Histogenesis and differentiation potential of central neurocytomas.

The central neurocytoma, a recently identified rare supratentorial brain tumor in young adults, is characterized by intraventricular location and a usually benign clinical course. In order to elucidate the histogenesis and differentiation potential of this neoplasm, we have undertaken an immunocytochemical and molecular biological study of four central neurocytomas. It was found by immunocytochemistry and immunoblotting that all tumors express neuron-specific enolase and synaptophysin. Western blots also revealed expression of the synaptic vesicle protein, synapsin I, neurofilament protein and glial fibrillary acidic protein in several neurocytomas which failed to exhibit immunoreactivity to these marker antigens on paraffin sections. Immunocytochemical reactions with antibodies to synaptophysin and glial fibrillary acidic protein on adjacent sections demonstrated coexpression in individual tumor cells. The neuronal form of the pp60src protein-tyrosine kinase, an oncogene-product specifically expressed in central nervous system neurons, was not detectable in two central neurocytomas investigated. N-myc, a proto-oncogene frequently amplified in childhood neuroblastomas, was present as a single copy gene in all central neurocytomas, indicating that amplification of this gene is not involved in the pathogenesis of the central neurocytoma. In accordance with ultrastructural evidence of synaptogenesis, we conclude that the central neurocytoma is a neuroectodermal tumor with consistent commitment for neuronal differentiation. Since these tumors retain a potential for additional glial differentiation, we propose an origin from bipotential progenitor cells in the periventricular matrix, which in the mammalian brain persists throughout adult life.

Spinal subependymoma presenting as an extramedullary tumor: case report.

A rare case of cervicothoracic subependymoma in a 25-year-old man is described. The tumor appeared as an extramedullary mass lesion, but a discrete, less well-demarcated portion was observed in the lateral part of the cord at the T2 level. Previous reports of spinal subependymomas are reviewed, and nosological possibilities of extramedullary presentation are discussed.

[Post-traumatic intracerebral hematoma]. / L'hématome intracérébral secondaire post-traumatique.

The clinical and therapeutic features of 18 delayed traumatic intracerebral hematomas (DTICH) were compared with those of 84 primitive traumatic intracerebral hematomas in order to determine the origin of this complication. This retrospective study found that: DTICH usually occurs the first week after trauma, but could happen several weeks later; patients with skull fractures are at higher risk (p less than 0.01); osmotherapy as well as barbiturate therapy seem to have no influence on this complication; craniotomy (or craniectomy) appears to be a significant factor in the cause of DTICH (p less than 0.05). The pathogenesis of DTICH could be the evolution of delayed necrosis in vessel walls from the contused area which frequently bleed after the evacuation of an extracerebral hematoma. On the other hand the cause of a DTICH after conservative therapy remained unclear.

[Corrective craniofacial surgery in the acrocephalosyndactylia syndrome (Saethre-Chotzen syndrome)]. / Kraniofaziale Korrekturoperation bei Akrozephalosyndaktylie-Syndrom (Saethre-Chotzen-Syndrom).

The possibility of plastic surgery in acrocephalosyndactylia syndrome during infancy is shown. Due to her main signs and symptoms and the mode of inheritance the patient suffered from an acrocephalosyndactylia syndrome type III (Saethre-Chotzen). Craniofacial surgery with frontal craniotomy, turn of frontal bone and frontal orbital advancement were performed at the age of eight months, using bone plates developed by Luhr. The reconstruction gave an aesthetically satisfactory result, and further development was normal. The condition for a good result is the cooperation between plastic surgeons, neurosurgeons, anaesthesiologists and paediatricians in specialised centres.

Intracerebral ganglioglioma.

Ganglioglioma in the temporal lobe was encountered in 0.6% of a series of 998 patients undergoing biopsy for intracranial tumors. It was more frequent in young adults and children. Seizures were the main symptom and had been present over a long period of time in some patients. Clinical examination also revealed intracranial pressure, focal signs, and behavioral problems, but these symptoms were not always evident. Electroencephalography was not specific. Calcifications were visible on computerized tomography (CT) in five cases. The cystic and well-circumscribed aspects of these tumors were apparent on CT scans; these features were confirmed at operation and on magnetic resonance imaging (MRI), when it was also found that the tumors were partially solid. Therefore, MRI seems to be a useful diagnostic method, particularly when a cystic tumor is revealed on CT, and is also valuable for postoperative monitoring. Surgical treatment for ganglioglioma is recommended, with total extirpation if possible.

The clinical course of surgically treated posttraumatic subdural hygromas.

The clinical course of 11 patients with a subdural hygroma, who underwent neurosurgery, was studied. In the first week after the operation no improvement of the mental status could be detected. We considered therefore that operation hardly contributed to improvement. Thus the need to operate is limited to special cases such as acute or space-occupying subdural hygroma.

Current brain tumour models with particular consideration of the transplantation techniques. Outline of literature and personal preliminary results.

The most well known brain tumour models will be discussed. It is a series of animal experiments with an induced tumour and with heterologous and homologous transplantation. This work will deal especially with technical problems, which have not so far been satisfactorily resolved. With the aid of a stereotaxic operation method, the exactness of the technique of transplantation could be improved. The tumour contamination problem of the injection pathway as well as of the cerebral spinal fluid compartment is satisfactorily resolved. The authors have at their disposal a standardized cerebral glioma model in the rat in order to study the interstitial chemotherapy of brain tumours.

[Are there sport-specific craniocerebral traumas?]. / Gibt es sportart-spezifische Schädel-Hirntraumen?

The incidence of sports accidents is on the increase. The authors examined the question whether this is also true of craniocerebral injuries during sports activities. For this purpose they studied and assessed all grade I and II craniocerebral injuries treated during 1982 at the departments of Surgery and Neurosurgery at the University of Göttingen. The craniocerebral injuries had a share of 13.5% in the total incidence of Sports accidents. This figure is markedly above the comparative figures quoted so far. The incidence of craniocerebral trauma varies from one sports discipline to another, depending on the popularity of the particular sport. However, a comparison with data published in the literature shows that craniocerebral trauma is the most frequent sports injury in all disciplines in which the head is particularly exposed.

Granular cell tumour in the third ventricle. Case report with histological, electron-microscopic, immunohistochemical and necropsy findings.

A rare granular cell tumour was found in the third ventricle of a 56-year-old woman. Histological and electron-microscopic features obtained from the biopsy material were identical to those of previously recorded cases. Immunohistochemical study demonstrated vimentin but not S-100 protein in the tumour cells. The possibility should be re-considered that granular cell tumours may have more than one cell of origin.

[Pneumatocephalus: a clinical contribution (author's transl)]. / Ein Beitrag zur Problematik des Pneumatozephalus.

Treatment of traumatic brain oedema leads to a decrease in raised intracranial pressure, and this may facilitate formation or progression of pneumatocephalus. Lumbar puncture or lumbar CSF drainage for treatment of CSF-rhinorrhoea/otorrhoea is occasionally responsible for the occurrence or enhancement of pneumatocephalus. Pneumatocephalus with radiological absence of fracture of the skull and absence of CSF leakage signifies communication between rhinocranium and encephalocranium: this supplies evidence of an open head injury. Post-traumatic opacification of the sphenoid sinus and presence of suprasellar air, as well as traumatic lesion of the optic chiasma are pathognomonic for the presence of a fracture of the planum sphenoidale. Computerised axial tomography is superior to plain skull x-rays in the localisation of intracerebral air.

[The ENT specialist's responsibility in the diagnosis of the olfactory meningeoma (author's transl)]. / Die Verantwortung des HNO-Arztes bei der Erkennung des Olfaktoriusmeningeoms.

The principal symptoms associate with olfactory groove meningeomas are anosmia and headache which lead the patient to an ENT specialist. Frontal sinusitis, migraine and neuralgia are the most frequent incorrect diagnosis. Positive radiological changes are found frequently on the plain films of patients with these olfactory tumors, even up to 70% according to the literature. It is important to bear this in mind regarding olfactory groove meningeomas to avoid mistakes in diagnosis.

Neuronal regression during ageing: an ultrastructural study of the human cortex.

Neuronal regression has been ultrastructurally investigated in a neuronal sampling of the ageing human cerebral cortex. Even though the number of specimens examined is limited, there is an indication of an age-related regression involving the intraneuronal "nucleus-ribosome system". Such regressive signs are characterized by the polymorphous outline, invagination, reduced size of the nucleus, and in the nucleolar texture. Recognizable changes in the cytoplasm are, alterations in the density and distribution of free ribosomes and in the structure and organization of the rough endoplasmic reticulum cisternae. Furthermore light cytoplasmic areas, and increased number of microtubules and the gradual congestion of the perikaryon by age pigments are reliable criteria for identifying the sequence of morphologic events that occur during neuronal ageing. The above data provide some insight into the neuronal process and adding to a previous proposed model of neuronal maturation.

[Treatment of post-traumatic cerebrospinal fluid rhinorrhea with lumbar drainage (author's transl)]. / Die Problematik der Behandlung der Liquorfistel bei frontobasalem Schädel-Hirntrauma mittels Lumbaldrainage.

Three patients with CSF-rhinorrhea following frontobasal skull and brain injury were treated with lumbar CSF drainage. Rhinorrhea was successfully stopped in one patient few hours after onset of the drainage while a pneumatocephalus developed in each of the remaining patients during the first post-trauma week. We believe that this latter occurrence was due to depression of intra-cranial pressure as a result of the drainage. As a further consequence of this, risk of intracranial infection increased in association with a hypoliquorrhea, and led to a tentorial pressure cone in one of the patients.

Pathological growth of skull--radiological fine structure in experimental animals.

The skulls of 55 mice (strain C57 Black) were studied radiologically at various ages. In the mouse, craniocaudal growth of the skull takes place exclusively within two synchondroses. Longitudinal growth is completed at 50 to 60 days of life and it is dependent on the pressure developed by the growing brain. In strain C57 Black congenital hydrocephalus occurs with an incidence of approximately 8%, causing a characteristic deformity of the skull. Hydrocephalus developing after 30 days of age causes deformity restricted to the calvarium. The base of the skull remains unchanged and may not be distinguished from that of normal individuals of the same age. Abnormal lateral growth of the base of the skull may be observed if hydrocephalus develops in the young mouse: At 25 days pp. the syndesmosis between ospetrosum and the adjacent bones is not yet solidified. Consequently, the ossa petrosa may yield to the increased intracranial pressure. The result is a measurable widening of the distance between the tips of the ossa petrosa. A radiological method is described, permitting high resolution of minute details of the skull of small experimental animals.

Schwannomas of the orbit.

The authors describe a case of intraorbital schwannoma. The tumour caused exophthalmos of 11 mm, and displacement with limitation of mobility of the eyeball. A review of cases from other studies is presented. This rare tumour orginates from the fifth cranial nerve. Exophthalmos is the primary clinical symptom. The value of several radiological examination techniques and possible surgical approaches are discussed.

[Cerebellar abscess as an intracranial complication of otogenic origin (author's transl)]. / Der Kleinhirnabszess als endokranielle Komplikation otologischer Erkrankungen.

Three cases of otogenic cerebellar abscesses, treated between 1976 and 1978, are reviewed. Early diagnosis is the most important factor in the successful management of these lesions. In localising subtentorial intracranial abscesses, computed axial tomography appears superior to other neuroradiological methods. Lumbar puncture is both inaccurate in diagnosis and dangerous to the patient, when increased intracranial pressure exists.

Intracerebral chondroma.

Intracerebral chondroma is an extremely rare condition. A case of a parasagittal intracerebral chondroma with no meningeal attachment is reported. The clinical and histological findings are described and a review of the literature is presented.