Cognitive and linguistic outcomes after awake craniotomy in patients with high-grade gliomas.

BACKGROUND: Preservation of language and cognition is crucial in glioma surgery, as they are crucial aspects of daily life functioning. Several studies claimed that awake surgery in eloquent areas is demanded in low and high-grade gliomas. Cognitive and language outcome has been less investigated in high-grade gliomas compared to low-grade. METHOD: We analyzed the neuropsychological and neuro-oncological outcome of nineteen patients (from a cohort of forty patients) who underwent fully awake surgery for resection of malignant tumors located in eloquent areas. RESULTS: Post-surgery, linguistic functions were unchanged in 80 % of patients. Slight impairments in memory and executive functions were observed in about 50 % of patients. Survival rate at one year follow-up was 89 %. Results showed that awake procedure is safe, well tolerated and related with good linguistic outcome similar to low-grade gliomas. The majority of patients reported a good outcome in term of quality of life. CONCLUSIONS: Our results confirm that awake surgery is associated to good cognitive and linguistic clinical outcome also in malignant tumors.

Spinal intradural extramedullary haemangioma: MRI and neurosurgical findings.

Haemangiomas, have rarely been encountered in the spinal intradural extramedullary space and the MRI findings of this entity have been described only in a few cases. We present the Magnetic Resonance Imaging (MRI) and surgical findings of a rare case of intradural extramedullary cavernous angioma located at the T1-T2 level in a 65-year-old man presented progressive paraparesis and upper thoracic back pain. On MRI, a well-circumscribed intradural solid mass, 1 cm in diameter, was detected and another enhancing nodular mass was found at the nerve roots of the cauda equina. The thoracic spinal lesion was removed and the histological diagnosis confirmed cavernous haemangioma. Although very uncommon, haemangioma should be included in the differential diagnosis when a spinal intradural extramedullary lesion is discovered and some neuroradiological findings could allow a presumptive diagnosis.

Effect of age on synaptic size in human brain tissue proximal to tumor masses.

OBJECTIVE: To measure the effect of age on synaptic morphologic rearrangements in human brain tissue peripheral to space-occupying lesions. STUDY DESIGN: Synaptic length (L) was measured interactively by computer-assisted image analysis in brain tissue samples from adult (mean age, 39 years) and old (mean age, 67.2 years) patients. Each group consisted of five subjects. RESULTS: L was reduced by 9% in the old vs. adult group of patients. A percent distribution of the data showed that junctional areas smaller than 0.25 micron accounted for 47.2% in old patients and 31% in the adults. CONCLUSION: The present findings are in contrast with current literature data documenting a significant increase in the percent of enlarged contact zones in the senile brain. We interpret these results in terms of synaptic dynamic morphology and suggest that they may reflect alterations of neuronal adaptive capabilities due both to the pathologic condition and age of the patients.

Cardiac myxoma with glandular elements metastatic to the brain 12 years after the removal of the original tumor.

This report describes a case of cardiac myxoma with glandular elements metastatic to the brain. The histological appearance of the brain tumor was characterized by irregularly shaped glands lined by a single layer of mucous-secreting cells. The glands rested on a stroma made of connective tissue with myxoid changes in which short cords of cells with eosinophilic cytoplasm were occasionally detected. The cardiac tumor was a myxoma in which only 2 small glandular structures were identified. Immunohistochemically, the gland-lining cells were positively stained by cytokeratin AE1-AE3, CAM 5.2, and B 72.3. CEA was detected as a thin layer on the luminal surface of the cells and in the cytoplasm of goblet cells. The myxoma cells in the stroma were not stained by cytokeratins. This is the first report of brain metastases from a cardiac myxoma made of glandular elements.