Image-guided stereotactic biopsy of infiltrative, multicentric and deep-seated supratentorial cerebral gliomas

Infiltrative cerebral gliomas remain a neurosurgical challenge despite the latest achievements in neuroimaging techniques and microsurgical approaches. In this paper the authors present their experience in 85 cases of stereotactic biopsies performed for infiltrative, multicentric and deep-seated cerebral gliomas. The stereotactic and neuroimagistic tools used for these procedures included the Leksell stereotactic system and the software: Stereotactic Planning System (SPS), NTPS 8.2. The histopatological results (according to World Health Organization (WHO) classification) were: 51 cases of glioblastomas (grade IV) (60%), 7 cases of anaplastic astrocytomas (grade III) (8,2%), 13 cases of grade II diffuse astrocytomas (15,3%), 6 cases of grade I astrocytomas (7,1%), one case of grade II oligodendroglioma (1,2%), 3 cases of anaplastic oligodendrogliomas (grade III) (3,5%), one case of grade I ganglioglioma (1,2%), one case of anaplastic ganglioglioma (grade III) (1,2%), and 2 cases of anaplastic ependymomas (grade III) (2,3%). In 21 cases (24,7%) the immunohistochemistry has been performed in order to obtain an accurate histopathological result. In this series, the early postoperative mortality was 0%, with no cases of clinically significant hemorrhages after biopsy procedures. Temporary increase of neurological deficits has been noticed in 7 patients (8,2%). In conclusion, image-guided stereotactic biopsy represents now a safe and accurate diagnostic method for cerebral gliomas, which can favorably influence the therapeutic management of the patients

Intramedullary spinal cord tumour (hemangioblastoma): Clinical case presentation

Hemangioblastomas represent cca. 1 - 2,5% of all the intracranial tumours and only 2 -3% at the level of the spinal cord. The symptomatology, usually insidious, is directly proportional with the size of the tumour. The native magnetic resonance imaging (MRI) scan and the use of a contrast agent is the investigation of choice for diagnosing intramedullary tumours. Authors report the case of a 51 years old man patient admitted in our institution for an intramedullary spinal cord tumor, developed insidious. The lesion was completely removed. Postoperatory outcome was excellent, and the histopathological result was: hemangioblastoma

Metastatic lymph criterion for colon cancer

U.M.F. ”Carol Davila”, Clinica chirurgicală, Spitalul Clinic de Urgență “Bagdasar-Arseni”, Serviciul de Anatomie Patologică, Spitalul Clinic de Urgență “Bagdasar-Arseni”, București, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011In studiul prospectiv a 126 pacienți cu cancer de colon (B = 70; 55,55 %, F = 56; 44,44 %), cu media vârstei de 65,26 ani (limite 20-89 ani), majoritatea aflați în stadiul clinic III (n = 72; 57,14 %) si IV (n = 49; 38,89 %) cu tumori situate mai frecvent pe colonul stâng (n = 86; 68,25 %) și mai ales, pe sigmoid (n = 64; 50,79 %), au fost operați în urgență (n = 42; 33,33 %) sau electiv ( n = 84; 66,66 %). Invazia în profunzimea peretelui colic (pT 3 = 49; 38,9 %; pT4 = 72; 57,1 %) a fost însoțită de creșterea numarului de noduli limfatici regionali afectați (pN1 = 29; 23,0 %; pN 2 = 43; 34,1 %). Existența anastomozelor limfatice, a căilor limfatice de scurtcircuitare, a invaziei venoase (n= 4; 3,17 %) explică metastazele limfatice la distanța (n = 8; 6,34 %) și a celor viscerale ( pM1 = 49; 38,9 %). Invazia limfatică a fost favorizată de histiocitoza (n = 5; 9,37 %), hiperplazia foliculilor limfatici( n = 3; 2,38 %) și de gradul de diferențiere celulară a tumorii (G3 = 21; 16,66 %). Complicațiile postoperatorii au apărut doar la pacienții ăn stadiile clinice III (n = 11; 15,41 %) si IV ( n = 15; 30,61 %). Postoperator s-au înregistrat 24 (19,04 %) decese, cele mai multe în tumorile din stadiul pT 4 (n = 18; 25 %). Supraviețuirea corectată la cinci ani pentru pacienții cu adenopatie metastatică din stadiul III a fost de 33,57 %, diferit pentru TN1 sub 4 noduli limfatici și pentru TN2 – mai mult de 4 noduli limfatici. Concluzii: Prezența adenopatiei metastatice are valoare informațională crucială în aprecierea evoluției postoperatorii precoce și tardive.In the prospective study of 126 patients with colon cancer (B = 70, 55.55%, F = 56, 44.44%), with an average age of 65.26 years (range 20-89 years), most are in stage clinical III (n = 72, 57.14%) and IV (n = 49, 38.89%) with tumors located more frequently in the left colon (n = 86, 68.25%) and especially the sigmoid colon (n = 64, 50.79%) were operated in emergency (n = 42, 33.33%) or elective (n = 84, 66.66%). Colic wall invasion depth (pT 3 = 49, 38.9%, pT4 = 72, 57.1%) were accompanied by an increase in the number of affected regional lymph nodes (pN1 = 29, 23.0%, pN 2 = 43, 34.1%). The existence of lymphatic anastomoses, bypass of the lymphatics, and venous invasion (n = 4, 3.17%) explain away lymphatic metastases (n = 8, 6.34%) and the visceral (PM1 = 49, 38.9 %). Lymphatic invasion was favored by histiocytosis (n = 5, 9.37%), hyperplasia of lymph follicles (n = 3, 2.38%) and degree of tumor cell differentiation (G3 = 21, 16.66%). Postoperative complications occurred only in patients in clinical stage III (n = 11, 15.41%) and IV (n = 15, 30.61%). Postoperative there were 24 (19.04%) deaths, mostly in tumors of stage pT 4 (n = 18, 25%). Corrected to five years survival for patients with metastatic adenopathy of stage III was 33.57%, different for TN1: under 4 lymph nodes and for TN2: more than 4 lymph nodes. Conclusions: The presence of metastatic adenopathy is crucial in assessing the informational value of early and late postoperative evolution

Controversies in multimodal treatment of pineal tumors: Experience of 84 cases

The pineal tumors represent one of the most difficult and challenging disease from all brain pathology due to the complex anatomy of the area and because of the diverse pathology of this type of tumors. The management of these tumors is multi modal and comprises the surgical approach followed by radiotherapy and chemotherapy. The authors present a large series of 84 consecutive operated cases of pineal tumors. All these cases have undergone one of the two main surgical approaches (occipito-transtentorial approach and supracerebellar - infratentorial approach). In 22 cases (26,1%) the tumor was totally removed, in 18 cases (21,4%) near total removal was obtained, in 33 cases (39,2%) partial removal and biopsy was performed in 11 cases (13,1%). From all 84 cases, 39 cases (46%) were germ cells tumors, 16 cases (19%) were pineal parenchyma tumors, in 27 cases (32%) were glial cell tumors and in 2 cases (3%) were miscellaneous tumors. As adjuvant therapy, radiotherapy played an important role within the multimodal management of pineal tumors. Therefore 61 cases have undergone the radiotherapy, which have been indicated for all sensitive tumors. The chemotherapy was applied in 41 cases, and consisted in a combination of cisplatin, bleomycin and actinomycin D. The outcome was good recovery in 56 cases (66%), moderate disability in 12 cases (14.7%), severe disability in 9 cases (10.2%) and death in 7 cases (8.8%).&nbsp

Olfactory groove meningiomas clinical and therapeutically features a retrospective study

Objectives. Descriptive, retrospective study assessing clinical symptomatology, ancillary diagnostic tests, therapeutically options and clinical outcome in the patients admitted with this diagnostic to Bagdasar-Arseni Clinical Emergency Hospital between 2000 and 2004. Method. Cases were included based on the diagnostic codes in the hospital archives and their clinical records were studied retrospectively. Subgroups were defined according to sex and age criteria in order to provide an accurate epidemiological evaluation. Results.20 cases of olfactory groove meningioma were admitted and investigated during the period mentioned above; 14 were female and 6 male (F/M = 2.3/1), between the ages of 46 and 77; mean age was 57.35±9. Ancillary diagnostic tests were used, including imaging techniques: CT, MRI, angio-MRI, corroborated with ophthalmologic examination. 18 patients underwent surgery. Exitus occurred in 2 patients, consecutive to respiratory insufficiency due to persistent pulmonary infections associated with prolonged immobilization. Conclusions. Olfactory groove meningiomas are a relatively rare disease, more frequent in females, 4th and 5th life decade. As symptomatology may be insidious, diagnosis is only achieved when the tumor is already large; frequently over 4 cm. Diagnosis is basically imagistic, allowing assessing dural and boning involvement. Surgical management with complete tumor removal is usually curative

Multiple intracranial meningiomas with different pathological subtype

Authors present the case of a 63 years old woman, admitted for left proptosis and hemicrania evolving for three months. At the screening CT scan with contrast were discovered two lesions: a left fronto-temporal mass, intensely contrast enhancing, with peritumoral edema, inserted on the sphenoid wing, extended in the infratemporal fossa and ethmoidal sinus; the other lesion was cystic, located parieto-temporally, in the corticosubcortical area, with a small tumor nodule located deeply. MRI defined the details and the size of the lesions: 63/65/71 mm left solid tumor suggesting a sphenoid wing meningioma, and a 67/62/72 mm right parietal-temporal cystic lesion with moderate mass effect. Authors insist on neurosurgical strategy for treatment of multiple intracranial masses with different consistency-solid and cystic. Adequate surgical planning was done after MRI with contrast examinations, which were strongly suggestive for multiple intracranial meningiomas. Surgical approach was done in two steps according to treat first the cystic lesion because we supposed that is a recent developed lesion with high risk of sudden volume increase followed by neurological deterioration. On another way, attacking first the solid tumor, we could have a high risk to decompensate the cystic lesion. Neurological and general evolution after two steps neurosurgery was without incidents with a very good outcome. Pathological examination revealed two different types of meningioma: microcystic and transitional