Correlation of intraluminal thrombosis in brain tumor vessels with postoperative thrombotic complications: a preliminary report.

OBJECT: Thrombotic complications (deep vein thrombosis and/or pulmonary embolization [DVT/PE]) occur in 18 to 50% of patients harboring brain tumors who undergo neurosurgical procedures. Such patients are at risk for DVT/PE because of immobility, paresis, hypovolemia, and lengthy surgery. The present study was undertaken to see whether tumor patients at highest risk for DVT/PE could be identified so that augmentation of prophylactic measures might be used to reduce the incidence of thrombotic complications. METHODS: The authors conducted a retrospective analysis of 488 patients enrolled in their brain tumor registries between 1988 and 1995, identifying 57 patients (12%) with recorded symptomatic DVT, PE, or both postoperatively. In 24 of these 57 cases histological specimens were retrievable for review, allowing an in-depth analysis. Forty-five patients were lost to follow-up review, and the remaining 386 patients had no record of systemic thrombosis. Slides of pathological specimens were retrievable in 50 cases in which there was no DVT/PE. From these 50 cases, 25 were selected at random to represent the control group by a blinded observer. Seventeen (71%) of the 24 brain tumor specimens obtained in patients with DVT/PE stained positively for intraluminal thrombosis (ILT) after hematoxylin and eosin had been applied. The odds ratio associated with the presence of ILT was 17.8, with a confidence interval ranging from 4 to 79.3. No evidence of ILT was found in 22 patients (88%) within the control group (p < 0.0001, Fisher's exact test). Other factors that may predispose patients with brain tumors to DVT/PE-limb paresis, extent of tumor removal, and duration of the surgery-were also analyzed and found not to be statistically significant. Therefore, these factors were not the basis for differences seen between the study and control groups. CONCLUSIONS: These preliminary observations suggest that the presence of ILT within malignant glioma or glioblastoma tumor vessels may represent a marker of tumor-induced hypercoagulability.

Late intracranial metastasis from esthesioneuroblastoma: case report and review of the literature.

Review of the literature reveals much disparity regarding the incidence, natural history, and survival rate in patients harboring esthesioneuroblastoma (olfactory neuroblastoma). The metastatic tendencies of this tumor have been highly variable in the literature, and reported intracranial involvement has been via local extension from the tumor's origin near the cribriform plate. Our present case describes a metastasis of esthesioneuroblastoma to the right parietal cortex and meninges in a patient without evidence of local recurrence after combined surgical and radiation therapy 5 years previously. The broad spectrum of biological behavior of this tumor, and its response to various therapies are discussed. The immunohistochemical and ultrastructural features of this unusual tumor are also presented. Recommendations are made for the management of these patients, including regular serial neurological examinations, serial computed axial tomography or magnetic resonance imaging of the head and neck, and, in the initial management, chemotherapy.