Low-cost self-irrigating bipolar forceps

A low cost method for providing continuous saline drip in bipolar diathermy is described, which use is adaptable to any type of standard bipolar forceps. The advantages of this system versus commercially available self-irrigating forceps are reported

Recurrence of brain abscess associated with asymptomatic arteriovenous malformation of the lung

Abstract On the basis of the data provided by literature the majority of patients with an arteriovenous malformation of the lung who develop a brain abscess suffer from hereditary hemorrhagic telangiectasia, or Rendu-Osler-Weber disease. Only nine cases of brain abscesses in which the arteriovenous malformation of the lung was isolated have been described and in all of these, clinical signs and/or alterations in the laboratory data were detected which can be attributed to the arteriovenous malformation itself. The case taken in this article would seem to be the first case of a recurrent brain abscess in a patient not suffering from Rendu-Osler-Weber with a completely asymptomatic arteriovenous malformation of the lung, both from the clinical point of view and from laboratory data. The authors stress the appropriacy of an angiographic pulmonary study in cases of recurrent brain abscesses, even where the chest X-ray has been negative

Infezioni cerebrali e crisi epilettiche in neurochirurgia

In this clinical study we present epileptic complications observed in a group of pts admitted to the Neurosurgical Clinic of the University of Milano for brain infections between Jan 76 and May 90. All patients were submitted to CT studies. 63 pts have been observed in the considered period. 16 pts died during hospital stay. Of the 47 discharged pts, all assuming antiepileptic drug prophylaxis, 45 (18 females, 27 males, age ranging from 5 to 69 years) have been followed-up (6 months to 10 years). Most patients had a brain abscess at admission. Epileptic seizures were a presenting symptom in 23.8% of the patients. 9 patients (20%) had seizures after discharge from the hospital. All seizures appeared within one year from admission and had a trend to repeat although all patients regularly assumed drug prophylaxis. We did not find any relation between seizures before and after hospital admission. A positive relation has been found between dimensions of the abscess and seizures, the latter beeing more frequent in pts with big lesions, and with frontoparietal localization. Seizures seem also to be less frequent in patients in whom abscess was surgically removed with its capsule vs. patients in whom it was only drained

Long-Standing Isolated Autoimmune Hypothalamitis Diagnosed with Endoscopic Transventricular Biopsy

Background Autoimmune hypothalamitis, which is among the causes of acquired central diabetes insipidus, has seldom been described in the literature. This condition is probably provoked by the production of anti-vasopressin-secreting cell antibodies and antihypothalamus antibodies and is often associated with pituitary or polyendocrine autoimmunity. Correct diagnosis and immediate treatment are essential to avoid the progression of the pathologic process. Case Description A woman diagnosed with central diabetes insipidus 12 years ago, who had panhypopituitarism and mild memory deficit, came to our attention. She refused radiologic studies. Magnetic resonance imaging performed in our unit showed a contrast-enhancing hypothalamic lesion. Lumbar puncture was negative for neoplastic markers. We decided to perform a biopsy of the lesion to obtain a histopathologic examination of the tissue and chose an endoscopic transventricular approach to reach the floor of the third ventricle. Autoimmune hypothalamitis was diagnosed and treatment with steroids and azathioprine was started. The lesion size decreased and was stable after 17 months of follow-up. Conclusions The endoscopic transventricular approach has proved to be an effective and safe way to obtain tissue samples for histopathologic examination from a region that is usually difficult to reach; it also gives direct visualization of the lesion, which makes sampling easier. The lesion size decreased after treatment but no clinical improvement was detected, either on the cognitive or on the endocrinologic side

Long-Standing Isolated Autoimmune Hypothalamitis Diagnosed with Endoscopic Transventricular Biopsy

Background Autoimmune hypothalamitis, which is among the causes of acquired central diabetes insipidus, has seldom been described in the literature. This condition is probably provoked by the production of anti-vasopressin-secreting cell antibodies and antihypothalamus antibodies and is often associated with pituitary or polyendocrine autoimmunity. Correct diagnosis and immediate treatment are essential to avoid the progression of the pathologic process. Case Description A woman diagnosed with central diabetes insipidus 12 years ago, who had panhypopituitarism and mild memory deficit, came to our attention. She refused radiologic studies. Magnetic resonance imaging performed in our unit showed a contrast-enhancing hypothalamic lesion. Lumbar puncture was negative for neoplastic markers. We decided to perform a biopsy of the lesion to obtain a histopathologic examination of the tissue and chose an endoscopic transventricular approach to reach the floor of the third ventricle. Autoimmune hypothalamitis was diagnosed and treatment with steroids and azathioprine was started. The lesion size decreased and was stable after 17 months of follow-up. Conclusions The endoscopic transventricular approach has proved to be an effective and safe way to obtain tissue samples for histopathologic examination from a region that is usually difficult to reach; it also gives direct visualization of the lesion, which makes sampling easier. The lesion size decreased after treatment but no clinical improvement was detected, either on the cognitive or on the endocrinologic side

Isolated cervical juvenile xanthogranuloma in childhood

STUDY DESIGN: This is a report of an exceptional case of isolated cervical juvenile xanthogranuloma in a child. OBJECTIVES: This case report draws attention to the fact that isolated xanthogranuloma of the central nervous system should be considered among possible diagnosis of subdural extramedullary spinal masses in children and young adults. SUMMARY AND BACKGROUND DATA: Isolated juvenile xanthogranuloma of the central nervous system is extremely rare. When located in the spinal canal it behaves like any extramedullary mass-occupying lesion. MRI depicts the tumor's association with adjacent structures. In cases in which a subtotal surgical removal was possible, radiotherapy has been indicated. METHODS: A three-year-old girl presented severe pain in the right shoulder and spastic tetraparesis. The MRI showed an intradural extramedullary mass homogeneously enhancing after DTPA-gadolinium infusion. Complete surgical removal of the tumor was performed through open-door laminoplasty. RESULTS: The child was pain free immediately after the surgical removal of the tumor. A gradual complete recovery of the neurologic deficits followed. Open-door laminoplasty provided sufficient operative space, and it minimized the impact on the growing spinal column. CONCLUSIONS: Isolated juvenile xanthogranuloma does not show any predilections of localization inside the central nervous system. Both intracranial and spinal juvenile xanthogranulomas appear isointense in MRI and enhance homogeneously with gadolinium. Whenever possible, total surgical removal alone seems to be curative. Otherwise, a subtotal removal of the tumor might be followed by radiotherapy. Immunohistochemical tests ensure the diagnosis

A sphingosine-1-phosphate autocrine loop promotes proliferation and stemness of glioblastoma stem cells

Sphingosine-1-phosphate (S1P) is an onco-promoter lipid that, after interaction with specific membrane receptors, can influence different cell properties strictly related to cancer. Increasing evidence indicates that S1P acts as a key regulator of growth, invasion, and therapy-resistance in human glioblastoma (GBM), the most common and fatal intracranial cancer in adults. Recent studies support that GBM contain a subpopulation of cells, named glioblastoma stem cells (GSCs), that plays a crucial role in tumor initiation, maintenance, and malignant progression. So far, little is known on the origin and role of S1P in GBM. In this study, we investigated the possible role of S1P in GSC proliferation and stemness. To this purpose, among different GSC lines prepared in our laboratory from GBM specimens, we selected two lines, representative of slow- and fast-proliferating cells, and named S-GSCs and F-GSCs, respectively. These GSCs demonstrated heterogeneity not only in their proliferative potential, but also in the expression of stemness markers. Indeed, the fast proliferative status of the F-GSC population was paralleled by a significant higher expression of stemness parameters than that of S-GSCs. Metabolic studies revealed that both GSC lines constitutively exhibit the property to rapidly export S1P into the extracellular microenvironment. Intriguingly, the proliferative properties of GSCs were related to an efficient secretion of newly produced S1P. Indeed, in the fast-proliferating cells, the extracellular S1P level was found up to 10-fold higher than that of slow-proliferating ones, suggesting that the high extent of S1P released by F-GSCs reflects, and most probably participates to their proliferative and stemness features. In addition, the presence of EGF and bFGF potentiated the constitutive capacity of GSCs to secrete newly synthesized S1P, indicating that cooperation between S1P and these growth factors is of relevance in the maintenance and proliferation of GSCs. For the first time, we then report that S1P is able to act as a survival, proliferative, and pro-stemness factor for GSCs, promoting both cell cycle progression and stemness phenotypic profile. These effects were counteracted by FTY720 (a precursor of S1P receptor inhibitor), implying S1P specific receptors in its GSC-stimulating effects. In conclusion, this work implicates S1P to be an autocrine/paracrine mediator acting as a mitogenic and stemness-favoring factor, through direct effects in GSCs, and possibly through the induction of their niche. This suggests that the inhibition of S1P release from GSCs and/or of S1P receptors could be a valuable strategy to curtail GBM progression

Autocrine sphingosine-1-phosphate fuels growth and stemness in glioblastoma stem cells

Sphingosine-1-phosphate (S1P) is an onco-promoter lipid that, after interaction with specific membrane receptors, acts as a key regulator of growth, invasion, and therapy-resistance of different tumors, including human glioblastomas (GBMs). These are the most common and lethal primary brain cancer in adults, exhibiting a dismal prognosis, despite diverse therapeutic approaches. Accumulating reports suggest that human GBMs contain glioblastoma stem cells (GSCs), a small subpopulation of cells determinant in tumor growth, and malignant progression. Little is known about the role of S1P in GSCs. Using GSCs derived from human GBM specimens with different proliferative index and stemness marker expression, we investigated the possible role of S1P in the proliferative and stemness properties of GSCs. Metabolic studies demonstrated that GSCs can rapidly export newly synthesized S1P, this process being enhanced in fast proliferating cells. Released S1P levels reached nM concentrations in response to increased extracellular sphingosine. Moreover, EGF and bFGF, recognized autocrine factors in GSC, potentiated the constitutive capacity of GSCs to secrete S1P, suggesting that cooperation between S1P and these growth factors is of relevance in GSC maintenance and proliferation. Of relevance, we then found that S1P is able to act as a proliferative and pro-stemness autocrine factor for GSCs, promoting both cell cycle progression and stemness phenotypic profile, in a receptor-dependent fashion. Overall, our results suggest that the GSC population is critically modulated by microenvironmental S1P, that acts as an autocrine signal to maintain a pro-stemness microenvironment and favoring GSC survival, proliferation and maintenance of stem properties. These findings could open novel opportunities for the development of effective treatments for GBMs

Microscopic versus endoscopic transsphenoidal surgery for pituitary adenoma: Analysis of surgical safety in 221 consecutive patients

Transsphenoidal route is now considered the gold standard for the removal of pituitary adenoma. Up to date, no clear superiority in terms of efficacy has been demonstrated between transsphenoidal microscopic and endoscopic approaches. Surgical safety may be a relevant argument in favor or against the choice of one of the two surgical approaches. In our experience, the microscope and the endoscope are both safe instruments for the resection of pituitary adenomas. Because of the lack of prospective randomized controlled trials, the choice of one of the two instruments should depend on surgeon-specific preferences and hospital assets. This article is protected by copyright. All rights reserved