Expression of Epidermal Growth Factor Receptor in Astrocytoma

It has been demonstrated that the epidermal growth factor receptor(EGFR) gene, the normal human counterpart of the viral erb-B oncogene, is amplified and overexpressed in 40-50% of malignant astrocytomas. Although little is known about the functional status of the overexpressed protein molecule, overexpression of a growth factor receptor evenly distributed throughout a tumor would be an ideal target for monoclonal antibody or growth factor receptor targeted therapy. We undertook the immunohistochemical study of the EGFR with malignancy grade. The results were as follows 1) Expression of EGFR was deteced in 1 case(6.7%) of low grade astrocytoma, 14 cases(63.6%) of anaplastic astrocytoma and 19 cases(73.1%) of glioblastoma multiforme. It was more frequent in malignant astrocytoma that low grade astrocytoma(p<0.01). 2) The distributed proportion and staing density of EGFR-expressed tumor cells was more increased in glioblastoma multiforme than anaplastic astrocytoma. 3) Regional heterogeneity of EGFR-expressed tumor cells was recognized in cases of EGFR expressed malignant astrocytoma. These results suggest that overexpression of EGFR would be involved in malignant progression of astrocytoma, and the use of monoclonal antibody or growth factor receptor targeted therapy maybe limited due to heterogeneity of EGFR expressed tumor cells in malignant asrotcytoma.

Clinical Analyzed of Thoracic Level Spinal Cord Injured Patients

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.

Subtemporal Transpetrosal Approach for Aneurysms of the Low-Lying Basilar Bifurcation

Surgical approaches for aneurysms of the basilar artery trunk are variable and utilized depending on the location of the aneurysms and direction of the fundus of the aneurysms. We operated one patient with low lying basilar bifurcation aneurysms facing toward the brain stem by subtemporal transpetrosal approach with successful clipping of aneurysms. The advantage of this approach to low-lying basilar bifurcation or basilar trunk aneurysms over the pterional, subtemporal(transtentorial), combined supratentorial and infratentorial, transoral, and suboccipital approach are discussed.