Dysembryoplastic neuroepithelial tumour: the Western Australian experience.

Dysembryoplastic neuroepithelial tumour (DNET) is a rare tumour that is usually seen in the context of epilepsy surgery. The purpose of this study was to provide a profile of DNET in an unbiased population. The 2020 brain tumours diagnosed in Western Australia in the 10-year period 1982-1991 were reviewed; 5 cases of DNET were identified. All patients were neurologically intact and presented with complex partial seizures from a young age. Surgery was performed for tumour resection or biopsy in all cases; no patient underwent surgery specifically for epilepsy control. The lesions were intracortical, multinodular and were composed of astrocytes, oligodendrocytes and neurons. Three patients underwent total or subtotal resection and their seizures were either abolished or reduced in frequency. Two patients had biopsies only and were clinically unchanged. There has been no evidence of recurrence in up to 8 years' follow-up. The diagnosis of DNET is important because it is a surgically treatable benign tumour.

Stereotactic biopsy of 100 intracerebral lesions at Sir Charles Gairdner Hospital.

The pathological findings in a retrospective review of 100 consecutive intracranial stereotactic biopsies are presented. Definite diagnosis could be established in the majority (89) of cases and included 85 neoplasms (69 primary cerebral tumors, 10 non-Hodgkin's lymphomas and 6 metastases) and 4 non-neoplastic processes. In the remaining 11 samples the findings were non-diagnostic; 2 consisted of normal glial tissue, while the remainder variously showed changes of necrosis, hematoma, histiocytic reaction or astrocytic proliferations of uncertain nature. Verification of the stereotactic diagnosis by examination of lesional tissue obtained at subsequent craniotomy or postmortem was possible in 7 of 10 cases. Two broad categories of diagnostic difficulty were identified in interpreting stereotactic biopsies: (1) accurate tumor typing and grading, and (2) the distinction between reactive and neoplastic astrocytic proliferations. Two essential components in the diagnostic process are: (1) careful correlation with the clinical and radiological findings; and (2) use of intraoperative smear and/or frozen section preparations to confirm specimen adequacy. By adhering to these principles accurate intraoperative diagnosis can usually be established, particularly for high grade astrocytoma, lymphoma and metastasis. Tumor typing is aided by the use of immunohistochemistry and ultrastructural examination and the examination of serial sections is of value in grading.

High-grade cerebral neuroblastoma: a case study.

The case of a 48-year-old male patient is reported in whom a primary malignant cerebral neoplasm was cured by its neurosurgical removal and by postoperative radiotherapy and chemotherapy. Initially, from the results of the examination of frozen and paraffin section, the tumour was considered to be a glioblastoma multiforme. Electronmicroscopy, immunohistochemistry and review of the light microscopy of the original biopsy sample after his death by suicide four-and-a-half years later showed the neoplasm to have been a primary cerebral neuroblastoma rather than a glioblastoma. The diagnosis of glioblastoma multiforme, which depends upon multiple non-specific microscopic findings, such as necrosis, abnormal blood vessels, anaplasia and the pleomorphism of tumour cells, often is imprecise. Our experience underlines the need for comprehensive neuropathological studies of malignant cerebral neoplasms, including transmission electronmicroscopy and immunohistochemistry. This is of particular importance in view of the dismal prognosis of glioblastoma multiforme and of the palliative, rather than curative, treatment programmes that frequently are indicated for this tumour. The value of our report is to demonstrate that a cerebral neuroblastoma, which potentially is curable, may be mistaken easily for a glioblastoma-even by competent neuropathologists.

Glomus intravagale tumour: aspects of management.

Glomus intravagale tumours are relatively rare tumours. A case is described and some aspects of its management are discussed with emphasis on the pre-operative investigation and diagnosis of this condition. Selective embolization of the lesion before operation is an important adjunct in treatment to reduce the vascularity of the tumour during operation. Intra-operative cardiac arrest due to traction of the vagus nerve was encountered. The methods to avoid this complication are discussed.

The total assessment of rheumatoid polyarthritis--evaluation of a training program for physiotherapists and occupational therapists.

We evaluated a training program for physiotherapists and occupational therapists in the total assessment of patients with rheumatoid polyarthritis. Close agreement was seen between the active joint counts of the rheumatologists and 36 therapists (p2 = 0.23). In the 7 quality variables for bedside case workups, a statistically significant learning effect was seen over the 6 week period (p2 = less than 0.005). In the 10 quality variables for the case presentations at Week 6, judged at the graduate medical trainee level, mean global scores achieved were 72.5%. Therapists reported a high level of satisfaction with all components of the program.

Meningioma occurring twenty-three years after a successfully treated cerebellar medulloblastoma: case report.

A 6 year old boy had a mid-line cerebellar medulloblastoma treated by local resection followed by craniospinal irradiation. Twenty-three years later he underwent temporal craniotomy to remove a cystic temporal meningioma. It is suggested that this is a radiation induced neoplasm.

Primary cerebral neuroblastomas. A clinicopathological study of one adolescent and five adult patients.

Neuronal differentiation was demonstrated by light microscopy, immunohistochemistry and electron microscopy in the cerebral neoplasms of one adolescent and five adult patients. The tumours exhibited a wide spectrum of cellular differentiation from low to high grade malignancy which seems to correlate well with their biological behaviour. The natural history of these 6 cerebral neuroblastomas is rather long compared to that of other malignant primary cerebral neoplasms of adulthood; however, 2 patients died, one survived about 5 yr after initial symptoms whilst an untreated patient survived more than 12 yr. It is suggested that morphological grading along the lines of Kernohan's system may be useful in determining the prognosis and postoperative management of patients with cerebral neuroblastomas.

Regional cerebral blood flow utilizing the gamma camera and xenon inhalation: reproducibility and clinical applications.

A modified collimator and standard gamma camera have been used to measure regional cerebral blood flow following inhalation of radioactive xenon. The collimator and a simplified analysis technique enables excellent statistical accuracy to be achieved with acceptable precision in the measurement of grey matter blood flow. The validity of the analysis was supported by computer modelling and patient measurements. Sixty-one patients with subarachnoid haemorrhage, cerebrovascular disease or dementia were retested to determine the reproducibility of our method. The measured coefficient of variation was 6.5%. Of forty-six patients who had a proven subarachnoid haemorrhage, 15 subsequently developed cerebral ischaemia. These showed a CBF of 42 +/- 6 ml X minute-1 X 100 g brain-1 compared with 49 +/- 11 ml X minute-1 X 100 g brain-1 for the remainder. There is evidence that decreasing blood flow and low initial flow correlate with the subsequent onset of cerebral ischaemia.

Medulloblastoma: a clinicopathological study of 42 cases.

Clinicopathological data have been collected for 42 patients with cerebellar medulloblastoma diagnosed and treated in Western Australia between the years 1961 and 1984. Thirty-one patients were male and 12 were over 14 years of age. In 31 patients the neoplasms were localized to the midline, while in 10 they were placed laterally in the cerebellar hemispheres. The remaining patient had a diffusely spreading neoplasm in the meninges of the posterior fossa. Thirty-nine underwent surgical treatment followed by postoperative radiotherapy. Three patients died in the early postoperative period. Twenty-four patients survived for one year or longer, 15 for two or more years, 10 for five years, and five survived longer than 10 years. The survival proportions estimated by the life-table method were 66% at one year, 48% at two years and 32% at 5 and 10 years. In one patient who survived for 23 years a meningioma developed, possibly due to radiotherapy.

Early cerebral blood flow and computerized tomography in predicting ischemia after cerebral aneurysm rupture.

Cerebral blood flow (CBF) was measured during the 1st week of subarachnoid hemorrhage in 46 patients who were in a good clinical grade and had a proven ruptured intracranial aneurysm. The mean initial CBF in patients who developed cerebral ischemia was 42 ml/min-1/100 gm brain-1, which was significantly lower than in patients who did not develop cerebral ischemia (49 ml/min-1/100 gm brain-1). This reduced CBF was not secondary to raised intracranial pressure or angiographic spasm. Patients with a reduced CBF (less than 50 ml/min-1/100 gm brain-1) and diffuse subarachnoid blood on computerized tomography had a very high incidence (78%) of cerebral ischemia, despite a good clinical grade at the time of measurement. Serial CBF measurements are of value in monitoring the evolution of cerebral vasospasm.

Cysticercosis of the fourth ventricle. A classic presentation of an old scourge.

The clinical, neuroradiological, and pathological features of cysticercosis of the fourth ventricle, which occurred in a Cambodian immigrant, are reported. Comparisons between this case and Bruns' original description of cysticercosis of the fourth ventricle are made.

Medical management of patients following a ruptured cerebral aneurysm, with epsilon-aminocaproic acid, kanamycin, and reserpine.

Patients suffering from a subarachnoid hemorrhage who were admitted to the Neurosurgical Unit of the Royal Perth Hospital during the period 1971 to 1979 were assessed with regard to the effectiveness of preoperative treatment with epsilon-aminocaproic acid, kanamycin, and reserpine. Forty-two patients who were treated with epsilon-aminocaproic acid had a rebleed rate of 2.3% compared to 1 9.7% rebleed rate in appropriately selected controls. Patients treated with kanamycin and reserpine had a preoperative cerebral vasospasm rate of 32% compared to a 26% rate in controls; however, kanamycin and reserpine were found useful for decreasing the postoperative complications of cerebral vasospasm.

Subarachnoid haemorrhage: epidemiology, natural history, and surgical treatment.

We analysed 360 patients who presented with a proven subarachnoid haemorrhage during the period 1971-78. The most common cause was a cerebral aneurysm (75%), with the anterior communicating artery being the most common site for a ruptured aneurysm. Overall mortality rate before surgical intervention was 28%. During the period of study, 106 Grade 1 patients underwent direct clipping of their aneurysms; this procedure was associated with a 6.6% mortality rate. Delayed surgical intervention was associated with a lower surgical mortality rate.

Compression of the tibial nerve by the tendinous arch of origin of the soleus muscle.

Details of 5 cases of surgically confirmed entrapment of the tibial nerve in the popliteal fossa are presented. In 4 cases the nerve was compressed beneath the tendinous arch of the origin of the soleus muscle. In 1 of these cases, thrombosis of a tributary of the popliteal vein with oedema of structures in the popliteal fossa and secondary compression of the nerve was found. In the fifth case the popliteal vein was compressed by the soleus arch with secondary compression of the nerve. The clinical presentation in these cases was characterised by severe pain and tenderness in the popliteal fossa, aggravated by active and passive dorsiflexion of the foot, inability to weight bear, and numbness and pain in the sole of the foot and heel. In each case, surgical exploration and division of the soleus arch led to prompt relief of symptoms.