Acta Neurochirurgica

The superior cervical ganglia (SCG) of newborn rats, which had been cultured as expiants for varying periods of time, were transplanted into the striatum of rats with unilateral 6-hydroxydopamine lesions of the nigrostriatal dopamine pathway to examine the survival and functional properties of the sympathetic neurons maintained in long-term culture prior to grafting. In the rats given the SCG cultured in vitro for 2 weeks, apomorphine-induced rotational behaviour was satisfactory reduced. The rats receiving the SCG from 4-week-old cultures showed only modest behavioural changes. The grafting of the SCG cultured for 6 weeks in vitro did not affect the rotational behaviour. These behavioural data corresponded with the histological assessment of the graft survival by use of catecholamine histofluorescence. The present results suggest the critical time period in vitro which might allow the cultured sympathetic neurons to be successfully grafted.

Pituitary apoplexy is a clinical syndrome of hemorrhage or infarction of a pituitary adenoma. It has classically been associated with pituitary macroadenomas. The authors report three cases of pituitary apoplexy that occurred in patients with pituitary microadenomas. The presentation, endocrine results, and radiological and clinical outcome of each patient are described. In each of these cases of pituitary apoplexy due to microadenoma, the presenting headache was mistakenly attributed to a different diagnosis. The authors propose that pituitary apoplexy associated with a microadenoma may be much more common than appreciated and could be misdiagnosed as headache of alternative cause. Clinicians and radiologists should be aware of this clinical presentation.

The following review of the literature describes the ganglioglioma, an uncommon mixed glioneuronal neoplasm, most often of low-grade histology, with a small, albeit well-documented, malignant potential. These tumors exhibit a strong epileptogenic propensity and most often present as new onset seizures or are discovered after a long history of refractory epilepsy. Despite their indolent course, the importance of gross total resection is well recognized to prevent anaplastic and malignant degeneration. Morphologically, the neoplasm is often cystic with an enhancing mural nodule, but can also be entirely solid. They are most often found in the temporal lobe but have been found throughout the neuraxis. An exceedingly rare location of the ganglioglioma is within the lateral ventricle. A systematic literature search revealed only eight reports documenting the occurrence of a ganglioglioma within the lateral ventricle. We describe an illustrative case of an intraventricular ganglioglioma with a prominent cystic component and enhancing mural nodule, which represents the classic radiographic appearance of gangliogliomas described in other locations. A superior parietal lobule approach offered excellent surgical access for tumor removal and the patient has remained free of neurological deficits following surgery. Regardless of location within the central nervous system, ganglioglioma should be on the differential diagnosis for any cystic mass with a mural nodule, particularly in the setting of epilepsy.

Quản lý tối ưu các u màng não nền sọ không triệu chứng vẫn là một đề tài gây tranh cãi. Chúng tôi đã đánh giá sự an toàn và hiệu quả của phẫu thuật xạ Gamma Knife (GKRS) trong việc quản lý các u màng não nền sọ không triệu chứng. Nghiên cứu hồi cứu này bao gồm những bệnh nhân được điều trị bằng GKRS cho các u màng não nền sọ không triệu chứng từ năm 1997 đến 2019. Dữ liệu lâm sàng-hình ảnh của bệnh nhân, đặc điểm khối u, và chi tiết quy trình đã được phân tích. Kết quả thuận lợi được xác định là không có tử vong liên quan đến quy trình hoặc thương tật thần kinh lâu dài, đồng thời có bằng chứng hình ảnh về kiểm soát khối u. Tiến triển và thoái lui của khối u được định nghĩa là sự gia tăng hoặc giảm đi > 20% thể tích từ mức nền đến nghiên cứu hình ảnh thần kinh cuối cùng. Thể tích khối u trong khoảng ± 20% thể tích nền được coi là ổn định. Ba mươi bảy bệnh nhân (30 nữ), tuổi trung bình 68 tuổi (khoảng từ 42–83 tháng) đã được điều trị bằng GKRS với một lần thực hiện cho 40 khối u màng não nền sọ không triệu chứng. Tại lần theo dõi lâm sàng trung bình là 58,5 tháng (khoảng từ 14–150 tháng), không có tử vong nào liên quan đến quy trình hoặc khối u đã được điều trị được ghi nhận. Tỷ lệ thương tật thần kinh lâu dài là 2,75%. Có sự giảm đáng kể về thể tích khối u trung bình (p < 0.001) từ 4.04 cc (SD 3.09 cc) trước khi xạ trị xuống còn 2.73 cc (SD 2.24 cc) tại lần theo dõi cuối cùng. Liều bờ cao hơn liên quan đến sự thoái lui của khối u tại lần theo dõi cuối (HR = 1.351; 95%CI [1.094–1.669]; p = 0.05). So với các nghiên cứu về lịch sử tự nhiên, GKRS mang lại sự kiểm soát khối u lâu dài và bảo tồn thần kinh cho phần lớn bệnh nhân được điều trị u màng não nền sọ không triệu chứng. Cần phải có thêm nghiên cứu để xác định phương pháp quản lý tối ưu cho các u màng não nền sọ không triệu chứng.

The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.

To analyze psychopathological outcome and health-related quality of life (QOL) for cohorts of patients undergoing transcranial or transnasal anterior skull base surgery. A prospective study of patients undergoing elective surgery for various entities of the anterior skull base was performed. Evaluation for depression (ADS-K score) and anxiety (PTSS, STAI-S, STAI-T, and ASI-3 scores) was done before surgery, at 3 and 12 months after surgery. The correlation between preoperative psychological burden and postoperative quality of life as measured by the SF-36 and EuroQol questionnaires was analyzed. Incidence and influence of these psychiatric comorbidities on clinical outcome were examined and compared between transnasal and transcranial subgroups. We included 54 patients scheduled for surgery of a pituitary adenoma or meningioma of the anterior skull base between January 2013 and July 2017. Of these, a cohort of 40 (74.1%) completed follow-up interviews after 3 and 12 months. There were 60.0% female patients, median age was 57 years. 57.5% of patients had a meningioma and were operated transcranially, while 42.5% of patients received transnasal surgery for pituitary adenoma. The proportion of pathological anxiety scores significantly decreased from 75.0 to 45.0% (p = 0.002), without difference between transnasal and transcranial subgroups. After 3 months, mean EuroQol VAS score non-significantly increased by 0.07 (p = 0.236) across the entire cohort without significant difference between transcranial and transnasal subgroups (p = 0.478). The transnasal cohort tended to score higher in anxiety scores, whereas the transcranial cohort demonstrated higher depression scores without significant difference, respectively. The individually declared emotional burden significantly decreased from 6.7 to 4.0 on the ten-point Likert scale (p < 0.001) equally for both subgroups (transnasal, − 2.3; transcranial, − 3.0; p = 0.174). On last examination, about half of the patients in each subgroup (41.2% vs. 52.2%; p = 0.491) expressed a considerable recovery of preoperative bodily complaints such as headaches, dizziness, and unrest defined as a score of at least 8 on the Likert scaled item. Both transnasal and transcranial approaches yield favorable postoperative QOL and psychopathological outcomes. The postoperative increase in QOL is partly influenced by preoperative expression of mental distress, which tends to resolve postoperatively.

Criteria for diagnosing abusive head trauma (AHT) or “shaken baby syndrome” are not well defined; consequently, these conditions might be diagnosed on failing premises. The authors have collected a total of 28 infants, from the US (20) and Norway (8), suspected of having been violently shaken, and their caregivers had been suspected, investigated, prosecuted or convicted of having performed this action. Among 26 symptomatic infants, there were 18 boys (69%) and 8 girls (31%)—mean age 5.1 month, without age difference between genders. Twenty-one of 26 symptomatic children (81%) had a head circumference at or above the 90 percentile, and 18 had a head circumference at or above the 97 percentile. After macrocephaly, seizure was the most frequent initial symptom in 13 (50%) of the symptomatic infants. Seventeen (65%) of the symptomatic infants had bilateral retinal haemorrhages, and two had unilateral retinal haemorrhages. All infants had neuroimaging compatible with chronic subdural haematomas/hygromas as well as radiological characteristics compatible with benign external hydrocephalus (BEH). BEH with subdural haematomas/hygromas in infants may sometimes be misdiagnosed as abusive head trauma. Based on the authors’ experience and findings of the study, the following measures are suggested to avoid this diagnostic pitfall: medical experts in infant abuse cases should be trained in recognising clinical and radiological BEH features, clinicians with neuro-paediatric experience should always be included in the expert teams and reliable information about the head circumference development from birth should always be available.

In Ergänzung einer früheren Mitteilung wird an Hand der Angiogramme von drei Fällen, von denen zwei autoptisch belegt sind, ein charakteristisches Verlagerungssyndrom der A. cer. post. bei einseitiger Verquellung der Cisterna basalis und ambiens mitgeteilt. Das Syndrom besteht in einer einseitigen Verformung der pedunkulären Gabel der A. cer. post. durch Medialverlagerung und gleichzeitige Streckung des Gefäßes auf der befallenen Seite. Der Arterienverlauf stellt ein getreues Abbild der Formveränderung des Mittelhirns dar und ermöglicht somit Schlüsse über Art und Ausmaß seiner Verformung und Verlagerung.

  Cell proliferation and cell death are opposing processes in tumour growth, with tumour progression reflecting the balance between proliferating and apoptotic cells. The purpose of the present study is to verify the hypothesis that an imbalance between apoptosis and proliferation can predict survival in patients with primary glioblastoma.   After the immunohistochemical study of Apostain and MIB-1 expression, the index of apoptosis (AI), the index of proliferation (PI), and the ratio AI/PI was recorded for each tumour specimen, in a series of 32 primary glioblastomas. Studies of correlation between AI and PI, between AI and survival, between PI and survival, and between the ratio AI/PI and survival, were performed using the Spearman rank correlation test. Furthermore, a comparative study of survival was performed for subgroups of patients with ratio AI/PI greater or lesser than 1, using the log rank test.   In the present series, values of AI and PI showed a wide distribution, with a mean±SD of 8.16±7.2, and of 12.69±21.1, respectively. The values for the ratio AI/PI ranged between 0.01 and 6.03 (mean±SD: 1.44±1.60). Statistical study failed to obtain correlation between AI and PI. Survival of patients not correlated with AI neither with PI. The ratio between AI and PI did not correlate with survival either. Nevertheless, when survival for the subgroups of patients showing a ratio AI/PI greater or lesser than 1 was compared, a significant difference was found (p: 0.02). Survival ranged between 50 and 81 weeks (mean of 58.5±11.05 weeks) for the 12 cases showing a ratio AI/PI greater than 1, and it ranged between 8 and 85 weeks (mean: 38.20±25.37 weeks) for the 20 cases showing a ratio AI/PI lesser than 1.   Our present results suggest that a clear imbalance between cell proliferation and apoptosis can predict outcome in patients operated on for a primary glioblastoma.