The case histories presented in conjunction with the relevant literature reviewed support the concept that microbial infections may influence immune responses in brain tumor defense.
ELS tumors are uncommon, and, to our knowledge, only seven cases associated with vHL disease have been reported in the literature. Although this association has been previously mentioned, no definitive studies have linked the two together. We report the eighth case of ELS tumor and vHL disease. We have demonstrated through molecular biological techniques, that, in our patient's tumor, a genetic mutation occurred, and that this mutation is similar to mutations previously reported in other neoplasms associated with vHL. We therefore suggest that ELS tumors be considered among the neoplasms associated with vHL.
The authors have evaluated the antiproliferative activity of verapamil, alone or in combination with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in brain-tumor cells. These effects were studied in vitro using four human glioma cell lines and in vivo using glioblastoma multiforme cells transplanted to athymic nude mice. The results showed that verapamil when used alone produced inhibition of tumor growth; however, when verapamil was used in combination with BCNU (in vitro), significant dose-dependent suppression of proliferation occurred in all four cell lines. The in vivo results were far more dramatic. Mice treated with BCNU (25 mg/kg) plus verapamil (50 mg/kg) achieved a 200-fold decrease in tumor growth with a greater than 80% regression in tumor size. Complete cures were achieved in 80% of the mice observed for at least 50 days following the completion of therapy. These findings support the use of verapamil in overcoming drug resistance in malignant brain tumors.
With the emergence of skull base surgery, several surgical approaches have been developed and redefined. These approaches provide surgeons with successful avenues to difficult lesions of the cranial base. The majority of lesions in which these skull base techniques have been successfully used have been for tumors. However, we find that with the provision of direct access to basal cisterns from the skull base techniques, complex and giant aneurysms are equally accessible for surgical intervention. In this report, we describe our techniques and results in the use of three different skull base approaches for the surgical management of four different complex posterior circulation aneurysms. The approaches that were used include the cranio-orbital-zygomatic (COZ) approach, the petrosal approach, and the transcondylar approach. Each approach provided a wide field with excellent exposure of vital structures with minimal brain retraction. Clippage of the aneurysm was successfully achieved in all cases.
METHODS
Cranio-Orbital-Zygomatic ApproachThe procedure for the COZ approach involves modifications based on the supraorbital approach described by Jane et al.1 The basic technical aspects of the COZ approach have been previously described.24 In the COZ approach, a supraorbital-pterional free bone flap is generated that consists of the frontotemporal bone in continuity with the anterior, superior, and lateral rim of the roof of the orbit (Fig. 1). The remainder of the orbital roof is removed as a posterior orbitotomy and reattached to the supraorbital-pterional bone flap (Fig. 2). Oblique osteotomies are placed at either end of the zygoma, and, with the inferior surface of the body of the zygoma attached to the masseter, the zygoma is easily retracted inferiorly, 251
In 1881, Maffucci described the syndrome bearing his name.1 It is a rare mesodermal disorder consisting of multiple enchondromata and hemangiomata. Nineteen years later, Ollier described enchondromatosis without the hemangiomata, a disease which would later bear his name.
CASE REPORTA 42-year-old black female presented to our institution with a 2-year history of progressive headaches, hemifacial spasms on the right, and ataxia. Neurologic examination revealed that she was lethargic with evidence of papilledema, multiple cranial nerve palsies, long tract findings, and cerebellar dysfunction. The preoperative bilateral auditory evoked response (BAER) and audiogram were abnormal, with sensory neural hearing loss on the right with evidence of retrocochlear involvement. A computerized tomographic (CT) scan and magnetic resonance imaging (MRI) scans with contrast revealed a very large tumor in the posterior fossa extending along the petrous ridge, superiorly through and into the posterior aspect of the cavernous sinus and extending well above the posterior clinoids into the diencephalon (Figs. 1, 2, 3). The tumor measured over 6 cm and was calcified irregularly. The tumor extended into the posterior fossa with deformation of the cerebellum and pons with compression of the neural axis with associated hydrocephalus. The tumor also extended above the tentorium with compression of the midbrain. The patient was treated with high doses of steroids and then underwent the first of her staged operations. The patient underwent a petrosal approach which provided access for both pre-and retrosigmoid routes to the tumor. A very large, extensively calcified tumor with spicules of bone was encountered. The tumor was shown to press against the pons and cerebellum, encircle the ninth and tenth cranial nerves, and completely surround the seventh and eighth nerve complex. The tumor extended from the petrous ridge to the petrous apex, completely surrounding the fifth and sixth cranial nerves and extending superiorly to press against the midbrain and third and fourth cranial nerves. The tumor also extended well above to the posterior clinoids. An arachnoid plane was developed between the tumor and the pons such that the tumor could be removed. With an incision through the tentorium via a presigmoid route, additional tumor was removed also from the midbrain and around the third and fourth cranial nerves. A gross total resection was achieved through this approach with 49
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