Loss of genetic material within 1p and 19q chromosomal arms in low grade gliomas of central nervous system.

Diffuse gliomas can constitute up to one third of all gliomas diagnosed in neurosurgical centers. Their invasive growth, progression to more malignant lesions, and the lack of standardized management guidelines render a significant clinical problem. The discovery of 1p and 19q chromosomal arms deletion in neoplastic cells will probably influence both more objective diagnosis and more accurate prediction of chemotherapy response. Defining the above mentioned deletion is becoming a standard procedure in Western European countries and in the USA when LGG is diagnosed. As a result an attempt has been made to detect deletion using fluorescence in situ hybridization and to determine its prognostic value. Genetic material from 34 grade II gliomas was examined. Separate 1p and 19q deletions were discovered in 14 and 16 cases respectively. Simultaneous occurrence of both was observed in 12. The frequency of occurrence of simultaneous deletions 1p and 19q varied based on histopathological diagnosis. This disorder was not observed in astrocytomas, in oligoastrocytomas it appeared in 50% cases. The highest incidence of deletion was noted in oligodendrogliomas and amounted to 66.7%, p < 0.005. Median survival in patients with diagnosed 1p and 19q deletion in their neoplastic cells is twice longer in comparison with patients in whom no such deletion was observed (80 months vs. 41 months, p < 0.05). Frontal location of a tumor occurred to be a statistically significant factor unfavorable for prognosis, p < 0.05. In the work presented the fluorescence in situ hybridization was successfully applied to identify deletion 1p/19q. Its incidence depends on the type of diagnosed glioma. Deletions also have prognostic significance in the test group what constitutes the basis for inclusion of determining deletion 1p/19q into diagnostic and treatment algorithm in LGGs.

Brain metastases in paediatric patients: characteristics of a patient series and review of the literature.

In contrast to the occurrence of brain metastases advanced malignant tumours in adult cancer patients, the dissemination of solid tumours to the brains of paediatric cancer patients is very uncommon. We present a neuro-pathological and clinical study of a group of children and adolescents with brain metastases (BM) from extracranial solid malignancies. The analysed patients were diagnosed with soft tissue sarcomas (three), germ cell tumours (three), or osteosarcoma, neuroblastoma, clear cell sarcoma of the kidney, or pleuropulmonary blastoma (one each). In our series, BM frequently coexisted with pulmonary metastases. Three different metastatic patterns were discernible: a solitary tumour, multiple lesions and diffuse parenchymal dissemination. Two cases showed haemorrhagic presentation. Most of the children died due to BM progression, while children with germ cell tumours showed the best prognosis. The histopathological pictures of BM can be different from the primary tumour, showing dedifferentiation or a diverse neoplastic component. The autopsy examination can still be helpful in the final diagnosis of certain cases with atypical clinical presentations.

[Modern approach to WHO grade II glioma classification and treatment--review of the literature]. / Nowe spojrzenie na klasyfikacje i terapie nowotworów glejowych II stopnia zlosliwosci wg WHO--przeglad pismiennictwa.

Although WHO grade II gliomas are slowly growing tumours, they inevitably show local recurrence and progression to higher grade counterparts. Progressive trials become time-consuming and troublesome because of relatively long survival and multimodal therapy. Recent discoveries in molecular pathology have divided patients into subgroups with different prognosis and expected response to therapy. Development did not omit surgical techniques, in particular intraoperative imaging and electrostimulation. The aim of radiotherapy development is preservation of the surroundings of the region of interest. Chemotherapy yields promising results notably with the possibility to choose patients with the best expected response. We present the current state of knowledge regarding these neoplasms.

Cerebellopontine angle tumours: radiologic-pathologic correlation and diagnostic difficulties.

A group of 119 cases of cerebellopontine angle (CPA) tumours was studied looking at the pathological composition, relative incidence of tumour types, their radiological features and the pathological-radiological correlations. Tumours with preoperative radiological diagnosis and verified pathologically were analyzed. Histopathologically the material consisted of 77 schwannomas and 42 non-acoustic tumours. Radiological retrospective evaluation of CT and/or MRI documentation was performed in 84 patients. The tumours were classified according to Koos's staging scale. Diagnostic discrepancies (histopathological vs radiological) according to the clinical stage of CPA tumours were analyzed. In our series non-acoustic tumours made up 37% of CPA lesions. Sharp tumour-pyramis angle and intracanalicular fraction are not exclusive features of schwannomas. Tumours in stage IV are the most heterogeneous and diagnostically difficult group.

[Results of 13 hypoglosso-facial anastomoses]. / Wyniki zespolen nerwu twarzowego z nerwem podjezykowym w materiale Kliniki Neurochirurgii AM w Gdansku.

BACKGROUND AND PURPOSE: Facial nerve paralysis significantly decreases the quality of life in patients after skull base tumors surgery. There are different options for surgical repair of the nerve. One of the most effective methods is the anastomosis of the distal trunk of the facial nerve with the proximal trunk of the hypoglossal nerve or with hypoglossal loop. MATERIAL AND METHODS: Thirteen hypoglosso-facial anastomoses had been performed in our department between 1999 and 2003. In all patients the facial nerve paralysis was due to the surgery in its proximity. In one case the patient suffered from petroclival chordoma, in one case ameloblastoma, one was with petroclival meningioma and the rest of cases were after vestibular schwannoma. The follow-up period lasted from 6 months to three years. The final result was expressed in House-Brackmann scale (HB) describing facial muscle strength. RESULTS: In two cases there was no improvement (HB 6), in two cases barely perceptible motion (HB 5), in five obvious weekness with disfiguring assymetry (HB 4) and in four obvious but not disfiguring dysfunction (HB 3). There was only one postoperative complication haematoma at the place of anastomosis requiring evacuation. CONCLUSION: Hypoglosso-facial anastomosis remains one of the most important techniques of the reanimation of the paralysed face. Its efficacy is limited, but it is a relatively safe procedure.

[Giant meningioma of the cranial vault and brain: a report of two cases who had not consented for more that 10 years]. / Olbrzymi oponiak sklepienia czaszki i mózgu--opisy przypadków dwóch chorych przez ponad 10 lat niezgadzajacych sie na operacje.

It is extremely rare nowadays to meet the patient with a giant tumour of the skull and brain with deformity of the head and who has not consented for any treatment for many years. We present two rare cases of large tumours. The first case is an example of good prognosis of the surgical procedure despite the extensive size of the tumour. The second shows the natural history of the cranial vault meningioma not treated for more than 30 years. We assume that frontal lobe syndrome was responsible for treatment decisions in both patients.

One step removal of dumb-bell tumors by postero-lateral thoracotomy and extended foraminectomy.

OBJECTIVE: Thoracic dumb-bell tumors are rare, usually benign tumors in the posterior mediastinum, consisting of intrathoracic and intraspinal parts. Surgical removal is the treatment of choice, performed by two teams - neurosurgeons and thoracic surgeons operating in a prescribed order. METHODS: Between 1994 and 1997 five patients had dumb-bell tumors removed in a one-step operation involving postero-lateral thoracotomy and extended foraminectomy. This operating method, rarely described in the medical literature, consists of intrathoracic and intraspinal parts being performed by a thoracic team independently or with the assistance of a neurosurgeon. Initially the intrathoracic part is resected, followed by an extensive widening of the intervertebral foramen to an appropriate extension and the removal of the remaining intraspinal part of the tumor. RESULTS: Four postero-lateral thoracotomies and one incision over a huge tumor in the thoraco-lumbal region, without entering the pleural cavity, were performed. In one patient postoperative, transient leakage of the cerebral fluid was observed. No form of late complications or neurologic sequelae have been reported within a 5-year follow-up. CONCLUSIONS: One-step removal of a dumb-bell tumor by postero-lateral thoracotomy and extended foraminectomy is a safe surgical procedure that can be performed by the thoracic team alone. Early and late surgical results confirm the appropriateness and usefulness of the method.

Posterior lumbar interbody fusion of the lumbo-sacral spine - treatment outcomes.

BACKGROUND: [corrected] The purpose of this article was to analyze treatment outcomes after lumbo-sacral spinal fixation by posterior lumbar interbody fusion using titanium threaded cages in the course of discopathy. MATERIAL AND METHODS: From 2000 to 2002 a group of 15 patients underwent lumbo-sacral spinal fixation by posterior lumbar interbody fusion. The indications for surgical treatment included lumbar discopathy, degenerative disc disease, recurrent disc herniation, and spondylolisthesis. The mean age was 44.9 years. The follow-up period was from 12 to 24 months. In all cases the cages were implanted by laminectomy with facetectomy. RESULTS: In 73.3% of the cases the outcome was good or very good, and in 13.4% of cases unsatisfactory. The only complication was hematoma in the surgical wound. CONCLUSIONS: Posterior lumbar interbody fusion using a titanium threaded cage is a safe and useful technique for the treatment of lumbar spine instability with or without neural compression. The small number of patients studied prevents further generalization.

Angiogenesis in glioblastoma--analysis of intensity and relations to chosen clinical data.

Microvascular proliferation (MVP) is one of the histopathological hallmarks of glioblastoma (GB). In this study angiogenic potential in GB was analysed according to the morphology of MVP and by assessment of vascular density. The analysis of relations of vascular parameters to chosen clinical features was performed. Tissue samples from 46 GB cases were examined. The clinical data included: patients' age (32-78 years), gender (17 women, 29 men), location (frontal lobe--13, temporal--18, parietal--14, two lobes--1) and tumour size in CT (2-9 cm). Tumour vascularisation was analysed morphologically and quantitatively. Histologically two types of MVP were distinguished: simple and glomeruloid. In vascular hot spots vessel density was assessed on sections immunostained for vWf. Simple type proliferation was found in all cases. Glomeruloid proliferation was found in 33 cases with mean age of patients 59.5 yrs, while in the group without glomeruloids mean age was 48 yrs (statistically significant difference, p < 0.01). Mean vascular density value in examined GB was 150.4 vessels/mm2 (median 141.5; SD--56.4) and younger age was related to higher vascular density (correlation coefficient R = -0.35; p = 0.017). Vascular parameters were related only to the patients' age among the analysed clinical data. The presented results show that morphologically microvascular proliferation is more intense in older GB patients, since higher vascular density is related to younger age. This observation may suggest the diversity of GB angiogenic potential depending on patients' age.