43 research outputs found
Coexisting intracranial tumors with pituitary adenomas: Genetic association or coincidence?
The co-occurrence of two or more brain tumors with different
histological features is rare. The authors report three rare cases of
intracranial tumors associated with pituitary adenomas. Two of the
pituitary tumors were functioning adenomas: a prolactinoma and a
thyrotropin secreting adenoma. Two of the associated intracranial
neoplasms were gliomas and one was a meningioma. Radiological and
clinical examination for syndromal association was negative in all
cases. We briefly discuss the presentation and treatment options of
these cases and review the 19 previous publications in the literature
of pituitary tumors occurring in association with other neoplasms and
explore the possible links underlying these co-occurring neoplasms. Our
three cases represent 0.86% of all pituitary tumors operated at our
institute over a 9-year period
Upregulation of ASCL1 and inhibition of Notch signaling pathway characterize progressive astrocytoma
Astrocytoma is the most common type of brain cancer constituting more than half of all brain tumors. With an aim to identify markers describing astrocytoma progression, we have carried out microarray analysis of astrocytoma samples of different grades using cDNA microarray containing 1152 cancer-specific genes. Data analysis identified several differentially regulated genes between normal brain tissue and astrocytoma as well as between grades II/III astrocytoma and glioblastoma multiforme (GBM; grade IV). We found several genes known to be involved in malignancy including Achaete-scute complex-like 1 (Drosophila) (ASCL1; Hash 1). As ASCL has been implicated in neuroendocrine, medullary thyroid and small-cell lung cancers, we chose to examine the role of ASCL1 in the astrocytoma development. Our data revealed that ASCL1 is overexpressed in progressive astrocytoma as evidenced by increased levels of ASCL1 transcripts in 85.71% (6/7) of grade II diffuse astrocytoma (DA), 90% (9/10) of grade III anaplastic astrocytoma (AA) and 87.5% (7/8) of secondary GBMs, while the majority of primary de novo GBMs expressed similar to or less than normal brain levels (66.67%; 8/12). ASCL1 upregulation in progressive astrocytoma is accompanied by inhibition of Notch signaling as seen by uninduced levels of HES1, a transcriptional target of Notch1, increased levels of HES6, a dominant-negative inhibitor of HES1-mediated repression of ASCL1, and increased levels of Notch ligand Delta1, which is capable of inhibiting Notch signaling by forming intracellular Notch ligand autonomous complexes. Our results imply that inhibition of Notch signaling may be an important early event in the development of grade II DA and subsequent progression to grade III AA and secondary GBM. Furthermore, ASCL1 appears to be a putative marker to distinguish primary GBM from secondary GBM
Identification of potential serum biomarkers of glioblastoma: serum osteopontin levels correlate with poor prognosis
Background: The aim of this study is to identify serum biomarkers with classification and prognosis utility for astrocytoma, in particular glioblastoma (GBM). Methods: Our previous glioma microarray database was mined to identify genes that encode secreted or membrane-localized proteins. Subsequent analysis was done using significant analysis of microarrays, followed by reverse transcription-quantitative PCR (RT-qPCR) and immunohistochemical validation in tumor tissues, ELISA and Western blot validation in sera, and correlation with survival of GBM patients. Results: Significant analysis of microarrays identified 31 upregulated and 3 downregulated genes specifically in GBMs. RT-qPCR validation on an independent set of samples confirmed the GBM-specific differential expression of several genes, including three upregulated (CALU, CXCL9, and TIMP1) and two downregulated (GPX3 and TIMP3) novel genes. With respect to osteopontin (OPN), we show the GBM-specific upregulation by RT-qPCR and immunohistochemical staining of tumor tissues. Elevated serum OPN levels in GBM patients were also shown by ELISA and Western blot. GBM patients with high serum OPN levels had poorer survival than those with low serum OPN levels (median survival 9 versus 22 months respectively; P = 0.0001). Further, we also show high serum TIMP1 levels in GBM patients compared with grade II/III patients by ELISA and downregulation of serum GPX3 and TIMP3 proteins in GBMs compared with normal control by Western blot analysis. Conclusions: Several novel potential serum biomarkers of GBM are identified and validated. High serum OPN level is found as a poor prognostic indicator in GBMs. Impact: Identified serum biomarkers may have potential utility in astrocytoma classification and GBM prognosis
Tube-assisted Minimally Invasive versus Open Posterior Decompression for Multilevel Degenerative Cervical Myelopathy: A Prospective Comparative Study
Objective There have been several reports of minimally invasive decompression for cervical canal stenosis and degenerative myelopathy. Most of these reports are for less than 4 levels and there have not been any comparative studies between Open and MIS cervical decompression for multilevel (â„4) degenerative cervical myelopathy. Methods Twenty consecutive patients were allotted to undergo either âOpenâ cervical laminectomy (n=10) or MIS posterior cervical decompression (n=10). All patients were evaluated for 1. Clinical, (JOA, MDI, NDI, Nurick grade, Blood loss, Duration of surgery); 2. Radiological (CSA of dural sac and Spinal cord, Muscle edema on post-op T2W MRI); 3. Laboratory (TLC, CRP, ESR, CPK) and 4. Physical (Isometric neck extensor muscle strength). Differences between Open and MIS groups were calculated with respect to above parameters. Results The mean number of levels decompressed was 4.4 (range, 4â6). MIS group had significantly longer duration of surgery and lesser blood loss as compared to open group. The patients in open group were more disabled than MIS group pre-operatively, as evidenced by higher MDI and NDI. However, proportionate improvements were seen in both groups post-operatively in terms of all clinical parameters. Postoperative increase in CSA of spinal cord was also identical in both groups. Elevations in CRP and ESR were significantly higher in Open group post-operatively as compared to MIS group. Post-operative extensor neck muscle strength improved to a higher extent in MIS group as compared to open group though this was not statistically significant. No patient had any major post-operative complications. Conclusion MIS posterior cervical decompression is safe and effective, can achieve similar extent of decompression and degree of clinical improvement as compared to open surgery. MIS has definite advantages of lesser blood loss, reduced tissue injury and better improvement in post-operative neck muscle strength as compared to open surgery
Trigeminal Neuralgia Due to a Small Meckel's Cave Epidermoid Tumor: Surgery Using an Extradural Corridor
Tumors at the petrous apex are associated with a variety of symptoms, which most often involve the trigeminal nerve. The authors present a rare case of a small epidermoid tumor in Meckel's cave that caused medically refractory trigeminal neuralgia. The surgical challenge associated with approaches to such lesions is discussed. The skull base tumor was excised completely through a small temporal craniotomy. The practicality of neuronavigation in reaching the petrous apex using a small extradural window is presented
Emergent management with favorable outcome of an unusual presentation of a primary CNS lymphoma in an immunocompetent patient
Can bradycardia pose as a âred herringâ in neurosurgery? Surgical stress exposes an asymptomatic sick sinus syndrome: Diagnostic and management dilemmas
Bradycardia in neurosurgery is almost always assumed to be secondary to intracranial conditions, specifically raised intracranial pressure causing Cushingâs reflex, the trigemino-cardiac reflex or brainstem lesions. We present a case of posterior fossa surgery in which persistent bradycardia developed in the postoperative period. A cardiac cause was initially overlooked since hydrocephalus was present preoperatively, which was initially assumed to be the cause of the bradycardia. The baseline pulse rate prior to surgery was 66 beats/minute. Only when repeated imaging revealed complete resolution of the hydrocephalus was a cardiology work up done and diagnosis of sick sinus syndrome established. The authors present an interesting case which demonstrates the need for a high degree of suspicion for such rare co-existing conditions. The diagnostic and management dilemmas are further discussed
Can bradycardia pose as a "red herring" in neurosurgery? Surgical stress exposes an asymptomatic sick sinus syndrome: Diagnostic and management dilemmas
Bradycardia in neurosurgery is almost always assumed to be secondary to
intracranial conditions, specifically raised intracranial pressure
causing Cushing\u2032s reflex, the trigemino-cardiac reflex or
brainstem lesions. We present a case of posterior fossa surgery in
which persistent bradycardia developed in the postoperative period. A
cardiac cause was initially overlooked since hydrocephalus was present
preoperatively, which was initially assumed to be the cause of the
bradycardia. The baseline pulse rate prior to surgery was 66
beats/minute. Only when repeated imaging revealed complete resolution
of the hydrocephalus was a cardiology work up done and diagnosis of
sick sinus syndrome established. The authors present an interesting
case which demonstrates the need for a high degree of suspicion for
such rare co-existing conditions. The diagnostic and management
dilemmas are further discussed