The role of technology in the modern stereotactic radiotherapy: protocol of the S.C. Radiotherapy of Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria

AIMS: The aim of this paper is the drafting of a uniform protocol within our Complex Radiotherapy Structure for the execution of stereotaxic radiant treatment. METHODS: We collected the different personal experiences of the members of the Radiotherapy Team, with a review of the literature of articles concerning the stereotaxic technique, taking into account the indications provided by the Italian Society of Radiotherapy (AIRO). RESULTS: It was possible to outline a scheme divided by body district designed to homogenize and standardize the stereotactic radiant treatment within our department. CONCLUSIONS: This work has allowed us to obtain a better organization of the work in the preparation, execution and post-treatment reassessment regarding a technique recently introduced in our Department.

Transplanted Neural Stem Cells: Playing a Neuroprotective Role by Ceruloplasmin in the Substantia Nigra of PD Model Rats?

Although mounting evidence suggests that ceruloplasmin (CP) deficiency and iron deposition are pivotal factors responsible for exacerbating demise of dopaminergic neurons in the substantia nigra (SN) of the Parkinsonism and neural stem cells (NSCs) are believed to be excellent candidates for compensating the lost dopaminergic neurons, there are few researches to explore the change of CP expression and of iron deposition in the pathological microenvironment of SN after NSCs transplantation and the ability of grafted NSCs to differentiate directionally into dopaminergic neurons under the changed homeostasis. With substantia nigral stereotaxic technique and NSCs transplantation, we found that tyrosine hydroxylase and CP expression decreased and iron deposition increased in the lesioned SN after 6-OHDA administration compared with control, while tyrosine hydroxylase and CP expression increased and iron deposition decreased after NSCs transplantation compared to 6-OHDA administration alone. Only a small number of embedding NSCs are able to differentiate into dopaminergic neurons. These results suggest that grafted NSCs have an influence on improving the content of CP expression, which may play a neuroprotective role by decreasing iron deposition and ameliorating damage of dopaminergic neurons and possibly underline the iron-related common mechanism of Parkinson’s disease and Wilson’s disease.

Interactions entre recherches fondamentale et clinique. Deux exemples tirés d'une expérience personnelle

ABSTRACT:Basic research helps to understand clinical knowledge which in turn leads to new fundamental research. Two examples are taken from the studies of the anomalies existing in the brain of patients suffering from Parkinson disease or deafferentation Pain. The researches performed to solve these two problems for the past 40 years (in particular by the author's working group) are replaced in the international context. In Man the precision of stereotaxic technique was improved by using the organisation of the somato-sensory thalamic projection described in animals by the physiologists. In the thalamus of Parkinsonian patients, the presence of cells bursting at tremor frequency led to search for the relations existing between the striato-nigral system and the motor thalamus. In the patients suffering from deafferentation Pain, a special role is attributed to the medial thalamus, whose characteristics were formerly studied in animals. The origin of the deafferentation Pain is nowadays studied in an animal model of this disease.

Stereotaxic reconstruction of the aqueduct of Sylvius

✓ A stereotaxic technique has been developed to cannulate the cerebral aqueduct in patients with hydrocephalus resulting from occlusion of the aqueduct of Sylvius. Precise placement of a 15- to 20-mm long radiopaque prosthesis between the third and fourth ventricles can reestablish the normal cerebrospinal fluid (CSF) pathway. Since 1974, seven patients have undergone aqueductal reconstruction. The surgical goal in this series was to manage the hydrocephalus by creating and maintaining a patent aqueductal channel. The follow-up period ranged from 1.5 to 6.5 years. In four cases, aqueductal reconstruction alone resulted in control of the hydrocephalus, although two patients underwent revisions of their prosthesis. Three patients ultimately required shunts, despite initial symptomatic improvement after reconstruction. In these seven cases (13 stereotaxic procedures), no mortality and no significant operative morbidity were encountered. Although the technique is relatively simple to perform, technical difficulties remain. At present, no clinical or radiographic test adequately discerns the ideal candidate for stereotaxic aqueductal reconstruction. Four patients required stereotaxic revision because of malposition or malfunction of the prosthesis. This approach should be reserved for patients with a short aqueductal occlusion, and normal distal CSF pathways and dynamics. The rationale, technique, problems, and results of stereotaxic reconstruction are presented.

Stereotaxic thrombosis of inaccessible intracranial aneurysms

✓ Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the successful treatment of aneurysms arising at the origin of the ophthalmic artery, within the cavernous sinus, within the sella turcica, and from the vertebrobasilar and the posterior inferior cerebellar arteries ventral to the brain stem. The aneurysms within the sella or cavernous sinus can be approached through the sphenoid sinus, and the aneurysms ventral to the brain stem can be approached through the clivus without opening the dura.