Gliosarcoma arising from oligodendroglioma (Oligosarcoma): A case report with genetic analyses.

Gliosarcomas are a type of bimorphic tumor composed of glial and sarcomatous elements, and are considered to be a variant of glioblastoma, WHO grade IV. To date, only rare cases of gliosarcoma with oligodendroglial components (oligosarcoma) have been reported. We report a case of oligosarcoma consisting of gliosarcoma arising from recurrent oligodendroglioma. A 53-year-old man, who had undergone a gross total resection of oligodendroglioma (WHO grade II) 11 years earlier, presented with a local tumor recurrence. The patient underwent a second gross total resection, whereupon a histopathological examination further revealed residual features of classical oligodendroglioma, and newly-developed sarcomatous characteristics. Both the primary and recurrent tumors showed 1p/19q co-deletion and mutation of the isocitrate dehydrogenase 1 (IDH1) gene, consistent with being oligodendroglial in nature. Loss of heterozygosity (LOH) of chromosome 1p/19q and IDH1 mutation have seldom been analyzed in previous reports of oligosarcomas. We report a rare case study supported by the results of genetic analyses. Our analyses have revealed that the sarcomatous component represents a metaplastic change occurring in the oligodendroglial element.

Factors influencing local tumor control after Gamma Knife radiosurgery for intracranial metastases from breast cancer.

Because evaluation of Gamma Knife radiosurgery (GKRS) for brain metastases (METs) has mainly been based on overall or progression-free survival rates, that is, patients' general condition and control of the primary disease, we focused on factors influencing local tumor control after GKRS for METs from breast cancer. Data were retrospectively collected from our institution's records of patients who had undergone GKRS twice or more for METs from breast cancer. Failed GKRS was defined as a tumor needing re-treatment by further GKRS or having already been treated by other modalities prior to later GKRS procedures. Influences of various factors on local tumor control were examined. GKRS was performed on 623 tumors in 123 sessions in 90 patients. Median follow up was 9months (range 1-41months). According to multivariate analysis, use of HER2-targeting agents, (hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.18-0.99, p=0.049), five or more lesions (HR 0.24, 95% CI 0.11-0.51, p<0.001), volume >1.2cm3 (HR 3.12, 95% CI 1.62-6.02, p<0.001), use of GK model B (HR 2.53, 95% CI 1.28-4.98, p=0.0076), and prescribed dosage ⩾18Gy (HR 0.19, 95% CI 0.01-0.51, p<0.001) were predictors of failed GKRS. Patients with METs from breast cancer with HER2-positive tumors, five or more lesions, and tumors of volume ⩽1.2cm3 are good candidates for GKRS. GK model C and Perfexion achieve better local tumor control than does GK model B. The recommended dosage is ⩾18Gy.

Triple-balloon shunt placement for carotid endarterectomy: a novel intraluminal shunt designed to preserve the internal and external carotid blood flow.

OBJECTIVE: To report a newly developed intraluminal triple-balloon shunt designed to preserve the blood flow of both the internal carotid artery (ICA) and the external carotid artery (ECA) during carotid endarterectomy in patients with a previous ipsilateral extracranial-intracranial bypass, in whom hemodynamic cerebral ischemia might be caused by cross-clamping at the ICA as well as the ECA. METHODS: The novel device consists of 3 silicone tubes equipped with balloons at each end. The design facilitates insertion proximally to the common carotid artery and distally to both the ICA and the ECA. RESULTS: The new shunt tube was used in 3 patients, each of whom had previously undergone ipsilateral superficial temporal artery-middle cerebral artery bypass for proximal middle cerebral artery occlusion. The blood flow of the middle cerebral artery and anterior cerebral artery was supplied independently from the ECA via the bypass and from the ICA, respectively. There were no shunt-related complications. CONCLUSIONS: This novel shunt device can be used safely and effectively in cases requiring preservation of the blood supply to both the ICA and the ECA during carotid endarterectomy.

[Usefulness of dynamic MRA and CTA in diagnosis and postoperative evaluation in spinal dural arteriovenous fistula: a case report].

Here we report a case of spinal dural arteriovenous fistula that was diagnosed on MRA and CTA, and then treated by endovascular embolization. A 56-year-old male presented with slowly progressive intermittent claudication and numbness of the lower extremities. T2-weighted MR imaging showed the swelling of the spinal cord with an intramedullary high signal intensity area and dilated vessels with signal flow void at the dorsal aspect of spinal cord. Dynamic MRA demonstrated the feeding artery, shunt point and the overview of dilated veins as seen with a CTA. Endovascular embolization using liquid material was performed under local anesthesia. The injection of glue included the distal feeding artery, the shunt itself and the initial part of the draining vein. A complete cure was achieved. CTA after embolization demonstrated the glue cast and the disappearance of the AV shunt and dilated veins that were visible before embolization. It was suggested that dynamic MRA and CTA are useful for the final diagnosis and postoperative evaluation of spinal dural arteriovenous fistulas.

[Spontaneous vertebral arteriovenous fistula manifestating as radiculopathy].

A 61-year-old man presented with a rare case of spontaneous vertebral arteriovenous fistula manifesting as radiculopathy of the left arm. MRI demonstrated an abnormal dilated vascular space on the left ventral aspect of the spinal canal and compression of the spinal cord and subarachnoid space. MRA disclosed a single high-flow vertebral arteriovenous fistula. Angiography showed a direct high-flow fistula at the C2-3 level between the left vertebral artery and the spinal extradural veinous plexus, and an abnormal dilated left vertebral artery with "string of beads"-like feature. The fistula was successfully obliterated by coil embolization with preservation of patency of the left vertebral artery, resulting in improvement of the signs and symptoms. Retrospectively this spontaneous vertebral arteriovenous fistula was considered in association with fibromuscular dysplasia.

[Multiple chronic subdural hematoma in shaken-baby syndrome].

We described a case of shaken-baby syndrome with multiple chronic subdural hematomas. A 10-month-old male baby was admitted to our hospital because of loss of consciousness and convulsions. CT scan revealed an acute subarachnoid hemorrhage extending into the interhemispheric fissure and supracerebellar space. The patient was treated conservatively, and discharged from the hospitaL Two months after ictus, a baby was admitted to our hospital with general fatigue. CT scan demonstrated multiple chronic subdural hematomas. Burr hole irrigation and drainage brought about complete disappearance of these lesions. Retrospectively, it was found that these multiple subdural hematomas were due to shaken-baby syndrome. Shaken-baby syndrome is a form of child abuse that can cause significant head injury, and subdural hematoma is the most common manifestation. It is well known that the outcome of shaken-baby syndrome is generally not good. It is important to suspect shaken-baby syndrome when a chronic subdural hematoma is seen in a baby.

Inferior temporal sulcus approach for amygdalohippocampectomy guided by a laser beam of stereotactic navigator.

OBJECTIVE: To describe a surgical technique for a minimally invasive transcortical transventricular amygdalohippocampectomy via the inferior temporal sulcus (ITS) using a stereotactic navigator. METHODS: Seven patients with medically intractable mesial temporal lobe epilepsy underwent an amygdalohippocampectomy via the ITS. By use of a laser-guided navigation system, the epileptogenic foci of the mesial temporal lobe were resected through a small linear operative route that was made by a brain speculum inserted from the ITS to the anterolateral floor of the temporal horn in the lateral ventricle. RESULTS: All patients completed at least a 1-year follow-up (range, 14-45 mo) after surgery and had improved neuropsychological parameters as a result of the operation. All patients became seizure-free after surgery. A Humphrey visual field perimeter detected no hemianopsia. CONCLUSION: Combined with the stereotactic navigation system, the ITS approach provides the least invasive amygdalohippocampectomy that preserves optic radiation. This approach seems beneficial especially in patients in whom the epileptic lesions are limited to the anterior mesial temporal lobe.

Implantation of deep brain stimulation electrodes in unshaved patients. Technical note.

Although hair removal prior to neurosurgery may increase the risk of infection, the practice of shaving the patient's entire head is still common, particularly in implant surgery. The authors describe a technique for implanting a deep brain stimulation electrode without shaving the patient's hair and present a retrospective analysis of 261 implantations in 221 cases.