Incidence and survival of gliomatosis cerebri: a population-based cancer registration study.

Gliomatosis cerebri (GC) comprises a rare widespread infiltrating growth pattern of diffuse gliomas. We explored the incidence patterns and survival rates of GC in a population-based registration sample from the Surveillance, Epidemiology and End, Results database (1973-2012). GC cases (n = 176) were identified based on their International Classification of Diseases in Oncology (ICD-O-3) morphology code (9381). We calculated age-adjusted incidence rates (AIR) and evaluated temporal trends. Survival was assessed with Kaplan-Meier curves and Cox regression models. The annual AIR of GC was 0.1/million. We noted increasing trends in the preceding registration years (1973-2002; annually, + 7%) and a tendency of clinical/radiological approaches to substitute the gold-standard histological assessment for diagnosis. GC was diagnosed in the entire age spectrum (range 1-98 years), but higher incidence rates (0.43/million) were noted among the elderly (≥ 65 years). A slight male preponderance was identified (male-to-female ratio: 1.4). Median overall survival was 9 months with a 5 year survival rate of 18%. Increasing age, primary tumor location not restricted to the cerebral hemispheres and rural residence at diagnosis were identified as negative prognostic factors, whereas receipt of radiotherapy, surgical treatment, race and method of diagnosis were not associated with outcome. This first comprehensive overview of GC epidemiology exemplifies the rarity of the disease, provides evidence for male preponderance and increased incidence among the elderly and shows lower survival rates compared to the published single center reports. Expansion of registration to histological and molecular characteristics would allow emergence of clinical prognostic factors at the population level.

The ancient Hellenic and Hippocratic origins of head and brain terminology.

Corpus Hippocraticum, a collection of Hippocratic writings, is considered to be the first written monument of rationale medicine. This article focuses on a series of ancient Hellenic words which are cited in Hippocratic passages and have been adopted in current head and brain terminology either invariably, i.e., keeping their original meaning, or as component parts of newly formed terms. This study aims to demonstrate first that the deeper roots of current neuroanatomical terminology spread in Hippocratic writings and second, that ancient Hellenic remains a living language that would probably ever continue to play a catalytic role in the formation of neuroanatomical glossary by providing accurate, emblematic, and functional terms.

The Hellenic and Hippocratic origins of the spinal terminology.

Numerous Hellenic terms have been gradually adopted during the development of modern medical science. Moreover, there are a significant number of words that derive directly from the Hippocratic texts. Hippocrates (ca. 460-ca. 377 BC), revered as the father of medicine, and his followers left behind a valuable heritage of medical knowledge that, practically, laid the foundations of Western medicine. Their theories, collected in Corpus Hippocraticum, transformed medicine by adding, mainly, clinical observation and inductive reasoning as significant parts of medical diagnosis and treatment. Additionally, Hippocratic writings have provided an invaluable heritage of medical terms for all medical fields. The present article examines the Hellenic and Hippocratic terminology referring to the spine and how this vocabulary has influenced and dominated upon modern spinal onomatology.

The future of peripheral nerve stimulation.

The field of peripheral nerve stimulation (PNS) is now experiencing a phase of rapid growth in number of patients, number of implanters, number of indications, and procedure types. This, however, appears to be only a beginning of major developments that could revolutionize the field of PNS. It is expected that the progress in PNS will continue simultaneously in several directions as new indications, new stimulation targets and new device designs evolve in the foreseeable future. Responding to a major need for safe and effective pain treatments and following a general trend toward less-invasive and nondestructive interventions, PNS has the potential of becoming a premier pain-relieving modality that will be used instead of or in combination with existing more established approaches such as spinal cord stimulation and pharmacological pain control. Recent technological advancements are cause for considerable optimism regarding the development of PNS and are likely to be a beginning of a major overhaul in our perception of PNS approaches. Expanding the number of applications will without question strengthen the field of PNS. The turning point, however, will not occur until sufficient scientific evidence is gathered to unequivocally prove its safety, clinical efficacy and cost-effectiveness, and when PNS applications become officially endorsed through regulatory approval of each indication. Such changes will allow implanters to use approved devices for approved indications--instead of the contemporary 'off-label' use--and at the same time give device manufacturers a chance to market these devices and support education on their appropriate use.

Bifocal cortical electrical stimulation for pain by interdural implantation of the electrodes.

Chronic electrical cortical stimulation (ECS) is an evolving therapy for alleviating treatment-refractory chronic pain syndromes. In this report, the authors describe a modified technique of ECS that involves resection of dural strips and interdural placement of the electrodes as a patch, and bifocal stimulation by implanting 2 electrode strips, that is, one over the motor and one over the sensory cortices. The technique was used in 4 patients with treatment-refractory pain syndromes: a 76-year-old woman with poststroke central pain, 2 women, (71 and 73 years old) with trigeminal pain, and a 44-year-old man with phantom limb pain. All 4 patients experienced a sustained significant improvement in the intensity of pain and have gained a substantially improved functionality and quality of life. An important finding in these patients was the constancy of impedance within a narrow values range throughout the postoperative period. For the cases, the follow-up exceeds 24, 15, 12, and 9 months. The factors affecting the efficacy of ECS are discussed. In the authors' opinion, interdural implantation of the electrodes holds the promise to improve the efficacy and consistency of ECS compared with the standard epidural or subdural implantation without increasing the risk of the procedure. The technical considerations and the potential therapeutic advantages of the interdural bifocal approach are discussed.

Restoration of erect posture in idiopathic camptocormia by electrical stimulation of the globus pallidus internus.

The authors report on 2 young patients who developed drug-resistant idiopathic dystonic camptocormia (bent spine) and were treated successfully by deep brain stimulation (DBS) of the globus pallidus internus (GPi). The first patient, a 26-year-old woman, suffered for 3 years from such severe camptocormia that she became unable to walk and was confined to bed or a wheelchair. The second patient, a 21-year-old man, suffered for 6 months from less severe camptocormia; he was able to walk but only for short distances with a very bent spine, the arms in a parallel position to the legs, and the hands almost approaching the floor to potentially support him in case of a forward fall. Within a few days following DBS, both patients experienced marked clinical improvement. At most recent follow-up (44 months in one case and 42 in the other), the patients' ability to walk upright remained normal. Similar findings have only been reported recently in a few cases of camptocormia secondary to Parkinson disease or tardive dyskinesia. On the basis of the experience of these 2 idiopathic cases and the previously reported cases of secondary camptocormia with a favorable response to GPi DBS, the authors postulate that specific patterns of oscillatory activity in the GPi are vital for the maintenance of erect posture and the adoption of bipedal walking by humans.

Treatment of idiopathic head drop (camptocephalia) by deep brain stimulation of the globus pallidus internus.

Deep brain stimulation of the globus pallidus internus has been shown to be beneficial in a small number of patients suffering from axial dystonias. However, it has not yet been reported as an effective treatment for the alleviation of idiopathic head drop. The authors describe a 49-year-old woman with idiopathic cervical dystonia (camptocephalia) who was unable to raise her head > 30 degrees when standing or sitting; her symptoms would abate when lying down. This disabling neurological condition was treated successfully with bilateral chronic electrical stimulation of the globus pallidus internus.

Paroxysmal otalgia due to compression of the intermediate nerve: a distinct syndrome of neurovascular conflict confirmed by neuroimaging. Case report.

The authors present the case of a 52-year-old female patient with a 6-year history of intractable paroxysmal otalgia. Preoperative magnetic resonance (MR) angiography demonstrated an anterior inferior cerebellar artery loop compressing the intermediate nerve in the seventh/eighth cranial nerve complex inside the internal auditory canal. The pain resolved completely after a microvascular decompression via a retromastoid craniotomy. To the best of the authors' knowledge, the combined neuroimaging and intraoperative findings of this case provide a unique demonstration that vascular compression of the intermediate nerve can be the exclusive cause of paroxysmal otalgia. Magnetic resonance imaging and MR angiography can establish the causative mechanism and distinguish this otalgia due to vascular compression of the intermediate nerve from other pain syndromes that are designated as geniculate neuralgia (GN). The present case indicates that intermediate nerve neuralgia is a distinct syndrome of neurovascular conflict and a variant of GN. The causative classification of GN should be reexamined with the use of advanced MR imaging.

Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication.

Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.

Rostral cingulate gyrus: A putative target for deep brain stimulation in treatment-refractory depression.

Surgery for intractable affective illnesses has generated considerable controversy over the last century. Deep brain stimulation (DBS) has revolutionized neurosurgical practice, especially in the field of advanced Parkinson's disease and, more recently, in selected medical-refractory cases of obsessive-compulsive disorder. In this paper, we propose a discrete area of the rostral cingulate gyrus as a potential target for DBS in medical-resistant depressive patients. Brodmann's area 24a has proved to be a vital link in the integration of neural circuits underlying depression, both through proposed neurobiological models and accurate neuroimaging studies. The full reversibility and adjustability of DBS offer the best chance to treat the multidimensional and life-span profile of depression, so giving hope to a great number of desperate human beings.

Hippocrates: a pioneer in the treatment of head injuries.

Hippocrates' treatise On Wounds in the Head represents an excellent source of information regarding the extent of experience with head injuries in classical antiquity. On the basis of clinical observation, the great physician gives an accurate description of the external appearance and consistency of the cranium. Fractures of the cranium are divided into six main categories, each of which is discussed separately, regarding its mechanism, clinical assessment, and treatment. The medical history and clinical evaluation are considered the most important factors when dealing with cranial trauma. Trepanation, a neurosurgical procedure still in practice today, is presented in detail. As a whole, the treatise, the first written work in medical history dealing exclusively with cranial trauma, reveals that Hippocrates was a pioneer in treating head injuries.

Mitochondria-rich normal, metaplastic, and neoplastic cells show overexpression of the epitope H recognized by the monoclonal antibody H.

The epitope H contains an O-linked N-acetylglucosamine (O-GlcNAc) residue in a specific conformation and/or environment recognized by monoclonal antibody H (mAbH). We have previously shown that the epitope H is present in more than one polypeptide and in various types of normal and pathological cells. In the present study, we focused on mitochondria-rich normal, metaplastic, and neoplastic cells, prompted by our recent immuno-electron microscopy findings that mAbH clearly stains the mitochondria of breast epithelial cells in infiltrating ductal breast carcinomas and fibroadenomas. The indirect immunoperoxidase method was applied using the mAbH to investigate the distribution of the epitope H in mitochondria-rich normal cells and in metaplastic and neoplastic oncocytic cells. Immunohistochemical staining for the mAbH was observed in oxyphil cells of parathyroid glands, in striated duct cells of parotid glands, in urinary tubules of kidneys, in parietal cells of gastric body mucosa, in oxyphil cells of Hashimoto's thyroiditis, in epithelial cells of Warthin's tumors of the parotid gland, in neoplastic cells of oxyphil adenomas and carcinomas (Hürthle's tumors) of the thyroid gland, and in neoplastic cells of oncocytomas of the kidneys. The present study shows that the epitope H is strongly expressed in mitochondria-rich normal cells, as well as in metaplastic and neoplastic oncocytic cells, which are known to have cytoplasms packed with mitochondria. Since mAbH recognizes an O-GlcNAc residue, our findings indicate that O-GlcNAc-glycosylated polypeptides are present at mitochondria where the components of the respiratory chain and energy transduction are localized. These findings may be of interest for gaining insight into the histophysiology of mitochondria-rich normal cells and into the pathogenesis of oncocytic lesions, since O-GlcNAc glycosylation may modify proteins involved in oncogenesis such as tumor suppressor proteins and oncoproteins, as well as proteins with important biological functions such as cytoskeletal proteins, transcription factors, heat-shock proteins, and chromatin proteins.

Hydrocephalus according to Byzantine writers.

OBJECTIVE: To describe hydrocephalus, the techniques applied for its treatment by Byzantine physicians, and their later influence. METHODS: A study and analysis of the original texts of the Byzantine medical writers, written in Greek, was undertaken. A comparison with current concepts also was made. RESULTS: Three eminent Byzantine physicians: Oribasius (4th century AD), Aetius (6th century AD), and Paul of Aegina (7th century AD) gave the first detailed information regarding hydrocephalus and its conservative and surgical treatment. These physicians, who were trained in Alexandria, quote the concepts of the now-lost works of the celebrated surgeons of the Pneumatic School of Alexandria Leonides and Heliodorus (1st century AD) and its follower Antyllus (2nd century AD). In the types of hydrocephalus they described, we identify the conditions currently known as cephalhematoma and subgaleal hematoma, for which conservative and surgical treatments were provided, and epidural hematoma, which was thought to be incurable. CONCLUSION: The term hydrocephalus was coined during the Hellenistic period. The clinical picture of the disease, however, as described by later Byzantine physicians, does not correspond to current concepts. The ideas of the Byzantine physicians were based on the ancient Hippocratic, Hellenistic, and Roman traditions, which influenced Arab medicine and then Western European medicine, thus constituting significant roots of modern neurosurgery.