Açaí (Euterpe oleracea) pulp-enriched diet induces anxiolytic-like effects and improves memory retention.

Background: Açaí (Euterpe oleracea) has a rich nutritional composition, showing nutraceutical and protective effects in several organs. In this study, the effects of an açaí-enriched diet on motor performance, anxiety-like behavior, and memory retention were deeply investigated. Methods: Eight-week male Wistar rats were fed with an Euterpe oleracea (EO) pulp-enriched diet, an olive oil-enriched (OO) diet (polyunsaturated fatty acid [PUFA] fat control diet), or a chow diet for 31 days (28 days pre-treatment and 3 days during behavioral tests). Afterward, animals were submitted to a battery of behavioral tests to evaluate spontaneous motor behavior (open-field test), anxiety-like behavior (elevated plus maze and open-field test), and memory retention (step-down). Oxidative stress in the hippocampus was evaluated by a lipid peroxidation assay. Results: EO-enriched diet did not influence the body weight and food intake but increased the glucose plasmatic level after 31 days under this diet. However, a similar fat-enriched diet stimulated a marked weight gain and reduced the food intake, followed by changes in the plasmatic lipid markers. EO-enriched diet preserved the motor spontaneous performance, increased the exploration in the aversive environment (anxiolytic-like effects), and elevated the latency to step-down (improved memory retention). The EO-enriched diet also reduced the level of lipid peroxidation in the hippocampus. These positive effects of EO-enriched diet can greatly support the usage of this diet as a preventive therapy. Conclusion: Taken together, the current study suggests that Euterpe oleracea-enriched diet promotes anxiolytic-like effects and improves memory consolidation, possibly due to the reduced levels of lipid peroxidation in the hippocampus.

Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes.

Background Extreme maternal morbidity is defined as "events that potentially threaten the life of a pregnant woman during pregnancy, childbirth or the puerperium, but that due to a medical intervention the patient does not die", and this is an indicator of health quality at the hospital and demographic level. Objective The aim of this study was to determine the prevalence of extreme maternal morbidity in the Women´s Hospital of Aguascalientes, Mexico. Material and methods A retrospective cross-sectional study was conducted under the criteria of the World Health Organization and the Latin American Federation of Obstetrics and Gynecology Societies for the definition of extreme maternal morbidity to determine the prevalence of near miss morbidity, between January 1 and December 31, 2016. Results We found 165 cases of extreme maternal morbidity; no maternal death was registered during the study year. The extreme maternal morbidity rate was 0.016 and 16.69 per 1000 live births; the ratio of extreme maternal morbidity cases / obstetric admissions was 11.07. The prevalence of extreme maternal morbidity was 1.6%. The main causes of extreme maternal morbidity were hypertensive disorders (57%), obstetric hemorrhage (29%), sepsis (1%) and other (13%). Conclusion Extreme maternal morbidity in our institution had a similar prevalence to that reported in other countries and was mainly caused by hypertensive disorders.

Diet enriched with the Amazon fruit açaí (Euterpe oleracea) prevents electrophysiological deficits and oxidative stress induced by methyl-mercury in the rat retina.

BACKGROUND: The protective effect of a diet supplemented by the Amazonian fruit Euterpe oleracea (EO) against methylmercury (MeHg) toxicity in rat retina was studied using electroretinography (ERG) and biochemical evaluation of oxidative stress. METHOD: Wistar rats were submitted to conventional diet or EO-enriched diet for 28 days. After that, each group received saline solution or 5 mg/kg/day of MeHg for 7 days. Full-field single flash, flash and flicker ERGs were evaluated in the following groups: control, EO, MeHg, and EO+MeHg. The amplitudes of the a-wave, b-wave, photopic negative response from rod and/or cone were measured by ERGs as well as the amplitudes and phases of the fundamental component of the sine-wave flicker ERG. Lipid peroxidation was determined by thiobarbituric acid reactive species. RESULTS: All ERG components had decreased amplitudes in the MeHg group when compared with controls. EO-enriched food had no effect on the non-intoxicated animals. The intoxicated animals and those that received the supplemented diet presented significant amplitude reductions of the cone b-wave and of the fundamental flicker component when compared with non-intoxicated control. The protective effect of the diet on scotopic conditions was only observed for bright flashes eliciting a mixed rod and cone response. There was a significant increase of lipid peroxidation in the retina from animals exposed to MeHg and EO-supplemented diet was able to prevent MeHg-induced oxidative stress in retinal tissue. CONCLUSION: These findings open up perspectives for the use of diets supplemented with EO as a protective strategy against visual damage induced by MeHg.

Development of a thematic collection of Musa spp accessions using SCAR markers for preventive breeding against Fusarium oxysporum f. sp cubense tropical race 4.

Bananas are one of the most consumed fruits worldwide, but are affected by many pests and diseases. One of the most devastating diseases is Fusarium wilt, caused by Fusarium oxysporum f. sp cubense (Foc). Recently, Fusarium tropical race 4 (Foc TR4) has been causing irreparable damage, especially in Asia and Africa where it has devastated entire plantations, including areas with Cavendish, which is known to be resistant to Foc race 1. Although this race is not yet present in Brazil, results obtained by Embrapa in partnership with the University of Wageningen, The Netherlands, indicate that 100% of the cultivars used by Brazilian growers are susceptible to Foc TR 4. In our study, 276 banana accessions were screened with sequence characterized amplified region (SCAR) markers that have been linked to the resistance of Foc TR 4. Two SCAR primers were tested and the results revealed that SCAR ScaU1001 was efficient at discriminating accessions with possible resistance in 36.6% of the evaluated accessions. This is the first attempt to develop a thematic collection of possible Foc TR 4 resistant banana accessions in Brazil, which could be tested in Asian or African countries to validate marker-assisted selection (MAS), and for use in the preventive breeding of the crop to safeguard our banana plantations against Foc TR 4. We believe that this is an important step towards the prevention of this devastating disease, especially considering that our banana plantations are at risk.

Use of morpho-agronomic traits and DNA profiling for classification of genetic diversity in papaya.

We examined the genetic diversity of papaya (Carica papaya) based on morpho-agronomic and molecular data. Twenty-seven genotypes grown in Brazil were analyzed with 11 AFLP primer combinations, 23 ISSR markers, 22 qualitative, and 30 quantitative descriptors. For the joint analyses, we used the Gower algorithm (Joint Gower) and the average value of the individual dissimilarity matrix for each type of data (Average-Joint Gower); 359 AFLP and 52 ISSR polymorphic bands were found. Approximately 29.2 and 7.7% of the AFLP and ISSR bands, respectively, were genotype-specific and may therefore be used for papaya variety protection. Although there was a significant correlation between the qualitative and quantitative descriptor dissimilarity matrices (r = 0.43), the morpho-agronomic data were not highly correlated with the molecular data. Moreover, correlation between AFLP and ISSR dissimilarity matrices was nearly null (r = -0.01). Joint Gower analysis of all data showed high correlations, especially for AFLP markers, most likely due to the larger number of bands, generating a strong bias in the diversity estimates. The Average-Joint Gower analysis allowed a better balance between the correlations for the continuous and the discrete variables. The results generated by clustering analysis distinguished 5 genetically distinct groups. While we found that papaya genotypes are significantly variable for many traits, we observed that Average-Joint Gower analysis allowed for genotype clustering based on the most widely used criterion for classifying papaya genotypes, which is fruit type ('Formosa' or 'Solo'). This information helps provide an accurate estimate of the genetic diversity and structure of papaya germplasm, which will be used for further breeding strategies.

An experimental evaluation of a loop versus a reference design for two-channel microarrays.

MOTIVATION: Despite theoretical arguments that so-called 'loop designs' for two-channel DNA microarray experiments are more efficient, biologists continue to use 'reference designs'. We describe two sets of microarray experiments with RNA from two different biological systems (TPA-stimulated mammalian cells and Streptomyces coelicolor). In each case, both a loop and a reference design were used with the same RNA preparations with the aim of studying their relative efficiency. RESULTS: The results of these experiments show that (1) the loop design attains a much higher precision than the reference design, (2) multiplicative spot effects are a large source of variability, and if they are not accounted for in the mathematical model, for example, by taking log-ratios or including spot effects, then the model will perform poorly. The first result is reinforced by a simulation study. Practical recommendations are given on how simple loop designs can be extended to more realistic experimental designs and how standard statistical methods allow the experimentalist to use and interpret the results from loop designs in practice. AVAILABILITY: The data and R code are available at http://exgen.ma.umist.ac.uk CONTACT: veronica.vinciotti@brunel.ac.uk.

Crohn's disease associated to chordoma: a case report

Crohn's disease is an inflammatory bowel disease characterized by remissions and exacerbations. Immunosuppressants are frequently used to induce and maintain remission in these patients. The use of the immunomodulator azathioprine has been associated to malignancies. Chordomas are rare, locally aggressive tumors arising from remnants of the notochord. A specific trigger for this tumor has not been identified and association to any medication has not been reported. The purpose of this report is to present the first case reported in the literature of Crohn's disease associated to a chordoma. The patient to be presented was on azathioprine therapy, among other medications. A review of literature revealed that Crohn's disease and chordoma have abnormalities in chromosomes 1 and 10. Inflammatory bowel disease and chordoma also have abnormalities in chromosomal regions 1p, 3p, and 7q. Despite these findings, a direct genetic relationship between these diseases is speculative.

Surgical management of meningioma en plaque of the sphenoid ridge.

BACKGROUND: Meningioma en plaque represents a morphological subgroup within the meningiomas defined by a carpet or sheet-like lesion that infiltrates the dura and sometimes invades the bone. Differential diagnosis includes fibrous dysplasia, osteoma, and osteoblastic metastasis. This study was conducted to obtain pathological information on patients with meningioma en plaque and to correlate with the surgical management. METHODS: A retrospective review of all the adult operative cases at the University Hospital in a seven and a half-year period from July 1, 1990 to December 31, 1997 identified 150 patients who were operated on for intracranial meningiomas. The medical records were reviewed to identify cases of meningioma en plaque. Forty-seven patients had involvement of the sphenoid ridge and 6 of them fulfill the criteria for meningioma en plaque. RESULTS: All 6 patients with meningiomas en plaque were female and had hyperostosis of the sphenoid bone. In 5 of them, the bone was sent for histopathological examination. Four of those had infiltration of the bone by meningioma cells. Proptosis was the most common presentation. Half of the patients presented with visual disturbances that improved after surgery. All patients were operated using a fronto-temporal approach with orbital decompression. CONCLUSION: All the involved bone should be removed to prevent recurrence. In those cases with involvement of the cavernous sinus and/or the orbital apex, a subtotal but extensive removal combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal frequently produces good functional and cosmetic results.

Fast and convenient divergent synthesis of aliphatic ester dendrimers by anhydride coupling.

A novel divergent approach was developed for the synthesis of dendritic aliphatic polyester structures using an acetal-protected anhydride derivative of 2,2-bis(hydroxymethyl)propionic acid as the acylating agent. This divergent synthesis is remarkable, because unlike all others, it only requires a small excess of reagent to achieve quantitative growth, and it requires no means of purification other than a simple solvent extraction or precipitation. A monodisperse sixth generation dendrimer with molecular weight of 30 711 Dalton and 192 masked hydroxyl groups was prepared in high yield and purity using 1,1,1-tris(hydroxyphenyl)ethane as the core molecule. Linear and star-shaped poly(ethylene glycol) (PEG) derivatives of narrow polydispersity were also used as core molecules in the divergent synthesis of dendritic-linear copolymer hybrids up to the fourth generation without requiring any chromatographic purification.

Structure and coding content of CST (BART) family RNAs of Epstein-Barr virus.

CST (BART BARF0) family viral RNAs are expressed in several types of Epstein-Barr virus (EBV) infection, including EBV-associated cancers. Many different spliced forms of these RNAs have been described; here we have clarified the structures of some of the more abundant splicing patterns. We report the first cDNAs representing a full-length CST mRNA from a clone library and further characterize the transcription start. The relative abundance of splicing patterns and genomic analysis of the open reading frames (ORFs) suggest that, in addition to the much studied BARF0 ORF, there may be important products made from some of the upstream ORFs in the CST RNAs. Potential biological functions are identified for two of these. The product of the RPMS1 ORF is shown to be a nuclear protein that can bind to the CBF1 component of Notch signal transduction. RPMS1 can inhibit the transcription activation induced through CBF1 by NotchIC or EBNA-2. The protein product of another CST ORF, A73, is shown to be a cytoplasmic protein which can interact with the cell RACK1 protein. Since RACK1 modulates signaling from protein kinase C and Src tyrosine kinases, the results suggest a possible role for CST products in growth control, perhaps consistent with the abundant transcription of CST RNAs in cancers such as nasopharyngeal carcinoma.

Calreticulin is expressed on the cell surface of activated human peripheral blood T lymphocytes in association with major histocompatibility complex class I molecules.

Calreticulin is an endoplasmic reticulum resident molecule known to be involved in the folding and assembly of major histocompatibility complex (MHC) class I molecules. In the present study, expression of calreticulin was analyzed in human peripheral blood T lymphocytes. Pulse-chase experiments in [35S]methionine-labeled T cell blasts showed that calreticulin was associated with several proteins in the endoplasmic reticulum and suggested that it was expressed at the cell surface. Indeed, the 60-kDa calreticulin was labeled by cell surface biotinylation and precipitated from the surface of activated T cells together with a protein with an apparent molecular mass of 46 kDa. Cell surface expression of calreticulin by activated T lymphocytes was further confirmed by immunofluorescence and flow cytometry, studies that showed that both CD8+ and CD4+ T cells expressed calreticulin in the plasma membrane. Low amounts of cell surface calreticulin were detected in resting T lymphocytes. By sequential immunoprecipitation using the conformation independent monoclonal antibody HC-10, we provided evidence that the cell surface 46-kDa protein co-precipitated with calreticulin is unfolded MHC I. These results show for the first time that after T cell activation, significant amounts of calreticulin are expressed on the T cell surface, where they are found in physical association with a pool of beta2-free MHC class I molecules.

Clinoid and paraclinoid aneurysms: surgical anatomy, operative techniques, and outcome.

BACKGROUND: Paraclinoid or ophthalmic segment aneurysms arise from the internal carotid artery (ICA) between the roof of the cavernous sinus and the origin of the posterior communicating artery. Clinoid aneurysms arise between the proximal and distal carotid dural rings. The complex anatomy of clinoid and paraclinoid ICA aneurysms often makes them difficult to treat by microsurgery. The natural history of these aneurysms varies, based on their location and anatomic relationships. Accurate preoperative assessment of the origin of these aneurysms is therefore a critical aspect of their management. METHODS: The authors reviewed 35 clinoid and paraclinoid ICA aneurysms operated in 28 patients and classify them according to their anatomic location and angiographic pattern. The operative techniques, surgical outcomes, and indications for surgery are reviewed. RESULTS: Based on surgical anatomy and angiographic patterns, the aneurysms were classified into two categories: clinoid segment and paraclinoid (ophthalmic) segment. The clinoid segment aneurysms consisted of medial, lateral and anterior varieties. The paraclinoid aneurysms could be classified topographically into medial, posterior and anterior varieties, or based on the artery of origin into ophthalmic, superior, hypophyseal, and posterior paraclinoid aneurysms. Ophthalmic aneurysms were most common (40%), followed by posterior ICA wall aneurysms (29%), superior hypophyseal aneurysms (14%), and clinoid aneurysms (17%). Twenty patients (71%) had single aneurysms. Of the remaining eight, six had bilateral aneurysms and two had unilateral multiple aneurysms. Of the 35 aneurysms, 32 were clipped satisfactorily, as confirmed by intraoperative or postoperative angiography. One small broad-based aneurysm was wrapped, and two others were treated by trapping and bypass techniques. Three patients who had bilateral aneurysms underwent successful clipping of four contralateral, left-sided aneurysms via a right frontotemporal, transorbital approach. On follow-up (mean, 39 months), 25 patients were in excellent condition (returned to their prior occupation), two were in good condition (independent, but not working), and one died postoperatively of vasospasm. CONCLUSION: Our increased knowledge of anatomy and refinements in operative techniques have greatly improved the surgical treatment of clinoid and paraclinoid aneurysms.

Tentorial dural arteriovenous fistula obliterated using the petrosal approach.

BACKGROUND: Tentorial dural arteriovenous fistulas (AVFs) are uncommon lesions usually treated surgically using a subtemporal exposure with division of the tentorium. This exposure requires significant retraction of the temporal lobe and has the possibility of significant arterialized venous bleeding if a draining vein is accidentally cut during division of the tentorium. Skull base surgical techniques may provide alternate approaches for the surgical treatment of tentorial dural AVFs. METHODS: A tentorial dural arteriovenous fistula supplied by the tentorial artery and drained by the petrosal vein was exposed and obliterated using the petrosal (subtemporal-presigmoid) approach. RESULTS: The petrosal approach allowed the exposure and division of the superior petrosal sinus and tentorium with direct visualization of the supratentorial and the infratentorial compartments, avoiding accidental damage to the draining veins. The dural fistula was easily obliterated after its venous drainage was interrupted and the tentorial artery occluded. CONCLUSIONS: Tentorial dural AVFs can be safely treated with interruption of the venous drainage. The exposure can be enhanced with a petrosal approach, decreasing the possibility of uncontrolled bleeding during the procedure.

Presence of antibodies to human papillomavirus virus-like particles (VLPs) in 11-13-year-old schoolgirls.

To allow meaningful approaches to vaccine development, it is important to know the extent of exposure to human papillomavirus (HPV) within the general population, and particularly the age at which the at risk population is infected. The humoral response to human papillomavirus is directed largely to conformationally-dependent epitopes on the whole virion. Virus-like particles (VLPs) of HPV types 1, 2, and 16 were produced using a baculovirus expression system, and were used in the intact state as antigen in an indirect ELISA. Anonymised serum samples from a cohort of Edinburgh schoolgirls were tested for the presence of IgG antibodies directed against the VLPs. The reproducibility of the ELISA was assured by repeated testing of control samples, and by testing all samples in duplicate and, where possible, on several occasions. Of 1,192 tested with the HPV16 VLPs, 90 (7.6%) were classified as clearly positive, and a further 87 (7.3%) were positive but close to the cutoff calculated by comparison with a group of consistently negative sera. Antibodies to HPV2 were detected in 37.5% (407/1,139) and antibodies to HPV 1 in 51.9% (558/1,076) of the schoolgirls. Antibodies to both HPV1 and HPV2 were found frequently, being present in 29.7% (295/ 993) of samples tested; 40 samples had antibodies to all three types. The significance of these results is discussed.

Chronic and subacute subdural hematoma in the adult population. The Puerto Rico experience.

OBJECTIVE: The purpose of this investigation was to study the epidemiology of chronic and subacute subdural hematoma in an adult population and associated factors such as treatment, recurrence, seizures, complications, and outcome. METHODS: We retrospectively reviewed 267 consecutive cases operated for a suspected diagnosis of chronic or subacute subdural hematoma during a six-year period. RESULTS: An incorrect diagnosis was done in 12 of the cases (4.5%) giving a total of 255 cases of chronic or subacute subdural hematoma. The mean age of the patients was 68-year old. Two-thirds of the cases were chronic and one-third were subacute. A history of head trauma was identified in 79% of the patients occurring more frequently in the subacute group. The hematoma was bilateral in 16% of the patients. Recurrence occurred in 7.8% of the cases, but there was no significant difference between chronic and subacute cases nor the type of operation done. Postoperative seizures occurred in 6.2% of the cases. Preoperative seizures are not associated to the development of postoperative seizures. A postoperative intracerebral hematoma occurred in 2.7% of the patients and was associated in most of the cases with a poor outcome. The morbidity rate was 9% and the mortality rate was 0.9%. Outcome is good in 95% of the patients. CONCLUSIONS: Chronic subdural hematoma occurs more frequently than subacute subdural hematoma. Surgical treatment modality and the use of a drain do not change the recurrence rate. Preoperative seizures are not associated to the development of postoperative seizures. The use of postoperative prophylactic antiepileptic drugs does not decrease the postoperative seizure rate even in the alcoholic patient, therefore, their prophylactic use is not indicated.

Aneurysm reinforcement in the anterior circulation.

BACKGROUND: Aneurysms are primarily treated with surgical clipping. Unclippable aneurysms are at risk of recurrent bleeding similar to the natural history of ruptured aneurysms. Aneurysm reinforcement with muslin and ethyl 2-cyanoacrylate may provide a safe and useful alternative to reduce the rebleeding rate in those aneurysms found to be unclippable at surgical exploration. METHODS: We examined a population of 19 patients with aneurysms treated by reinforcement with muslin and ethyl 2-cyanoacrylate. One patient was lost to follow-up. Patients had a mean follow-up of 60 months. The yearly risk of rebleeding was calculated and compared to the natural history of the disease. RESULTS: Most of the aneurysms were located in the middle cerebral artery or the anterior communicating artery. The two main causes for reinforcement were a wide base aneurysm or the presence of arterial branches originating from or intimately adherent to the dome. Those patients with aneurysms in which reinforcement was used as the primary and only treatment had a risk of rebleeding of 2.95% per year. The group of patients with ruptured aneurysms in which the reinforcement was used to supplement a clip had no rebleeding. When all the patients with ruptured aneurysms are combined, there is a risk of rebleeding of 1.94% per year. Unruptured aneurysms treated with reinforcement had not shown hemorrhage. No complications related to the use of muslin or ethyl 2-cyanoacrylate were found in this study. CONCLUSION: The reinforcement with muslin and ethyl 2-cyanoacrylate provides some protection in patients with aneurysms for which direct clipping cannot be done and in those clipped cases in which there is a residual neck or dome. This protection is inferior to clipping, but reduces the risk of rebleeding during the first 6 months after the initial hemorrhage. A longer follow-up is needed to determine if it provides better protection for late rebleeding than the natural history of ruptured aneurysms.

Magnetic resonance angiography of giant aneurysms. Pitfalls and surgical implications.

OBJECTIVE: Magnetic resonance angiography (MRA) can be used to identify cerebral aneurysms. In this report, techniques for the diagnosis of giant cerebral aneurysm using MRA are discussed. Pitfalls in the diagnosis are presented. BACKGROUND: Giant cerebral aneurysms, which can be partially or totally thrombosed, or may have slow flow, can be confusing and difficult to diagnose. Giant cerebral aneurysms with thrombus formation, produce an artifact in time-of-flight MRA in which the thrombus simulates flowing blood. METHOD: Five consecutive patients with the suspected diagnosis of giant cerebral aneurysm by MRA were analyzed. Neuroradiological studies were reviewed. RESULTS: In 20% of the cases, the correct diagnosis was made using MRA; in 60% of the cases, a correct diagnosis was made, but the size or the presence of flow was not correctly identified; in 20% of the cases, the diagnosis was incorrect. Four patients with giant cerebral aneurysms who presented a diagnostic and a therapeutic challenge are discussed. CONCLUSION: Unless MRA findings are combined with computed tomography scan and magnetic resonance imaging findings, the exact nature of the sac contents of giant cerebral aneurysms cannot be identified.

The clinoidal space: anatomical review and surgical implications.

This study describes the anatomy of the clinoidal space exposed after the anterior clinoid process (ACP) is removed. Five cadaver heads injected with colored latex in the arterial and venous systems were used. Each was cut in half to provide ten specimens for inspection. The bone that covered the medial side of the cavernous and clinoidal internal carotid artery (ICA) was removed. The ACP was removed and its dural layers were preserved. The removal of the ACP establishes an area called the clinoidal space. In this space, the clinoidal ICA is exposed. This space is delimited by two dural rings that anchors the clinoidal ICA. Most of the clinoidal space is located anterolateral to the artery where the ACP is found, but there is a small triangular space posterior to the artery and another space anteromedial to it. The clinoidal ICA is completely encased by connective tissue in this space. The clinoidal space is extracavernous, therefore, bleeding occurs only if the connective tissue layer is broken.

Giant aneurysm of the proximal anterior cerebral artery.

BACKGROUND: Giant aneurysms originating from the proximal anterior cerebral artery (A1) are extremely rare. Only 12 cases have been reported previously. CASE REPORT: A case of giant A1 aneurysm, which occurred in a patient with a progressive visual loss, is presented. The previous 12 cases are reviewed and discussed. This patient was treated by trapping and decompression of the aneurysm. These aneurysms bleed very rarely; they usually present with signs and symptoms secondary to the mass effect, including visual loss and progressive dementia. Most of these aneurysms have been treated by direct trapping of the aneurysm or by occlusion of the proximal anterior cerebral artery. CONCLUSIONS: In most cases, trapping and decompression of the aneurysm is the treatment of choice, since they involve a long segment of the A1 that does not allow preservation of the parent artery if direct clipping is performed.

Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life.

OBJECTIVE: In this report, we evaluate the recurrence- and progression-free survival of patients with meningiomas involving the cavernous sinus. METHODS: The rates of tumor recurrence and progression in 119 patients with meningiomas involving the cavernous sinus treated between 1983 and 1993 were analyzed. RESULTS: The mean follow-up period was 33.8 months. There were seven recurrences of completely resected tumors (7 of 73, 10%) and seven progressions of incompletely resected tumors (7 of 46 15%). Life table analysis of recurrence- and progression-free survival was performed. The recurrence-free survival rate was 94% at 3 years and 81% at 5 years. In contrast, the progression-free survival rate was 87% at 3 years and 62% at 5 years (P = 0.0456). There were two patterns of recurrence or progression. The first group of tumors had an aggressive biological behavior with growth at multiple areas of resection; the second group showed growth at or near the margins of resection. Functional status continued to improve slowly during the follow-up period; however, there was no statistically significant difference between the Karnofsky scores obtained 3 to 12 months postoperatively and the follow-up Karnofsky scores (obtained > 1 yr postoperatively). CONCLUSION: Surgery for meningiomas involving the cavernous sinus seems to provide excellent tumor control. Our experience suggests that for the majority of these tumors, complete tumor resection can be performed with acceptable risks of morbidity and mortality and seems to increase the duration of recurrence-free survival. The long-term quality of life of surviving patients is satisfactory, with the great majority of the patients being independent.