Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients.

INTRODUCTION: The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS: A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS: The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION: Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

Factors associated with anxiety and depression in the management of acoustic neuroma patients.

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

Complete recovery following atlantoaxial fracture-dislocation with bilateral carotid and vertebral artery injury.

A patient sustained a flexion-distraction injury with atlantoaxial dislocation and traumatic dissection of the carotid and vertebral arteries bilaterally. Difficulties in management including fracture reduction and stabilization, avoidance of further vascular injury and preservation of neural function are discussed.

Os odontoideum: report of three cases.

Os odontoideum is a condition in which a smoothly corticated ossicle exists dorsal to the anterior arch of C1, taking the place of the rostral dens, but with no bony connection to the body of the axis. Three patients presented with this condition: the first with Lhermitte's phenomenon 10 years after significant trauma, the second as an incidental finding during routine cervical spine imaging following a road traffic accident, and the third with recurrent transient quadriparesis precipitated by falls from a surfboard. Patients had at least 10 mm of sagittal instability on dynamic imaging and the second patient had a minimum sagittal canal diameter of only 11.5 mm. Posterior atlanto-axial fixation was successfully achieved in all cases using polyaxial screws and rods with the assistance of computed tomography-based image guidance. Image guidance provided an invaluable aid to preoperative planning and intraoperative placement of the posterior spinal instrumentation.

Disseminated intravascular coagulation complicating resection of a malignant meningioma.

A 70-year-old woman developed disseminated intravascular coagulation (DIC) during a craniotomy for a parasagittal anaplastic/malignant meningioma. This was successfully treated with rapid resection of the tumour and haematological replacement, but a poor neurological outcome resulted. The tumour was demonstrated to express tissue factor, an important causative factor in other tumour associated DIC and previously shown to be expressed by malignant meningiomas. A link between the two is suggested.

Systemic inflammatory response syndrome and acute neurological disease.

Systemic inflammatory response syndrome is a common clinical entity often presenting as a complication of neurological disease or trauma. Clear diagnostic criteria exist. Induced pathological mechanisms include both immunological and endothelial dysfunction, and coagulopathy, which may lead to multiple organ failure and significant morbidity. Possible therapeutic mechanisms are discussed, but this complex syndrome is poorly understood and successful treatment may depend on further research into control mechanisms.

Establishment of primary human meningiomas as subcutaneous xenografts in mice.

Meningiomas are the most frequently occurring benign central nervous system tumours. We determined whether a subcutaneous animal model of meningioma was feasible by implanting fresh meningioma tissue from six patients into 60 athymic (nude) mice, either as tissue blocks (38 mice) or as cell suspensions (22 mice). The tumour take-rates were 74% (block) and 50% (suspension), and the xenografts retained the original tumour grade and subtype morphology by light microscopy. Comparison of cell proliferation markers in xenografts and original tumours gave similar immunohistochemical score rates for Ki-67, but not for PCNA. With the exception of one atypical tumour surgical specimen, all tumours lacked p53 immunopositivity. Transmission electron microscopy of sections of tumour xenografts revealed ultrastructural features, including desmosomes and desmosome-like structures, characteristic of well-differentiated meningiomas. The xenografts grew progressively with a volume increase of more than 10-fold over 6-11 months and an apparent doubling time of 16 weeks. This study demonstrates the utility of the subcutaneous meningioma xenograft as a model for further biological and therapeutic studies.

Spinal leptomeningeal metastasis from cerebral glioblastoma multiforme presenting with radicular pain: case report and literature review.

BACKGROUND: We present a case of spinal leptomeningeal metastasis from an intracranial glioblastoma multiforme that presented with radicular pain. CASE DESCRIPTION: A 55-year-old man with a previously treated supratentorial glioblastoma multiforme presented with a 12-month history of thoracic radicular pain. MRI of the thoracic spine demonstrated an intradural extramedullary metastatic tumor deposit at the levels of T8-T10. External beam radiotherapy to the thoracic spine provided a minimal decrease in the intensity of the radicular pain. The lack of appreciation of the metastatic potential of the primary intracranial tumor resulted in delayed diagnosis and treatment. CONCLUSION: Spinal leptomeningeal metastasis needs to be suspected in patients with a past history of intracranial glioblastoma multiforme, who present with the clinical features of radiculopathy or myelopathy. Awareness of this condition will facilitate appropriate intervention.

Spontaneous haemorrhage into an empty sella turcica mimicking pituitary apoplexy.

We present a case of spontaneous haemorrhage into an empty sella turcica with the features of subclinical pituitary apoplexy. A 66-year-old woman with a previously resected pituitary adenoma presented four months later with progressive headache and visual deterioration. Cranial MRI demonstrated hyperacute blood products in a recurrent pituitary adenoma. Operative findings were of subacute blood in an empty sella turcica. There was no operative or subsequent histological evidence of tumour recurrence. The intrasellar haemorrhage was evacuated via a trans-sphenoidal approach, resulting in a rapid improvement in visual function. Endocrine deficits required thyroxine, corticosteroid and desmopressin supplementation. Haemorrhage into an empty sella turcica has not been previously described and needs to be suspected as a clinical entity in patients presenting with the features of pituitary apoplexy. Awareness of this clinical condition will prevent preoperative misdiagnosis.

Determination of the activation spectrum of aluminium phthalocyanine chloride against cultured meningioma cells using a tunable laser.

The activation spectrum of the photosensitising agent aluminium phthalocyanine chloride (ClAlPc) was determined using cultured meningioma cells as the biological target. Cells were irradiated with tunable lasers over the wavelength range 605-1000 nm and photocytotoxicity was measured 24 h later by a tetrazolium assay. The photoactivation spectrum was found to be relatively narrow with a sharply defined maximum at 675-680 nm, a readily accessible wavelength for commercially available diode lasers. The absorption spectrum of ClAlPc in aqueous solution was broad and featureless, contrasting markedly with the activation spectrum. However, as the content of an organic solvent (dimethylsulphoxide) was increased, the absorption spectrum progressively resembled the activation spectrum. It is concluded that the absorption spectrum of ClAlPc in aqueous solution is determined by drug aggregation, which can be prevented by an organic environment. This implies that the active form of ClAlPc in cells is the monomeric species probably located in cellular membranes.

Subcellular distribution and photocytotoxicity of aluminium phthalocyanines and haematoporphyrin derivative in cultured human meningioma cells.

The photocytotoxicity characteristics of aluminium phthalocyanine chloride (AIPc), aluminium phthalocyanine disulphonate (AlS2Pc), aluminium phthalocyanine tetrasulphonate (AlS4PC) and haematoporphyrin derivative (HpD) were compared using primary cultures of human meningioma cells. Cells were preincubated with the photosensitising agent for 16 h, then illuminated for 15 min with broad band red light (5 OW/cm2). The resultant cytotoxicity was assessed by tetrazolium (MTT) reduction 24 h later. AlPc was found to be 400, 10,000 and 250 times more potent that AlS2Pc, AlS4Pc and HpD, respectively, as an in vitro photosensitizing agent for meningioma cells. The subcellular localisation of AlPc, AlS2Pc, AlS4Pc and HpD in meningioma cells was determined by confocal laser scanning microscopy. None of the agents localized to the nucleus. The distribution of ALPc was quite diffuse through the cytoplasm. In contrast, AlS2Pc and AlS4Pc were localized vesicles suggestive of lysosomes, and HpD in membranous organelles distinct from mitochondria. AlPc and HpD were tested with five different meningioma samples and provided a range of IC50 values from 0.009 to 0.022 OM and from 3.5 to 6.5 OM, respectively. When the MTT assay with AlPc was performed 0, 24, 48 and 72 h after illumination, the mean IC50 values were 0.25, 0.037, 0.019 and 0.012 OM, respectively, indicating that the cytotoxic effect continued to increase up to 72 h. Cells were incubated with AlPc and HpD for different times up to 24 h before exposure to light. AlPc cytotoxicity was half-maximal with an incubation time of 8 h, whereas HpD cytotoxicity was half-maximal with an incubation time of 2 h, implying slower uptake kinetics for AlPc than for HpD. These data indicate unique features of AlPc which suggests its application as a potent, non-toxic photosensitizer in the photodynamic therapy of human meningiomas.

Diagnostic markers demonstrating successful culture of human meningioma cells.

The light microscopic and ultrastructural features of cultured meningioma cells were compared with those of surgically resected specimens. Meningioma cells normally show variable degrees of epithelial or mesenchymal differentiation. In cultured cells, well formed psammoma bodies and whorls were seen by light microscopy and specialised intercellular junctions were observed by electron microscopy. Cytogenetic analysis was also shown to be a useful diagnostic marker to differentiate cultured meningioma from contaminant proliferating fibroblastic and endothelial cells. These methods have demonstrated that the cells cultured from operative samples were predominantly meningioma cells. The ability to reproducibly cultivate populations of meningioma cells should facilitate in vitro assessment of potential adjunctive treatment modalities.