Solitary choroid plexus tuberculoma in an adult patient. Case illustration

6nononenoneDoglietto F.; Marchese E.; Puca A.; Vellone V.G.; Tirpakova B.; Sanguinetti M.Doglietto, F.; Marchese, E.; Puca, A.; Vellone, V. G.; Tirpakova, B.; Sanguinetti, M

Surgical treatment of craniopharyngiomas: The transsphenoidal approach

OBJECTS: Craniopharyngiomas are histologically benign tumors that represent a surgical challenge owing to the frequent involvement of critical structures such as the pituitary, the chiasm, and the hypothalamus. Transsphenoidal surgery (TSS) has been classically used for intrasellar craniopharyngiomas, but its role for the treatment of suprasellar lesions is still evolving and debated. We therefore reviewed our experience and the pertinent literature on the use of TSS for the treatment of craniopharyngiomas. PATIENTS AND METHODS: In a series of 109 patients who underwent surgery for craniopharyngiomas, TSS was the first choice of approach in 67 cases (61%) (34 females and 33 males, age range: 12 to 79 y). Follow-up ranged from 2 to 25 years (mean: 6.5 y). A standard transsphenoidal approach was used in patients with an exclusively intrasellar (13 patients) or an intrasellar and suprasellar tumor (41 patients); in 13 cases of exclusively suprasellar tumors an extended transsphenoidal presellar (10 patients) or transsellar approach (3 patients) was used, with a sublabial microscopic, endoscope-assisted technique. RESULTS: Total removal was achieved in 42 patients (63%). All patients had a good clinical outcome. Postoperative cerebrospinal fluid leakage occurred in 10 cases, but only 1 case required surgical repair of the sella. There were 9 cases (14%) of tumor regrowth. Three illustrative cases are thoroughly discussed to present the extended transsphenoidal approaches and the limits of TSS. CONCLUSIONS: When used in appropriately selected craniopharyngiomas and by neurosurgeons with extensive experience in pituitary surgery, TSS offers excellent results with minor risks. \ua9 2009 Lippincott Williams & Wilkins, Inc

Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson's Disease Patients

Regular exercise ameliorates motor symptoms in Parkinson's disease (PD). Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11). The effects of exercise on resting energy expenditure (REE), glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS) were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS), bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK). However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr) recovery (31P-MRS) were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF) expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS). Exercise training improved the clinical state in early/mid-stage Parkinson's disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise-induced improvements in the PD clinical state were associated with specific adaptive changes in muscle functional, metabolic, and molecular characteristics.www.ClinicalTrials.gov, identifier NCT02253732