Background and Purpose-This prospective study was conducted to compare the outcomes of surgical clipping and endovascular treatment in acute (Ͻ72 hours) aneurysmal subarachnoid hemorrhage (SAH). Methods-One hundred nine consecutive patients were randomly assigned to either surgical (nϭ57) or endovascular (nϭ52) treatment. Clinical and neuropsychological outcome was assessed at 3 and 12 months after treatment; MRI of the brain was performed at 12 months. Follow-up angiography was scheduled after clipping and 3 and 12 months after endovascular treatment. Results-One year postoperatively, 43/41 (surgical/endovascular) patients had good or moderate recovery, 5/4 had severe disability or were in a vegetative state, and 9/7 had died (NS) according to intention to treat.

Malignant glioma is a devastating brain tumor with no effective treatment. This randomised, controlled study involved 36 patients with operable primary or recurrent malignant glioma. Seventeen patients were randomized to receive AdvHSV-tk gene therapy (3 x 10(10) pfu) by local injection into the wound bed after tumor resection, followed by intravenous ganciclovir (GCV), 5 mg/kg twice daily for 14 days. The control group of 19 patients received standard care consisting of radical excision followed by radiotherapy in those patients with primary tumors. The primary end-point was survival as defined by death or surgery for recurrence. Secondary end-points were all-cause mortality and tumour progression as determined by MRI. Overall safety and quality of life were also assessed. Findings were also compared with historical controls (n = 36) from the same unit over 2 years preceding the study. AdvHSV-tk treatment produced a clinically and statistically significant increase in mean survival from 39.0 +/- 19.7 (SD) to 70.6 +/- 52.9 weeks (P = 0.0095, log-rank regression vs. randomized controls). The median survival time increased from 37.7 to 62.4 weeks. Six patients had increased anti-adenovirus antibody titers, without adverse effects. The treatment was well tolerated. It is concluded that AdvHSV-tk gene therapy with GCV is a potential new treatment for operable primary or recurrent high-grade glioma.

Herpes simplex virus thymidine kinase (HSV tk) gene therapy combined with ganciclovir (GCV) medication is a potential new method for the treatment of malignant glioma. We have used both retrovirus-packaging cells (PA317/tk) and adenoviruses (Adv/tk) for gene therapy for malignant glioma. Retrovirus-packaging cells were used for eight tumors in seven patients and adenoviruses were used for seven tumors in seven patients. As a control group, seven tumors in seven patients were transduced with lacZ marker gene 4-5 days before tumor resection. Safety and efficacy of the gene therapy were studied with clinical evaluation, blood and urine samples, MRI follow-up, and survival of the patients. Four patients with adenovirus injections had a significant increase in anti-adenovirus antibodies and two of them had a short-term fever reaction. Frequency of epileptic seizures increased in two patients. No other adverse events possibly related to gene therapy were detected. In the retrovirus group, all treated gliomas showed progression by MRI at the 3-month time point, whereas three of the seven patients treated with Adv/tk remained stable (p < 0.05). Mean survival times for retrovirus, adenovirus, and control groups were 7.4, 15.0, and 8. 3 months, respectively. The difference in the survival times between the adenovirus and retrovirus groups was significant (p < 0.012). It is concluded that HSV tk gene therapy is safe and well tolerated. On the basis of these results further trials are justified, especially with adenovirus vectors.

Specific neuropsychological tests are of little value in diagnosing NPH. Mini-Mental status examination was neither of value in diagnosing NPH nor in prediction of the outcome. In this study the infusion test did not improve diagnostic accuracy of NPH, but shunt placement relieves urinary incontinence and walking disability in patients with increased ICP. The patients with positive Alzheimer diagnosis on biopsy did not improve.

Parenchymal high-SI lesions on T2- and intermediate-weighted MR images are more frequent after early surgical rather than endovascular treatment of the ruptured aneurysm, and lesion volumes correlate with the neuropsychologic test performance.

Preoperative and postoperative cognitive and memory functions, psychiatric outcome, and EEGs were evaluated in 32 epileptic patients who underwent temporal lobe surgery. The presence and location of preoperative slow wave focus in routine EEG predicted memory functions of the non-resected side after surgery. Neuropsychological tests of the function of the frontal lobes also showed improvement. Moreover, psychiatric ratings showed that seizure free patients had significantly less affective symptoms postoperatively than those who were still exhibiting seizures. After temporal lobectomies, successful outcome in postoperative memory functions can be achieved in patients with unilateral slow wave activity in preoperative EEGs. This study suggests a new role for routine EEG in preoperative evaluation of patients with temporal lobe epilepsy. (NeurolNeurosurg Psychiatry 1995;58:674-680 depth electrodes, the delayed memory scores have been lower preoperatively and postoperatively compared with the results for patients with purely unilateral findings.9 In our study, we hypothesised that the location of slow wave activity might also reflect disturbance in memory functions.Most epilepsy centres perform psychiatric examinations of patients undergoing preoperative evaluations for epilepsy surgery. Less than half of these centres, however, use organised postoperative psychiatric follow up.10 In each patient, the comparison during the follow up is more reliable with standardised rating scales, as the psychiatric status can also be expressed in numerical form. The standardisation of these evaluation protocols is recommended.The relation of neuropsychological variables to EEG after surgery for epilepsy is poorly understood. It is not known whether the presence and location of preoperative non-epileptiform EEG abnormalities predict cognitive outcome in patients with temporal lobe epilepsy. Thus the aim of this study was to evaluate preoperative and postoperative neuropsychological and psychiatric variables in relation to EEG and clinical outcome in patients referred for temporal lobe surgery. We wanted to determine whether it would be possible to predict postoperative neuropsychological or psychiatric changes based on preoperative routine EEG findings. Materials and methods PATIENTSThirty two consecutive patients with epilepsy (12 men, 20 women) were studied, all of whom underwent presurgical evaluation for temporal lobe surgery at Vaajasalo Hospital. These patients had intractable complex partial seizures with or without secondary generalisation. The mean age of the patients at the time of surgery was 36 (range 17-54) years, and the mean duration of epilepsy 25 (range 8-42) years. The mean seizure frequency was 14 (range 2-75) per month. Their mean education period was nine (range 6-15) years. Temporal lobectomies (14 left, 18 right) were performed at

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Auditory orienting and discrimination were studied with combined multi-channel EEG and MEG recordings in a patient with unilateral amygdala-hippocampus-partial temporal lobe resection of the right hemisphere. The results revealed abnormalities of habituation in alerting- and orienting-related responses, and discrimination-related responses, elicited by auditory stimulation contralateral to the resected cerebral hemisphere. These results give support to the notions about the role of the amygdala and hippocampus in alerting and orienting, respectively, and of the temporal cortex in auditory discrimination.