ABSTRACT
Tumours of the quadrigeminal plate in adults are usually benign. Nevertheless, obstructive hydrocephalus due to compression of the Sylvian aqueduct is an almost invariable early finding. Whether or not direct excision is undertaken, temporary or permanent treatment of the hydrocephalus is warranted. Endoscopic third ventriculostomy is an alternative to insertion of a shunt and provides both acute and long-term relief of hydrocephalus-related symptoms. We chose a two-stage approach for treating a tectal ganglioglioma in an adult: endoscopic third ventriculostomy followed by surgical excision. The advantages and disadvantages of each therapeutic strategy are discussed.
Subject(s)
Brain Stem Neoplasms/surgery , Ganglioglioma/surgery , Hydrocephalus/surgery , Tectum Mesencephali/surgery , Third Ventricle/surgery , Ventriculostomy/methods , Adult , Brain Stem Neoplasms/complications , Brain Stem Neoplasms/pathology , Cerebral Aqueduct/pathology , Cerebral Aqueduct/physiopathology , Decompression, Surgical/methods , Endoscopy/methods , Ganglioglioma/complications , Ganglioglioma/pathology , Humans , Hydrocephalus/pathology , Hydrocephalus/physiopathology , Magnetic Resonance Imaging , Male , Tectum Mesencephali/pathology , Tectum Mesencephali/physiopathology , Third Ventricle/pathology , Third Ventricle/physiopathology , Treatment Outcome , Ventriculostomy/instrumentationABSTRACT
Caveolin-1 (Cav-1) protein has been documented in several neoplasms with a controversial role in cell proliferation, tumour development and progression. The aim of the present study was to investigate the Cav-1 immunohistochemical expression in human meningiomas. Sixty-two cases, classified as 11 meningothelial (17%), 12 transitional (19%), 5 fibrous (8%), 3 microcystic (5%), 3 secretory (5%), 1 clear cell (2%), 1 chordoid (2%) and 26 (42%) atypical meningiomas, were selected from our pathological files. Clinico-pathological data, including Ki-67 values and survival data were also available. Ten leptomeningeal samples were utilized as normal tissue control. For each case, a polyclonal antibody against Cav-1 was applied and an intensity distribution (ID) score was determined. The Cav-1 immunoexpression was found in 95% of meningiomas with a variable ID score, while only minimal, not uniform, reactivity was noted in non-neoplastic meninges. Of note, higher Cav-1 ID score was significantly correlated with tumour site, Simpson's grade, histological type, higher histologic grade, Ki-67 labelling index > or = 4% and clinical course. Kaplan-Meier curves demonstrated a significantly worse survival in patients with higher Cav-1 ID score, Ki-67 > or = 4% and 2-3 Simpson grade. Multivariate analysis indicated that only Ki-67 was an independent prognostic factor. Increased immunoexpression of the Cav-1 seems to be associated with the biological aggressiveness of meningiomas, reflecting a worse prognosis.
