Twenty-nine patients haboring primary or recurrent malignant gliomas were treated with direct implantation of radioactive sources into the tumor in afterlozded, removable catheters using stereotatic technique between November 1987 and October 1990. Indine-125(I-125) was implanted in 22 patients and high dose rate(HDR) Iridium-192(Ir-192) in 7 patients. All patients had been treated with external radiation and most had been treated with chemotherapeutic agents. one or more sources were placed in each tumor to deliver 5000-8000 cGy to the tumor's periphery for I-125 and 3000 cGy for HDR Ir-192. Eleven of 13 patients with glioblastoma multiforme were alive at 35 weeks whose mean survival was 74 weeks, and remained two were expired at 35 and 78 weeks, respectively. All 5 patients with anaplastic astrocytoma were alive at 39 weeks whose mean survival was 74 weeks. Five of 9 recurrent blioblastoma were alive at 22 weeks whose mean survival was 44 weeks, and remained three were expired at 13, 17 and 22 weeks respectively. All two patients with anaplastic astrocytoma were alive at 22 and 52 weeks, respectively. Four patients with deep seated analphastic astrocytoma(3 in the thalamus and 1 in the third ventricle) were treated successfully by brachytheray without any surgical morbidity and mortality and they were still alive 38, 48, 74 and 123 weeks after brachytherapy. There were few minor postoperative complications including 3 meningitis. 2 leak of cerebrospinal fluid and 3 radiation necrosis without any mortality. The authors conclude that the brachytherapy with temporary implanted I-125 or Ir-192 sources may provide long-term survial in selected patients with primary or recurrent malignant gliomas.
Astrocytoma ; Brachytherapy* ; Catheters ; Cerebrospinal Fluid ; Glioblastoma ; Glioma* ; Humans ; Meningitis ; Mortality ; Necrosis ; Postoperative Complications ; Thalamus

A yeast-like strain was isolated from the brain abscess of a patient diagnosed with astrocytoma. Morphological and molecular analysis on D1/D2 domain in the 26S rRNA gene and internal transcript spacer region of the strain revealed that the strain belonged to the genus Pseudozyma. To the best of our knowledge, this is the first report on the isolation of a Pseudozyma strain from brain abscess.
Aged ; Astrocytoma/*complications ; Brain Abscess/complications/diagnosis/*microbiology ; Brain Diseases/*complications ; DNA, Fungal/genetics ; Humans ; Male ; Mycological Typing Techniques ; Phylogeny ; RNA, Ribosomal/genetics ; Ustilaginales/classification/genetics/*isolation &purification

Astrocytoma ; pathology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed ; Tuberous Sclerosis ; complications ; diagnostic imaging ; pathology

Surgical resection may not be the appropriate first treatment for all intracranial mass lesions, especially for deep or midline lesions. And a precise histopathological diagnosis is mandatory to develop adequate and specific treatments. The advent of modern imaging and CT-compatible stereotactic frames has greatly simplified the performance of streotactic procedure for small and deep seated brain tumors. We present a 44-month experience on 94 stereotactic procedures of intracranial mass lesions, using Brown-Roberts-Wells(BRW) and Cosman-Roberts-Wells(CRW) system. Procedures were undertaken with the patient under the local anesthesia for biopsy(78 procedures), cyst aspiration and/or Ommaya reservoir insertion(9 procedures), and brachytherapy(5 procedures) and under the general anesthesia for stereotactic-guided microsurgery(2 procedures). Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 8.5%(8 of 94 procedures). The postoperative complications were transient and not seriour, except aggravation of obstructive hydrocephalus in two cases of lateral ventricular tumors. Specific and correct histological diagnoses were achieved in 73(94%) of 78 biopsy. We could not obtain a specific diagnosis in 3 cases(2 cases of reactive gliosis, 1 case of necrosis). And in two cases with a diagnosis of anaplastic astrocytoma and oligodendroglioma grade I on the basis of surgical specimens by craniotomy, stereotactic biopsy revealed astrocytoma grade II and nonspecific inflammation respectively. Our data suggest that CT-guided stereotactic biopsy is a reliable and safe method for histologic diagnosis of brain-tumoral conditions and the method of choice for deep-seated and midline lesions.
Anesthesia, General ; Anesthesia, Local ; Astrocytoma ; Biopsy* ; Brain Neoplasms ; Craniotomy ; Diagnosis ; Gliosis ; Humans ; Hydrocephalus ; Inflammation ; Mortality ; Oligodendroglioma ; Postoperative Complications

Surgical resection may not be the appropriate first treatment for all intracranial mass lesions, especially for deep or midline lesions. And a precise histopathological diagnosis is mandatory to develop adequate and specific treatments. The advent of modern imaging and CT-compatible stereotactic frames has greatly simplified the performance of streotactic procedure for small and deep seated brain tumors. We present a 44-month experience on 94 stereotactic procedures of intracranial mass lesions, using Brown-Roberts-Wells(BRW) and Cosman-Roberts-Wells(CRW) system. Procedures were undertaken with the patient under the local anesthesia for biopsy(78 procedures), cyst aspiration and/or Ommaya reservoir insertion(9 procedures), and brachytherapy(5 procedures) and under the general anesthesia for stereotactic-guided microsurgery(2 procedures). Procedural objectives were satisfactorily accomplished with no mortality and an overall complication rate of 8.5%(8 of 94 procedures). The postoperative complications were transient and not seriour, except aggravation of obstructive hydrocephalus in two cases of lateral ventricular tumors. Specific and correct histological diagnoses were achieved in 73(94%) of 78 biopsy. We could not obtain a specific diagnosis in 3 cases(2 cases of reactive gliosis, 1 case of necrosis). And in two cases with a diagnosis of anaplastic astrocytoma and oligodendroglioma grade I on the basis of surgical specimens by craniotomy, stereotactic biopsy revealed astrocytoma grade II and nonspecific inflammation respectively. Our data suggest that CT-guided stereotactic biopsy is a reliable and safe method for histologic diagnosis of brain-tumoral conditions and the method of choice for deep-seated and midline lesions.
Anesthesia, General ; Anesthesia, Local ; Astrocytoma ; Biopsy* ; Brain Neoplasms ; Craniotomy ; Diagnosis ; Gliosis ; Humans ; Hydrocephalus ; Inflammation ; Mortality ; Oligodendroglioma ; Postoperative Complications

OBJECTIVETo study the immunohistochemical expression and diagnostic significance of CD34 in brain tumors of patients with refractory epilepsy.

METHODSImmunohistochemical study for CD34 was performed on formalin-fixed paraffin-embedded tissue blocks of 54 cases of brain tumors occurring in patients with refractory epilepsy. The tumor types included ganglioglioma (GG, number = 21), dysembryoplastic neuroepithelial tumor (DNT, number = 8), tumors/lesions which had the transitional features that between glioneuronal hamartia and mixed neuronal-glial tumor (number = 21) and pleomorphic xanthoastrocytoma (PXA, number = 4). Cases of glioblastoma (number = 4) and oligoastrocytoma (number = 5) were used as controls.

RESULTSTwenty of the 21 cases of GG, 1 of the 8 cases of DNT, 16 of the 21 cases of tumors/lesions which had the transitional features and 3 of the 4 cases of PXA showed cytoplasmic and membranous positivity for CD34. The adjoining brain tissues in 9 of the 18 cases of GG, 6 of the 16 cases of tumors/lesions which had the transitional features and 1 of the 3 cases of PXA also expressed CD34. In contrast, only 1 case of glioblastoma showed membranous positivity for CD34.

CONCLUSIONSCD34 preferred to staining for GG and PXA. Which represent a valuable tool for distinguishing GG, PXA and DNT, oligoastrocytoma, glioblastoma.

Antigens, CD34 ; metabolism ; Astrocytoma ; complications ; metabolism ; pathology ; surgery ; Brain Neoplasms ; complications ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Epilepsy ; etiology ; Ganglioglioma ; complications ; metabolism ; pathology ; surgery ; Glioblastoma ; complications ; metabolism ; pathology ; Humans ; Neoplasms, Neuroepithelial ; complications ; metabolism ; pathology ; surgery

Gliofibroma is a rare astrocytic tumor, composed of a glial component ranging from benign to high grade of malignancy and a consistently benign mesenchymal component. Its exact biological behavior is not fully known. In addition, histogenesis and prognostic factors are also still debatable. We herein present a rare case of gliofibroma in a 25-yr-old male with seizure. A computed tomographic scan of the brain showed a 1.5 cm-sized, enhancing mass with calcification. Histologically, the tumor consisted of glial fibrillary acidic protein (GFAP)-positive glial cells admixed with a mesenchymal component and extensive collagen lay down. The glial cells displayed variable cellularity, but without mitosis or necrosis. Since the MIB-1 labeling index was up to 35.8% in the cellular areas of the glial component, it could be considered to be a predictor of worse prognosis.
Adult ; Astrocytoma/*diagnosis/pathology ; Brain Neoplasms/*diagnosis/pathology ; Glial Fibrillary Acidic Protein/biosynthesis ; Human ; Immunohistochemistry ; Male ; Mitosis ; Necrosis ; Prognosis ; Seizures/complications ; Tomography, X-Ray Computed

OBJECTIVE: This study was undertaken to evaluate operative results and prognosis according to preoperative clinical status and histopathological finding of spinal cord tumor. METHODS: We analyzed of clinical feature, tumor location, histopathologic finding, operative results and prognosis in 55 patients with spinal cord tumor during last 10 years. RESULTS: 1) The incidence of spinal cord tumors varies with the age of affected patients who are 2 to 75 years of age. Peak incidences were in the 5th and 7th decade of life, and the ratio of male to female was 1.2:1. 2) The most common histopathologic type was neurinoma(41.9%). 3) The tumors were located most frequently in the thoracic area(22 cases, 40.0%) and in the intradural extramedullary space(30 cases, 54.5%). 4) The most common initial clinical feature was pain in 20 cases(36.4%). For neurologic status on admission, 30 cases(54.5%) showed motor disturbance. 5) In radiologic studies, there were abnormal finding in 21 cases from plain X-rays among 37 cases. The entire 20 cases in when myelography was done showed subarachnoid blockade, either complete or incomplete. The magnetic resonance imaging, regard as the most accurate diagnostic method, revealed the exact location of the tumor and the relationship of the tumor with the adjacent anatomical structure. 6) The total removal was possible in 36 cases(65.5%), subtotal removal in 17 cases(30.9%) and biopsy in 2 cases (3.6%). Nineteen cases(90.5%) among 21 cases with preoperative radiculopathy group showed recovery or improvement, where as only 11 cases(36.7%) among 30 cases with preoperative motor weakness group showed recovery or improvement, with statistically significant difference(p<0.01). Pathologically, 26 cases(83.9%) among 31 cases of neurinoma and meningioma showed postoperative recovery or improved, but only 1 case(6.3%) among 16 cases of metastatic tumor, astrocytoma and ependymoma recovered. Postoperative complication noted in 5 cases(9.1%), and were noted postoperative hematoma, pneumonia, pulmonary edema and spinal cord infarction. CONCLUSION: Preoperative neurologic status and histopathologic finding are considered important factors of Postoperative outcome in patients with spinal cord tumor.
Astrocytoma ; Biopsy ; Ependymoma ; Female ; Hematoma ; Humans ; Incidence ; Infarction ; Magnetic Resonance Imaging ; Male ; Meningioma ; Myelography ; Neurilemmoma ; Pneumonia ; Postoperative Complications ; Prognosis ; Pulmonary Edema ; Radiculopathy ; Spinal Cord Neoplasms* ; Spinal Cord*

OBJECTIVETo study the clinicopathologic features of brain tumors occurring in patients with medically intractable epilepsy.

METHODSThe clinical, radiologic and pathologic features of brain tumors occurring in 35 patients with intractable epilepsy encountered during the period from January, 2005 to April, 2008 in Xuanwu Hospital were retrospectively reviewed.

RESULTSThe mean age of seizure onset and duration of disease were 14.3-year-old and 8.6 years, respectively. Abnormal signals were observed in 94.3% of cases (33/35) by magnetic resonance imaging. The histologic types of brain tumors included ganglioglioma (13/35, WHO grade I and 6/35, WHO grade II), dysembryoplastic neuroepithelial tumor (3/35, WHO grade I), pleomorphic xanthoastrocytoma (3/35, WHO grade II), diffuse astrocytoma (1/35, WHO grade II), oligoastrocytoma (1/35, WHO grade II), angiocentric glioma (1/35, WHO grade I) and meningioangiomatosis (1/35). The 6 remaining cases showed features seen in between glioneuronal hamartoma and mixed neuronal-glial tumor. Most of these tumors were located in the temporal lobe (27/35) and associated with focal cortical dysplasia. Immunohistochemical study showed a remarkable expression of CD34 in gangliogliomas.

CONCLUSIONSBrain tumors in patients with medically intractable epilepsy are almost always benign and located in the temporal lobe. Most of them represent mixed neuronal-glial tumors and some show transitional features in-between glioneuronal hamartoma and mixed neuronal-glial neoplasm. The similar morphologic pattern and biological behavior of glioneuronal hamartoma and mixed neuronal-glial tumor may suggest a common pathogenetic mechanism.

Adolescent ; Adult ; Antigens, CD34 ; metabolism ; Astrocytoma ; complications ; metabolism ; pathology ; Brain Diseases ; complications ; metabolism ; pathology ; Brain Neoplasms ; complications ; metabolism ; pathology ; Child ; Child, Preschool ; Epilepsy ; etiology ; metabolism ; Female ; Ganglioglioma ; complications ; metabolism ; pathology ; Glioma ; complications ; metabolism ; pathology ; Hamartoma ; complications ; metabolism ; pathology ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Oligodendroglioma ; complications ; metabolism ; pathology ; Retrospective Studies ; Temporal Lobe ; pathology ; Young Adult

We report a case of acute comitant esotropia in a child with a cerebellar tumor. A 3-year-old boy was referred for management of a 9 month history of acute acquired comitant esotropia. On first presentation, the patient's angle of esodeviation was 50 prism-diopters (PD) at distance and near fixation without any lateral incomitance. The cycloplegic refraction revealed +0.75 diopters in both eyes. Very mild bilateral papilledema was found on the fundus examination, but the neurological examination did not reveal any other pathological findings. Brain MRI showed a 5 cm mass located in the midline of the cerebellum as well as hydrocephalus. The mass was completely excised and histological examination confirmed the diagnosis of pilocytic astrocytoma. Despite neurosurgery, the patient's strabismus remained unresolved. One year after neurosurgery, both medial rectus muscles were surgically recessed by 6 mm, resulting in esotropia of 8PD at distant and near fixation without restoration of bifoveal fusion at follow-up 2 years after the eye muscle surgery. Therefore, acute onset comitant esotropia in a child can be the first sign of a cerebellar tumor, even without any other neurological signs and symptoms.
Acute Disease ; Astrocytoma/*complications/surgery ; Brain/pathology ; Cerebellar Neoplasms/*complications/diagnosis/surgery ; Child, Preschool ; Esotropia/*etiology/pathology/physiopathology/surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Neurosurgical Procedures ; Oculomotor Muscles/surgery ; Refraction, Ocular ; Time Factors