. Therefore, attention has turned from tumor histology to tumor biology. Proliferating cell nuclear antigen (PCNA), a cell cycle-regulated protein, has been recently characterized as the cofactor of DNA polymerase-δ, an enzyme required for DNA replication. The rate of synthesis of PCNA directly correlates with the proliferative state of cells. Immunohistochemical labeling of this antigen is now possible with monoclonal antibodies that allow for its demonstration in routinely fixed, paraffin-embedded specimens. In this study, the PCNA labeling index (LI) was determined for 83 meningiomas, including tumors with both benign and malignant clinical courses and with benign, atypical, and malignant histologies, apparent after total or subtotal resections. No statistical difference was found between the LI on recurrence and that found at initial presentation. In addition, stepwise multivariate regression analysis failed to identify any combination of factors (age, gender, race, age of specimen, tumor histology, Simpson grade of resection) that contributes to the predictive strength of the PCNA LI for tumor recurrence. However, for LIs less than 2%, only one of 26 gross totally resected tumors recurred (mean follow up 53 months); for LIs more than 7%, five of 13 gross totally resected tumors recurred (mean follow up 55 months). The difference in recurrence rates between gross totally resected meningiomas with PCNA LIs less than 2% and those with PCNA LIs more than 7% achieved statistical significance with a Fisher's exact probability equaling 0.011. The authors conclude that quantitative PCNA labeling of meningiomas is a promising technique that can provide meaningful prognostic information.

The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

2000 ◽  
Vol 93 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Victor A. Aletich ◽  
Gerard M. Debrun ◽  
Mukesh Misra ◽  
Fady Charbel ◽  
James I. Ausman
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
Guglielmi Detachable Coil ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
The University ◽  
Fine Print

Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

Remote congenital cerebral arteriovenous fistulae associated with aortic coarctation

1992 ◽  
Vol 76 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Francis H. Tomlinson ◽  
David G. Piepgras ◽  
Douglas A. Nichols ◽  
Daniel A. Rüfenacht ◽  
Sue C. Kaste
Keyword(s):  
Caesarean Section ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Vascular Lesions ◽  
Prenatal Ultrasonography ◽  
Arteriovenous Fistulae ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A neonate presented with anatomically discrete cerebral arteriovenous fistulae located in the right sylvian fissure and the cerebellar vermis that were initially detected by prenatal ultrasonography. Following delivery of the baby by Caesarean section, both malformations were treated by surgical obliteration. These intracranial vascular lesions were associated with cardiac anomalies and a periductal coarctation of the aorta, which was treated with a left subclavian rotational arterial pedicle repair. Follow-up examination of the infant at age 13 months demonstrated an excellent clinical result with normalization of the circulation. The pathophysiology of this syndrome is discussed and the literature reviewed.

An intracranial cartilage-containing meningeal tumor

1973 ◽  
Vol 39 (2) ◽  
pp. 261-264 ◽  
Author(s):  
P. G. Lynch ◽  
E. Uriburu
Keyword(s):  
Dura Mater ◽  
Cerebral Hemisphere ◽  
Mesenchymal Tumor ◽  
Content Type ◽  
Meningeal Tumor ◽  
Mesenchymal Tissue ◽  
Right Cerebral Hemisphere ◽  
The Right ◽  
Fine Print

✓ A case is recorded in which a solitary cartilage containing mesenchymal tumor arising from the dura mater over the convexity of the right cerebral hemisphere was successfully removed. The tumor was composed of mesenchymal tissue in which there were several large islands of typical cartilage, sometimes calcified. Suggestions are made as to the possible classifications of this unusual tumor.

Clinical application of a new bioabsorbable artificial dura mater

2002 ◽  
Vol 96 (4) ◽  
pp. 731-735 ◽  
Author(s):  
Keisuke Yamada ◽  
Susumu Miyamoto ◽  
Motohiro Takayama ◽  
Izumi Nagata ◽  
Nobuo Hashimoto ◽  
...  
Keyword(s):  
Dura Mater ◽  
Latent Infection ◽  
Neurosurgical Procedures ◽  
Resonance Imaging ◽  
Content Type ◽  
Dural Substitute ◽  
Collagenous Tissue ◽  
Foreign Body Reactions ◽  
Fine Print

Object. In their pursuit of a better substitute for dura mater in neurosurgical procedures, the authors review their experience with GM972. Methods. A newly developed synthetic dural substitute composed of bioabsorbable polymers (GM972) was placed in 53 patients during neurosurgical procedures. The handling properties of the material, surgical wound features, and findings of hematological, computerized tomography, and/or magnetic resonance imaging examinations were evaluated. The average follow-up period was 35.5 months. The handling properties and biocompatibility of this new dural substitute were highly satisfactory, and no significant complication was observed. In patients who underwent a second surgery performed more than 18 months after the initial operation, this new dural substitute was found to have been replaced by autologous collagenous tissue. Because of its bioabsorbability, chronic foreign body reactions to this synthetic dural substitute were negligible. Conclusions. In this report the authors support the effectiveness and safety of this bioabsorbable artificial dural substitute that provides a reduced risk of transmission of latent infection.

A 10-year follow-up review of patients who underwent Leksell's posteroventral pallidotomy for Parkinson disease

2001 ◽  
Vol 94 (4) ◽  
pp. 552-558 ◽  
Author(s):  
Marwan I. Hariz ◽  
A. Tommy Bergenheim
Keyword(s):  
Parkinson Disease ◽  
University Hospital ◽  
Yahr Stage ◽  
Content Type ◽  
Long Term Effect ◽  
Posteroventral Pallidotomy ◽  
The Mean ◽  
The University ◽  
Fine Print

Object. The clinical condition of patients with Parkinson disease (PD) who had undergone posteroventral pallidotomy (PVP) between 1985 and 1990 was evaluated at a mean of 10 years postsurgery. These patients were part of a larger series described in the first paper on Leksell's PVP that was published in 1992. Methods. Thirteen consecutive patients who had undergone pallidotomy at the University Hospital of Northern Sweden were tracked. Hospital and clinic records that had been updated regularly by the patients' various neurologists, geriatricians, and other clinicians were reviewed. Emphasis was placed on assessing the evolution of PD symptoms after surgery, and changes in the general health and social condition of the patients. The mean follow-up duration was 10.5 years (range 3–13.5 years). Five patients underwent a total of seven subsequent surgeries for their PD, 4 months to 11 years after the initial pallidotomy. The mean Hoehn and Yahr stage was 3 at the first surgery and 3.7 at the last follow-up review (p < 0.005). Dosages of levodopa and dopamine agonists were increased in all patients, without recurrence or induction of dyskinesias contralateral to the pallidotomy. Contralateral tremor, if it was initially controlled by surgery, remained improved. However, most patients exhibited a gradual recurrence of akinesia and an increase in gait freezing. Cognitive decline and presentation with diseases unrelated to PD were not uncommon. Conclusions. The long-term effect of PVP on dyskinesias was not only curative but also appeared to be prophylactic. Contralateral tremor was improved in the majority of patients, although additional surgeries for PD were needed in some patients. Further progression of axial and akinetic symptoms, and an eventual decline in cognition together with other concomitant illnesses, contributed to increased disability in several patients.

Supraclinoid internal carotid artery fenestration with an associated aneurysm

1993 ◽  
Vol 79 (3) ◽  
pp. 438-441 ◽  
Author(s):  
Michael J. Banach ◽  
Eugene S. Flamm
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
The Third ◽  
The Right ◽  
Fine Print ◽  
Supraclinoid Internal Carotid Artery

✓ The case of an aneurysm occurring at the site of fenestration of the supraclinoid portion of the left internal carotid artery (ICA) is reported. A 37-year-old woman presenting with subarachnoid hemorrhage was found to have bilateral ICA aneurysms at the level of the posterior communicating arteries (PCoA's). The patient underwent right-sided craniotomy with uneventful clipping of the right PCoA aneurysm, and attempted clip placement on the contralateral left ICA aneurysm. The follow-up angiogram revealed a residual dome on the left ICA aneurysm, which was noted to originate at the proximal end of a fenestration of the left supraclinoid ICA. This represents the third reported case of fenestration of the intracranial ICA associated with an aneurysm. Intracranial artery fenestrations and their embryological origins are also reviewed.

Seeding of malignant meningioma along a surgical trajectory on the scalp

2002 ◽  
Vol 97 (3) ◽  
pp. 683-686 ◽  
Author(s):  
Wolf O. Lüdemann ◽  
Richard Obler ◽  
Marcos Tatagiba ◽  
Madjid Samii
Keyword(s):  
Malignant Meningioma ◽  
Tumor Removal ◽  
Content Type ◽  
First Report ◽  
The Right ◽  
Cell Dissemination ◽  
The Brain ◽  
Fine Print

✓ The authors report the case of an 11-year-old boy with a malignant meningioma of the right frontal meninges. The tumor was asymptomatic, despite visible exophytic extracranial growth. Neuroimaging demonstrated an en plaque meningioma bulging into the brain. Six months after the tumor had been totally removed by surgery, an isolated subcutaneous metastasis developed at the right preauricular area of the scalp, originating at the scar left by the first surgery. After removal of this metastasis, radiotherapy was conducted. To date the follow-up examinations have not revealed any additional metastases. To the best of the authors' knowledge, this is the first report of a seeding of a subcutaneous metastasis in a child with a malignant meningioma. The authors review the literature with reference to malignant meningiomas and their formation of metastasis. In cases of malignant meningiomas, piecemeal tumor removal carries the risk of iatrogenic cell dissemination even when precautions are taken.

Intraspinal mesenchymal chondrosarcoma

1994 ◽  
Vol 80 (5) ◽  
pp. 928-930 ◽  
Author(s):  
Alok Ranjan ◽  
Geeta Chacko ◽  
Thomas Joseph ◽  
Sushil M. Chandi
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Dura Mater ◽  
Microscopic Examination ◽  
Mesenchymal Chondrosarcoma ◽  
Pia Mater ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A 52-year-old man presented with symptoms of progressive cervical radiculomyelopathy. A myelogram showed an intradural block at the C-6 level. Magnetic resonance T1-weighted imaging revealed a hypointense, sausage-shaped mass extending from C-3 to C-6, located posterolaterally on the right side and pushing the spinal cord to the left and anteriorly. At surgery, a mass was found attached solely to the pia mater, with a normal arachnoid and dura mater overlying it. The mass was excised completely and microscopic examination identified a mesenchymal chondrosarcoma. The patient was symptom-free 6 months after surgery.

Stereotactic radiosurgery for pediatric intracranial arteriovenous malformations: the University of California at San Francisco experience

2002 ◽  
Vol 97 (1) ◽  
pp. 48-55 ◽  
Author(s):  
Matthew D. Smyth ◽  
Penny K. Sneed ◽  
Samuel F. Ciricillo ◽  
Michael S. Edwards ◽  
William M. Wara ◽  
...  
Keyword(s):  
Partial Response ◽  
San Francisco ◽  
Arteriovenous Malformations ◽  
University Of California ◽  
Content Type ◽  
Obliteration Rate ◽  
The Mean ◽  
The University ◽  
Fine Print

Object. Stereotactic radiosurgery for arteriovenous malformations (AVMs) is an accepted treatment option, but few reports have been published on the results of this treatment in children. In this study the authors describe a series of pediatric patients with a minimum follow-up duration of 36 months. Methods. From 1991 to 1997, 40 children (26 boys and 14 girls) with AVMs were treated with radiosurgery at the University of California at San Francisco (UCSF). Follow-up information was available for 31 children (20 boys and 11 girls) in whom the median age at initial treatment was 11.2 years (range 3.4–17.5 years). The median follow-up duration was 60 months (range 6–99 months). Sixteen percent of the AVMs were Spetzler—Martin Grade II; 68%, Grade III; 10%, Grade IV; and 6%, Grade V. The mean volume of the AVMs was 5.37 cm3 and the median volume was 1.6 cm3. The mean marginal dose of radiation was 16.7 Gy and the median dose was 18 Gy (range 12–19 Gy). Angiography performed in 26 children confirmed obliteration of the AVM nidus in nine patients (35%), partial response in 16 patients (62%), and no response in one patient (4%). In five patients who refused angiography, magnetic resonance (MR) imaging revealed obliteration in two patients and partial response in three patients, bringing the overall obliteration rate associated with initial radiosurgery to 35%. Logistic regression analysis confirmed a significant correlation between marginal dose prescription and response (p = 0.025); in AVMs that received at least 18 Gy there was a 10-fold increase in the obliteration rate (63%) over AVMs that received a lower dose. Lesions smaller than 3 cm3 were associated with a sixfold increased obliteration rate (53%) over lesions larger than 3 cm3 (8%), but AVM volume was not a statistically significant predictor of response (p = 0.09). Twelve patients have since undergone repeated radiosurgery and are currently being followed up with serial MR imaging studies (in five cases, the AVM is now obliterated). During the follow-up period (1918 patient-months) there were eight hemorrhages in five patients, with a cumulative posttreatment hemorrhage rate of 3.2%/patient/year in the 1st year and a rate of 4.3%/patient/year over the first 3 years. There were two permanent neurological complications (6%) and no deaths in this study. Conclusions. The lower overall obliteration rate reported in this series is most likely due to the larger mean AVM volumes treated at UCSF as well as conservative dose—volume prescriptions delivered to children. Significantly higher obliteration rates were observed when a marginal radiation dose of at least 18 Gy was delivered. The permanent complication rate is low and should encourage those treating children to use doses similar to those used in adults.

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