Historical origin and meaning of the term „glial tumor“

In everyday neurosurgical practice, the term „glial tumor“ is associated with astrocytomas, glioblastomas, and oligodendrogliomas, although historically this has not always been the case. The term „glial tumor“ was first given by Virchow in the 19th century as a term initially combining all primary brain tumors under this name. It derives from the name of the group of „supporting“ nerve cells - glia or neuroglia (from the Greek glia - glue), a group which for many years was wrongly ascribed only a cohesive or supporting function.In 1926, in their classification of glial tumors - A Classification of the Tumors of the Glioma Group on a Histogenetic Basis with a Correlated Study of Prognosis, one of the founding fathers of neuropathology Percival Bailey and the founding father of modern neurosurgery – Harvey Cushing ascribed several different tumors in this group: in addition to neuroepithelioma, spongioblastoma multiforme, astrocytoma and ependymoma, they also add medulloblastoma, astroblastoma, oligodendroglioma and unipolar spongioblastoma. Since then, the classification of glial tumors has undergone many changes to its current form. In the latest classification of brain tumors published in 2021, glial tumors are united in a common group together with glioneuronal and neuronal tumors. Their extensive group includes tumors with different prognosis, age presentation, molecular profile and therapeutic response. From a neurosurgical point of view, the term „glial tumor“ does not carry a prognostic value, but only determines the belonging of the tumor to the astrocyte, oligodendrocyte cell line or their precursor cells. In relation to that an interesting question arises- why the remaining tumors originating from glial cells other than astrocytic, such as ependymomas, lost their belonging to the group of glial tumors, or such as intracranial schwannomas, are not included in it at all

Methods of cognitive status research in patients with glioblastoma

Introduction: Glioblastoma is a high-grade, aggressive central nervous system tumor with predominantly astrocytic differentiation, characterized by fast invasive growth into the surrounding brain parenchyma and aggressive clinical course. The short life expectancy of patients diagnosed with glioblastoma necessitates the need to maximize their quality of remaining life. One of the most common reasons for quality of life impairment in these patients is the cognitive deficit accompanying the disease. There is a lack of a unified and standardized method for the assessment of cognitive functions in these patients, which meets all the necessary criteria to be convenient and usable in the wide clinical practice.Aim: The aim of the present study is to compare the Montreal cognitive assessment (MoCA) brief screening test with an extended neuropsychological examination to determine its applicability in patients diagnosed with glioblastoma. Material and methods: The study includes 27 patients undergoing neurosurgical intervention for histologically proven IDH-wildtype glioblastoma in the Department of Neurosurgery, “St. Marina” University Hospital – a tertiary healthcare center, for the period January 2019 to December 2022. Preoperatively, patients were examined with the short MoCA screening test and an extended neuropsychological examination including the following subtests: Issac set test, Trail making test A and B, Luria test, Raven‘s color matrices, Stroop test and Bender test.Results: Of all the patients studied, those with a MoCA score below 26 points present at least one negative test of the extended neuropsychological examination. MoCA patients with scores of 26 or more do not demonstrate cognitive impairment in the extended neuropsychological impairment.Conclusion: The obtained results support the claim that the MoCA short screening test is applicable for preoperative diagnosis of cognitive disorders in patients with glioblastoma. Due to the study‘s small sample size, further research is needed to definitively prove this claim

Age as a factor for cognitive decline in patients with glial tumors

Introduction: Cognitive impairment appears in almost all patients with glial tumors during the course of this neuro-oncological disease. There are various reasons for this in regards to the glial tumor: grade of malignancy, rate of growth, molecular nature, mass effect, and presence of perifocal edema. But these factors do not always correlate with the degree of patient’s cognitive impairment. The present study’s aim is to account for age as a factor in the occurrence of cognitive decline in patients with glial tumors.Materials and methods: The study includes thirty two patients diagnosed with a glial tumor, treated operatively in the Neurosurgery Clinic of University hospital „St. Marina“ in Varna between 2019 and 2022 year. Twenty nine of those patients are diagnosed with glioblastoma, two are diagnosed with diffuse astrocytoma and one with astrocytoma grade 3 according to WHO. The mean age of the patients is 58.4 ± 11.4 years. The youngest patient is 25 years old and the oldest is 78 years old. Preoperatively, all patients are subjected to a series of cognitive tests.Results: From the studied sample, patients diagnosed with glioblastoma showed lower cognitive scores compared to the patients diagnosed with other glial tumors. Patients diagnosed with glioblastoma are significantly older than the patients diagnosed with other glial tumors.Conclusion: The older age of patients affected by glioblastoma may be an additional reason beside tumor factors for lower cognitive test outcome compared to patients affected by lower-grade gliomas

Chiari I malformation - a review

Introduction: Chiari malformations (types I-IV) are a group of complex brain abnormalities in the lower posterior skull that can lead to herniation of cerebellar tonsils into the spinal canal, sometimes causing non-communicating hydrocephalus. This condition is mostly presented at birth (congenital), although in many cases they may not become clinically apparent until adulthood.Aim: The aim of this work is to underline the pathophysiology, clinical manifestations and treatment of Chiari I malformation.Material and methods: Chiari type I malformation is the most common and the least severe of the spectrum, often diagnosed in adulthood. The cerebellar tonsils are displaced below the level of the foramen magnum, which causes compression of the cervicomedullary junction and interruption of normal flow of cerebrospinal fluid (CSF) leading to clinical syndrome. It is hypothesized that Chiari type I originates as a disorder of para-axial mesoderm, which results in formation of a small posterior fossa.Symptoms of Chiari I develop as a result of: (1) compression of medulla and upper spinal cord, (2) compression of cerebellum, and (3) disruption of CSF flow through foramen magnum. Compression of the cord and medulla may result in myelopathy and lower cranial nerve dysfunction. Compression of cerebellum may result in ataxia, dysmetria and nystagmus. Disruption of CSF flow through foramen magnum accounts for the most common symptom - pain.Results: MRI is the most widely used imaging study for diagnosing Chiari malformation.  Patients with CM who have minimal or symptoms without syringomyelia can be treated conservatively. Symptomatic patients should be offered surgical treatment. Its goals are decompression of cervicomedullary junction and restoration of normal CSF flow in the region of foramen magnum.Conclusion: It has been noted that early surgical intervention is associated with better outcome in cases of symptomatic Chiari I malformation

Dandy-Walker malformation - a review

Introduction: Dandy-Walker malformation (DWM) is a rare congenital disorder that involves the cerebellum and the fourth ventricle. The absence or hypoplasy of the vermis, cystic dilatation of the fourth ventricle and enlarged posterior fossa are the key features of the malformation. These abnormalities often result in problems with movement, coordination, intellect, mood, and other neurological functions. Symptoms often occur in infancy and the most common clinical manifestation (20-80% of the cases) is hydrocephaly which leads to macrocephaly.Aims: The aim of this work is to underline the ethiology, diagnosis, neuroanatomy, and threatment of Dandy-Walker syndrome.Materials and methods: We present a review of recent studies, including case reports and MRI scans of patients suffering from DWM.Results: Although its pathogenesis is not completely understood, there are several genetic loci related to DWM. Multiple genetic and environmental factors likely play a part in determining the risk of developing this disorder. The condition can be a feature of other hereditary diseases, such as Edwards syndrome (trisomy 18). Imaging modallies - computerised tomography, magnetic resonance imaging and ultrasound  are crucial for the diagnosis of DWM and distinguishing this disorder from other cystic posterior fossa lesions. Most cases of DWM are associated with anomalies of other areas of the the central nerves system including absence of corpus callosum and displasia of the cingulate gyrus. The treatment is mainly surgical - endoscopic or creating a shunt.Conclusion: DWM carries a high mortality rate ~70% in live born fetuses, often due to associated abnormalities. It is thought to carry a poorer prognosis if diagnosed prior to 21 weeks of gestation and better prognosis if diaginosed postnatally