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

Long-term high-level exercise promotes muscle reinnervation with age.

he histologic features of aging muscle suggest that denervation contributes to atrophy, that immobility accelerates the process, and that routine exercise may protect against loss of motor units and muscle tissue. Here, we compared muscle biopsies from sedentary and physically active seniors and found that seniors with a long history of high-level recreational activity up to the time of muscle biopsy had 1) lower loss of muscle strength versus young men (32% loss in physically active vs 51% loss in sedentary seniors); 2) fewer small angulated (denervated) myofibers; 3) a higher percentage of fiber-type groups (reinnervated muscle fibers) that were almost exclusive of the slow type; and 4) sparse normal-size muscle fibers coexpressing fast and slow myosin heavy chains, which is not compatible with exercise-driven muscle-type transformation. The biopsies from the old physically active seniors varied from sparse fiber-type groupings to almost fully transformed muscle, suggesting that coexpressing fibers appear to fill gaps. Altogether, the data show that long-term physical activity promotes reinnervation of muscle fibers and suggest that decades of high-level exercise allow the body to adapt to age-related denervation by saving otherwise lost muscle fibers through selective recruitment to slow motor units. These effects on size and structure of myofibers may delay functional decline in late aging.Trial registration: ClinicalTrials.gov (NCT01679977)

Long-term high-level exercise promotes muscle reinnervation with age.

The histologic features of aging muscle suggest that denervation contributes to atrophy, that immobility accelerates the process, and that routine exercise may protect against loss of motor units and muscle tissue. Here, we compared muscle biopsies from sedentary and physically active seniors and found that seniors with a long history of high-level recreational activity up to the time of muscle biopsy had 1) lower loss of muscle strength versus young men (32% loss in physically active vs 51% loss in sedentary seniors); 2) fewer small angulated (denervated) myofibers; 3) a higher percentage of fiber-type groups (reinnervated muscle fibers) that were almost exclusive of the slow type; and 4) sparse normal-size muscle fibers coexpressing fast and slow myosin heavy chains, which is not compatible with exercise-driven muscle-type transformation. The biopsies from the old physically active seniors varied from sparse fiber-type groupings to almost fully transformed muscle, suggesting that coexpressing fibers appear to fill gaps. Altogether, the data show that long-term physical activity promotes reinnervation of muscle fibers and suggest that decades of high-level exercise allow the body to adapt to age-related denervation by saving otherwise lost muscle fibers through selective recruitment to slow motor units. These effects on size and structure of myofibers may delay functional decline in late aging. Trial registration: ClinicalTrials.gov (NCT01679977)