Primary spinal cord tumors of childhood: effects of clinical presentation, radiographic features, and pathology on survival

To determine the relationship between clinical presentation, radiographic features, pathology, and treatment on overall survival of newly diagnosed pediatric primary spinal cord tumors (PSCT). Retrospective analysis of all previously healthy children with newly diagnosed PSCT at a single institution from 1995 to present was performed. Twenty-five pediatric patients (15 boys, average 7.9 years) were diagnosed with PSCT. Presenting symptoms ranged from 0.25 to 60 months (average 7.8 months). Symptom duration was significantly shorter for high grade tumors (average 1.65 months) than low grade tumors (average 11.2 months) (P = 0.05). MRI revealed tumor (8 cervical, 17 thoracic, 7 lumbar, 7 sacral) volumes of 98–94,080 mm3 (average 19,474 mm3). Homogeneous gadolinium enhancement on MRI correlated with lower grade pathology (P = 0.003). There was no correlation between tumor grade and volume (P = 0.63) or edema (P = 0.36) by MRI analysis. Median survival was 53 months and was dependent on tumor grade (P = 0.05) and gross total resection (P = 0.01) but not on gender (P = 0.49), age of presentation (P = 0.82), duration of presenting symptoms (P = 0.33), or adjuvant therapies (P = 0.17). Stratified Kaplan–Meier analysis confirmed the association between degree of resection and survival after controlling for tumor grade (P = 0.01). MRI homogeneous gadolinium enhancement patterns may be helpful in distinguishing low grade from high grade spinal cord malignancies. While tumor grade and gross total resection rather than duration of symptoms correlated with survival in our series, greater than one-third of patients had reported symptoms greater than 6 months duration prior to diagnosis

Greffes cérébrales: aspects éthiques et scientifiques [Brain grafts: ethical and scientific aspects].

Neural grafting will dramatically modify the treatment of major cerebral and medullary illnesses. This new approach has already been used in Parkinson's disease, perhaps too early according to our knowledge in that field. Ethical problems are numerous with brain grafting but one may hope in next future a better understanding of the mechanisms involved in these procedures and a solution to most of ethical objections to perform that treatment

Surgery of intramedullary spinal cord tumours

SCOPUS: cp.jinfo:eu-repo/semantics/publishe

Management of mass lesions of the brain stem.

Nine original articles dealing with the neurosurgical management of mass lesions of the brain stem and published in the nineties have been reviewed. The manage ment of these lesions remains controversial and the papers reviewed reflect the different attitudes that prevail. They suggest, however, that the experience gained in this field will allow more optimal management of this difficult lesion in the future. Optimal management of patients with brain stem mass lesions certainly requires high-quality neuroimaging, especially MRI. The type of lesions found in the pediatric population are different than in adults, and their management should also be different. Indeed, in children, the MRI characteristics of brain stem lesions, when coupled with the clinical history, match well with the pathological diagnosis and outcome in most cases. Therefore, many authors consider that pathological sampling is not required to initiate further treatment in children. This attitude is, however, controversial and not shared by all neurosurgeons and neuropediatricians. In adults, some authors advocate aggressive surgery, attempting the removal of focal intrinsic tumors using well-defined surgical approaches. Except in non-glial tumors, such as cavernomas and hemangioblastomas, the morbidity remains high and it is difficult to assess the risk versus benefit ratio in term of survival and quality of life. Thus, the direct surgical us approach should be limited to those cases with a clear exophytic tumor that will allow surgical removal with minimal morbidity. In the other cases, stereotactic biopsy represents a valuable alternative and will provide an accurate diagnosis, allowing each patient to be managed with the optimal specific therapy

Les métastases de méningiomes. A propos de deux cas.

Two cases of meningiomas with metastasis are presented. The first case is typically a fibroblastic meningioma. After a local recurrence, dissemination occurs in the CSF with multiples localizations. The second case is a parasagittal meningioma of meningotheliomatous type. After two recurrences, a lymph node metastasis is discovered. Three modes of dissemination are known: through the blood vessels, the lymphatics or the CSF. The different spreads and mechanisms are discussed