Despite recent advances in the development of novel targeted chemotherapies, the prognosis of malignant glioma remains dismal. The chemo-resistance of this tumor is attributed to tumor heterogeneity. To explain this unique chemo- resistance, the concept of cancer stem cells has been evoked. Cancer stem cells, a subpopulation of whole tumor cells, are now regarded as candidate therapeutic targets. Here, the author reviews and discusses the cancer stem cell concept.
Brain ; Brain Neoplasms ; Glioma ; Neoplastic Stem Cells ; Population Characteristics ; Prognosis

PURPOSE: In order to provide a systematic and standardized treatment course for MVD patients, a critical pathway (CP) program was developed and the results of its long term application were analyzed. METHODS: This was a methodological study. The CP was established and applied to 75 (step I) and 1,216 (step II). Another group of 56 with similar features was used as a control group. RESULTS: The application of CP turned out to be useful in many regards: the rate of hearing loss was reduced from 1.8% to 0% (step I) and 0.5% (step II), and low cranial nerve palsy was reduced from 1.8% to 1.3% and 0.7%, respectively. The length of hospitalization decreased by 2.56 days (25.2%) for step I and 3.05 days (30.0%) for step II. Days of ICU stay were reduced by 7.9% and 1.8%. The total cost per patient was reduced by 14.8% (step I). The cost per day was increased by 13.7% and 52.4%. An increase in the patient satisfaction index was noted, as shown in the ICU information guide (p=.002). CONCLUSION: The development and application of CP was found to improve the quality of medical treatment and the efficacy of hospital management in MVD patients. Well organized and efficient system and multidisciplinary teamwork are the key component of the successful application of CP.
Cranial Nerve Diseases ; Critical Pathways* ; Hearing Loss ; Hospitalization ; Humans ; Methods ; Microvascular Decompression Surgery* ; Patient Satisfaction ; Quality Control

Ischemic brain injury is associated with a stress response that includes hyperglycemia. Hyperglycemia is believed to aggravate cerebral ischemia. To review animal and human studies on the relationship between transient hyperglycemia and brain ischemia that elucidate some of the mechanisms for the deleterious effect of hyperglycemia, we searched computerized data sources and articles for human studies and experimental models that evaluated the association between hyperglycemia and cerebrovascular disorders containing ischemic brain injury. Most studies have shown that hyperglycemia in patients with ischemic brain injury is associated with a worse clinical outcome. The mechanisms of damaging process of hyperglycemia include tissue lactic acidosis, accumulation of extracelluar glutamate, blood-brain barrier disruption and brain edema formation.
Acidosis, Lactic ; Animals ; Blood-Brain Barrier ; Brain Edema ; Brain Injuries ; Brain Ischemia ; Cerebrovascular Disorders ; Information Storage and Retrieval ; Glutamic Acid ; Humans ; Hyperglycemia* ; Models, Theoretical

Hemifacial spasm (HFS) is characterized by tonic clonic contractions of the muscles innervated by the ipsilateral facial nerve. Compression of the facial nerve by an ectatic vessel is widely recognized as the most common underlying etiology. HFS needs to be differentiated from other causes of facial spasms, such as facial tic, ocular myokymia, and blepharospasm. To understand the overall craniofacial abnormalities and to perform the optimal surgical procedures for HFS, we are to review the prevalence, pathophysiology, differential diagnosis, details of each treatment modality, usefulness of brainstem auditory evoked potentials monitoring, debates on the facial EMG, clinical course, and complications from the literature published from 1995 to the present time.
Blepharospasm ; Craniofacial Abnormalities ; Diagnosis, Differential ; Evoked Potentials, Auditory, Brain Stem ; Facial Nerve ; Hemifacial Spasm* ; Microvascular Decompression Surgery ; Muscles ; Myokymia ; Prevalence ; Spasm ; Tics

Cervical pregnancy is a rare form of ectopic gestation in which the blastocyst implants in the cervical mucosa below the histologic cervical os. Because of the serious vaginal bleeding, hysterectomy was usually done in the management of cervical pregnancy. Howerver, conservative treatment is desirable for women who want to be pregnancy in the future. Methotrexate has been utilized recently for conservative management of cervical pregnancy. We report a case of cervical pregnancy which was treated succesfully with intramuscular methotrexate injection.
Blastocyst ; Female ; Humans ; Hysterectomy ; Methotrexate* ; Mucous Membrane ; Pregnancy* ; Uterine Hemorrhage

OBJECTIVE: The purpose of this study was to analyze outcomes and identify prognostic factors in patients with cerebral metastases from non-small cell lung cancer (NSCLC) treated with gamma knife radiosurgery (GKS) particularly, focusing on associations of biomarkers and systemic treatments. METHODS: We retrospectively reviewed the medical records of 134 patients who underwent GKS for brain metastases due to NSCLC between January 2002 and December 2012. Representative biomarkers including epidermal growth factor receptor (EGFR) mutation, K-ras mutation, and anaplastic lymphoma kinase (ALK) mutation status were investigated. RESULTS: The median overall survival after GKS was 22.0 months (95% confidence interval [CI], 8.8–35.1 months). During follow-up, 63 patients underwent salvage treatment after GKS. The median salvage treatment-free survival was 7.9 months (95% CI, 5.2–10.6 months). Multivariate analysis revealed that lower recursive partition analysis (RPA) class, small number of brain lesions, EGFR mutation (+), and ALK mutation (+) were independent positive prognostic factors associated with longer overall survival. Patients who received target agents 30 days after GKS experienced significant improvements in overall survival and salvage treatment-free survival than patients who never received target agents and patients who received target agents before GKS or within 30 days (median overall survival: 5.0 months vs. 18.2 months, and 48.0 months with p-value=0.026; median salvage treatment-free survival: 4.3 months vs. 6.1 months and 16.6 months with p-value=0.006, respectively). To assess the influence of target agents on the pattern of progression, cases that showed local recurrence and new lesion formation were analyzed according to target agents, but no significant effects were identified. CONCLUSION: The prognosis of patients with brain metastases of NSCLC after GKS significantly differed according to specific biomarkers (EGFR and ALK mutations). Our results show that target agents combined with GKS was related to significantly longer overall survival, and salvage treatment-free survival. However, target agents were not specifically associated with improved local control of the lesion treated by GKS either development of new lesions. Therefore, it seems that currently popular target agents do not affect brain lesions themselves, and can prolong survival by controlling systemic disease status.
Biomarkers ; Brain ; Carcinoma, Non-Small-Cell Lung ; Follow-Up Studies ; Humans ; Lymphoma ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Phosphotransferases ; Prognosis ; Radiosurgery* ; Receptor, Epidermal Growth Factor ; Recurrence ; Retrospective Studies ; Salvage Therapy

Bilateral cervical spondylolysis with spondylolisthesis is a rare congenital anomaly involving a complex malformation of the posterior elements of the cervical vertebra accompanied by a spondylolisthesis. It is a part of the spectrum of cervical spondylolysis and usually occurs at C-6. It is important to recognize this anomaly, particularly in trauma or other pathological conditions, to avoid mistaking it with the other more serious entities such as fractures, locked facets, and bony erosions by tumor. We report a case of congenital spondylolisthesis of the sixth cervical vertebra and outline the radiographic findings for differential diagnosis. A 41-year-old male was presented with a di-fficulty in moving his neck for one and a half months. He also complained of tingling sensation in both upper extremities. Clinical and radiological evaluations showed that he had congenital cervical spondylolisthesis. On the plain cervical spine films, there was an anterior displacement of the sixth cervical vertebra on the seventh vertebra. CT scan demonstrated bilateral defects of pars interarticularis of the sixth vertebra. There was also a lengthening antero-posterior(AP) diameter in the central canal at C6 level. The spinous process of C6 showed a spina bifida. We perfo-rmed an anterior interbody fusion using an autologous iliac bone, plate and screw fixation. It is important for the physicians to recognize the difference between the congenital cervical spondylolisthesis and fracture or other pathological conditions to institute an appropriate therapy. This anomaly may have clinical implications and may even require surgical interventions. We report a rare case of a congenital spondylolisthesis of the 6th cervical vertebra successfully treated with surgical intervention with a review of pertinent literature.
Adult ; Diagnosis, Differential ; Humans ; Male ; Neck ; Sensation ; Spinal Dysraphism ; Spine* ; Spondylolisthesis* ; Spondylolysis ; Tomography, X-Ray Computed ; Upper Extremity

Hyperreactio luteinalis(HL)referes to moderate to marked cystic bilateral enlargement of ovaries due to benign theca lutein cysts, usually related to hydatidiform mole or choriocarcinoma. After its first description by Berger in 1938, almost 53 cases of HL unassociated with trophoblastic disease have been reported in the literature. We encountered one such case in a 34 years old female which was incidentally diagnosed during cesarean section at term.
Adult ; Cesarean Section ; Choriocarcinoma ; Female ; Humans ; Hydatidiform Mole ; Lutein ; Ovary ; Pregnancy ; Trophoblasts

OBJECTIVE: The factors that influence the prognosis of patients with hemifacial spasm (HFS) treated by microvascular decompression (MVD) have not been definitely established. We report a prospective study evaluating the prognostic factors in patients undergoing MVD for HFS. METHODS: From January 2004 to September 2006, the authors prospectively studied a series of 293 patients who underwent MVD for HFS. We prospectively analyzed a number of variables in order to evaluate the predictive value of independent variables for the prognosis of patients undergoing MVD. The patients were followed-up at regular intervals and divided into as cured and unsatisfactory groups based on symptom relief. Uni- and multivariate analyses were performed using logistic regression models. RESULTS: A total 273 of 293 (94.2%) patients achieved symptom relief within one year after the operation. Intraoperatively, the indentation of the root exit zone was observed in 259 (88.5%) patients. Uni- and multivariate analyses revealed that the symptoms at postoperative 3 months (p<0.001) and indentation of the root exit zone (p=0.036) were associated with good outcomes. CONCLUSION: The intraoperative finding of root exit zone indentation will help physicians determine the prognosis in patients with HFS. To predict the prognosis of HFS, a regular follow-up period of at least 3 months following MVD should be required.
Follow-Up Studies ; Hemifacial Spasm ; Humans ; Logistic Models ; Microvascular Decompression Surgery ; Multivariate Analysis ; Prognosis ; Prospective Studies

OBJECTIVE: It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. METHODS: Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. RESULTS: Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. CONCLUSION: Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.
Astrocytoma ; Biopsy ; Brain ; Brain Injuries ; Brain Neoplasms ; Catheterization ; Germinoma ; Humans ; Hydrocephalus ; Neoplasms, Neuroepithelial ; Neuroendoscopy ; Pineal Gland ; Pinealoma ; Thalamus ; Third Ventricle ; Track and Field