Surgery for spinal cord lipomas.

OBJECTIVES: To analyze the results after surgery for spinal cord lipomas. METHODS: The authors report their results of management of 63 non consecutive random children with spinal cord lipomas treated over a period from 2001 to 2005, at the All India Institute of Medical Sciences, New Delhi, India, a tertiary care neurosurgical centre. RESULTS: There were 63 cases consisting of 32 (52%) conus lipomas, 14 (22%) filum lipomas, 14 (22%) lipomeningomyelocele (lipoMMC), 2 (2.5%) cases of lipomyelocystocele and one (1.5%) case of mixed lipoma. None of the patients who were asymptomatic before surgery deteriorated neurologically, irrespective of the type of lipoma till the last follow up. In those patients with preexisting neurological deficits, the improvement in motor, sensory and bladder abnormalities was only to an extent of 15 %, 16 % and 21 % respectively. None of the children with preexisting neurological deficit regained overall normal function. Nevertheless, the improvement in symptoms after surgery made the patients lead a better social life. Only 6 % of patients developed deterioration in neurological function after surgery, all of them occurring in patients already having pre-operative deficits. CONCLUSIONS: The authors recommend prophylactic surgery which is safe and effective in preventing neurological deficits, irrespective of the type of lipoma. Most of the patients benefit only to some extent even after surgery, once they develop neurological dysfunction. A close long term follow up is recommended in order to detect neurological deterioration even in children operated prophylactically.

Post operative 'pituitary apoplexy' in giant pituitary adenomas: a series of cases.

This is report on four cases of giant pituitary tumors that developed postoperative pituitary apoplexy after they had undergone a partial tumor resection. Three patients had undergone surgery by a transsphenoid route and one patient underwent surgery by transcranial route. Postoperative CT scan showed hemorrhagic expansion of residual tumor mass. All the four patients were re-explored transcranially and hemorrhagic swelling of the tumor was observed. In three cases, the tumor had swollen to a size greater than twice the original tumor. All the four patients had a fatal outcome.

Expression of the neurotrophin receptors Trk A and Trk B in adult human astrocytoma and glioblastoma.

Neurotrophins and their receptors of the Trk family play a critical role in proliferation, differentiation and survival of the developing neurons. There are reports on their expression in neoplasms too, namely, the primitive neuroectodermal tumours of childhood, and in adult astrocytic gliomas. The involvement of Trk receptors in tumour pathogenesis, if any, is not known. With this end in view, the present study has examined 10 tumour biopsy samples (identified as astrocytoma, pilocytic astrocytoma and glioblastoma) and peritumoral brain tissue of adult patients, for the presence of Trk A and Trk B receptors, by immunohistochemistry. The nature of the tumour samples was also confirmed by their immunoreactivity (IR) to glial fibrillary acidic protein. In the peritumoral brain tissue, only neurons showed IR for Trk A and Trk B. On the contrary, in the tumour sections, the IR to both receptors was localized in the vast majority of glia and capillary endothelium. There was an obvious pattern of IR in these gliomas: high levels of IR were present in the low-grade (type I and II) astrocytoma; whereas in the advanced malignant forms (WHO grade IV giant cell glioblastoma and glioblastoma multiforme) the IR was very weak. These findings suggest that Trk A and Trk B are involved in tumour pathogenesis, especially in the early stage, and may respond to signals that elicit glial proliferation, and thus contribute to progression towards malignancy.