Efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles in the preoperative embolization of meningiomas.
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BACKGROUND AND PURPOSE: Trisacryl gelatin microspheres are a new, commercially available nonabsorbable embolic agent. The purpose of this study was to evaluate their efficacy in the preoperative embolization of meningiomas as compared with polyvinyl alcohol (PVA) particles of various sizes. METHODS: In 30 consecutive patients, trisacryl gelatin microspheres (150-300 microm) were used for the preoperative superselective embolization of meningiomas (group 1). Thirty other consecutive patients had embolization with PVA particles of 45 to 150 microm (n = 15, group 2) and of 150 to 250 microm (n = 15, group 3). Extent of devascularization, intraoperative blood loss, blood transfusion, and hemostasis at the time of surgery were recorded for every patient. The inflammatory reaction, the extent of necrotic areas, and the most distal intravascular location of the embolic agent (arterial, arteriolar, precapillary, capillary) were recorded. RESULTS: There was no significant difference in the extent of angiographic devascularization among the groups. Intraoperative blood loss differed significantly between groups 1 and 2 and groups 1 and 3, but not between groups 2 and 3. The trisacryl gelatin microspheres were located more distally in tumor vessels than were the PVA particles of either size. The extent of intratumoral necrosis was not significantly different between the two embolic agents. In all groups there was a mild inflammatory tissue reaction in the vicinity of the embolic agent. CONCLUSION: Trisacryl gelatin microspheres may be effective in the preoperative embolization of meningiomas, producing significantly less blood loss at surgery than seen with PVA particles of either size, possibly because of the significantly more distal vascular penetration of the microspheres. (+info)
The use of craniotomy to approach supratentorial lesions is quite well established in the literature. The use of craniotomy for posterior fossa approaches, however, is not well described. The aim of this article is to describe the technical aspects of this approach and to delineate the important landmarks. In our cases, posterior fossa craniotomies have been utilized for treat different pathologies. Additionally, the technique has not added any additional risk, and the cosmetic results have been excellent. (+info)
Meningitis carcinomatosa originating from an alpha fetoprotein-producing gastric cancer.
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Alpha fetoprotein (AFP)-producing gastric cancer is relatively rare and meningitis carcinomatosa is similarly a rare manifestation among the neoplastic diseases. There have been no previous reports of meningitis carcinomatosa originating from AFP-producing gastric cancer. A 68-year-old man with AFP-producing gastric cancer was treated with cisplatin and doxifluridine because of multiple liver metastases. Although the liver lesion was reduced to 30% of pretreatment size after 6 courses of chemotherapy, meningitis carcinomatosa subsequently occurred. Immunostaining of AFP and magnetic resonance imaging (MRI) were useful in the diagnosis of meningitis caused by AFP producing cancer cells. (+info)
MR imaging- and MR spectroscopy-revealed changes in meningiomas for which embolization was performed without subsequent surgery.
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We describe our experience with follow-up MR imaging and MR spectroscopy in two patients after embolization of meningiomas without subsequent surgery. In both patients there was a marked reduction in tumor size and a decrease in contrast enhancement associated with spectroscopic signs of fatty degeneration. We did not observe regrowth; however, in one patient with incomplete angiographic devascularization, residual vital tumor tissue was seen at follow-up examinations. (+info)
Treatment of leptomeningeal metastases evaluated by interphase cytogenetics.
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PURPOSE: Although cytologic examination of CSF is the primary method for the evaluation of response to therapy for leptomeningeal metastases (LMMs), the procedure's sensitivity decreases throughout the course of protracted therapy. We studied whether this response could be monitored more accurately through the detection of numerical chromosomal aberrations by interphase cytogenetics, using fluorescence in situ hybridization (FISH). PATIENTS AND METHODS: Seven patients treated for LMMs and with a known numerical aberration for chromosome 1 in their pretreatment CSF were included in this study. Up to 16 consecutive CSF samples were analyzed by means of the fluorescence in situ hybridization (FISH) technique for cells with aberrant chromosome 1 content. The results of routine cytology and FISH analyses were compared and were correlated with each patient's neurologic status. RESULTS: Routine cytology detected malignancies in only 24 of the 76 samples, all of which were classified as chromosomally abnormal by FISH (except for two samples that could not be evaluated). Moreover, FISH demonstrated aneusomic cells in 32 additional samples, which could therefore be classified as malignant. The FISH results correlated better with patient neurologic status in that more malignant cells were detected in the CSF of neurologically deteriorating patients. CONCLUSION: Using FISH in addition to performing routine cytologic examination of CSF led to a more accurate evaluation of response to treatment in patients treated for LMMs. (+info)
Cerebrospinal fluid seepage through polyglactin 910 dura substitute manifested as spinal extradural collection of fluid.
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Following excision of pilocytic astrocytoma, a 12-year-old girl underwent posterior cranial fossa synthetic duraplasty with polyglactin 910 mesh. On the 8th postoperative day, unusual extradural collection was diagnosed by spinal magnetic resonance imaging. On the 14th postoperative day, cerebrospinal fluid leakage in the upper part of the postoperative wound was noticed. Unusual extradural collection detected by spinal magnetic resonance imaging was assumed to be the consequence of cerebrospinal fluid seepage and a warning sign of cerebrospinal fluid leakage following synthetic posterior fossa duraplasty. This case shows that polyglactin 910 mesh may be ineffective when used for posterior cranial fossa duraplasty in children, although it is considered as valuable as autologous tissue. (+info)
We present the radiologic and pathologic findings in a boy who presented with diffuse leptomeningeal enhancement and whose clinical status deteriorated over the course of 5 years. During this period, MR images showed progression of the enhancement in the subarachnoid spaces, formation of intraaxial cysts, and hydrocephalus. Autopsy findings revealed diffuse oligodendroglioma throughout the leptomeninges of the brain and spine, with no definite intraaxial focus. The radiologic and pathologic features of diffuse leptomeningeal oligodendrogliomatosis are reviewed. (+info)
Apoptotic activity and bcl-2 immunoreactivity in meningiomas. Association with grade and outcome.
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We retrospectively evaluated 90 meningiomas for bcl-2 expression, apoptosis counts (per 10 high-power fields [HPF]), MIB-1 labeling indices (LI), and mitosis counts (per 10 HPF). Characteristics were as follows: 37 low-grade (benign) meningiomas: mean apoptosis count, 1.2; MIB-1 LI, 1.0; mitosis count, 0.1; and bcl-2 positivity, 40%; 29 atypical meningiomas: apoptosis count, 3.3; MIB-1 LI, 5.5; mitosis count, 2.2; and bcl-2 positivity, 62%; 24 malignant meningiomas: apoptosis count, 6.5; MIB-1 LI, 12.0; mitosis count, 6.0; and bcl-2 positivity, 67%. By univariate analysis, MIB-1 LI, apoptosis and mitosis counts, and tumor grade were associated significantly with death due to tumor; by multivariate analysis, only mitosis count was independently associated with death due to tumor. We compared similar data for 27 patients with nonrecurrent tumors and 32 patients with recurrent meningiomas. Histologic sections from the initially resected tumor and from the most recent recurrence were reviewed. Only the apoptosis count was significantly higher by univariate analysis in the initial resection specimens from tumors that ultimately recurred vs nonrecurrent tumors. Expression of bcl-2, MIB-1 LI, and mitosis count did not correlate with recurrence. By multivariate analysis, only extent of surgical resection was associated significantly with tumor recurrence. Although bcl-2 immunostaining was not associated statistically with outcome, bcl-2 positivity was more common in atypical and malignant meningiomas than in low-grade tumors. (+info)