The postsynaptic density from human neocortex (hPSD) was isolated and 1461 proteins identified. hPSD mutations cause 133 neurological and psychiatric diseases and show enrichment in cognitive, affective and motor phenotypes underpinned by sets of genes. Strong protein sequence conservation within mammalian lineages, particularly in hub proteins, indicates conserved function and organisation in primate and rodent models. The hPSD is a key structure for nervous system disease and behaviour.

Meningiomas are by far the most common tumours arising from the meninges. Progressive enlargement of the tumour leads to focal or generalised seizure disorders or neurological deficits caused by compression of adjacent neural tissue. Surgery remains the primary treatment of choice, although the use of fractionated radiotherapy or stereotactic single-dose radiosurgery is increasing for meningiomas that are incompletely excised, surgically inaccessible, or recurrent and either atypical or anaplastic. Although most meningiomas have good long-term prognosis after treatment, there are still controversies over management in a proportion of cases. We review various features of meningioma biology, diagnosis, and treatment and provide an overview of the current rationale and evidence base for the various therapeutic approaches.

A previous placebo-controlled trial has shown that biodegradable 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafers (Gliadel wafers) prolong survival in patients with recurrent glioblastoma multiforme. A previously completed phase 3 trial, also placebo controlled, in 32 patients with newly diagnosed malignant glioma also demonstrated a survival benefit in those patients treated with BCNU wafers. Because of the small number of patients in that trial, a larger phase 3 trial was performed to confirm these results. Two hundred forty patients were randomized to receive either BCNU or placebo wafers at the time of primary surgical resection; both groups were treated with external beam radiation postoperatively. The two groups were similar for age, sex, Karnofsky performance status (KPS), and tumor histology. Median survival in the intentto-treat group was 13.9 months for the BCNU wafertreated group and 11.6 months for the placebo-treated group (log-rank P-value stratified by country = 0.03), with a 29% reduction in the risk of death in the treatment group. When adjusted for factors affecting survival, the treatment effect remained positive with a risk reduction of 28% (P = 0.03). Time to decline in KPS and in 10/11 neuroperformance measures was statistically significantly prolonged in the BCNU wafer-treated group (P ≤ 0.05). Adverse events were comparable for the 2 groups, except for CSF leak (5% in the BCNU wafer-treated group vs. 0.8% in the placebo-treated group) and intracranial hypertension (9.1% in the BCNU wafer-treated group vs. 1.7% in the placebo group). This study confirms that local chemotherapy with BCNU wafers is well tolerated and offers a survival benefit to patients with newly diagnosed malignant glioma. Neuro-Oncology 5, 79-88, 2003 (Posted to Neuro-Oncology [serial online], Doc. 02-023, February 10, 2003 P resently, malignant gliomas are treated by resection, external beam radiation, and, in some cases, systemic chemotherapy (Cairncross et al

A previous placebo-controlled trial has shown that biodegradable 1,3-bis (2-chloroethyl)-1-nitrosourea (BCNU) wafers (Gliadel wafers) prolong survival in patients with recurrent glioblastoma multiforme. A previously completed phase 3 trial, also placebo controlled, in 32 patients with newly diagnosed malignant glioma also demonstrated a survival benefit in those patients treated with BCNU wafers. Because of the small number of patients in that trial, a larger phase 3 trial was performed to confirm these results. Two hundred forty patients were randomized to receive either BCNU or placebo wafers at the time of primary surgical resection; both groups were treated with external beam radiation postoperatively. The two groups were similar for age, sex, Karnofsky performance status (KPS), and tumor histology. Median survival in the intent-to-treat group was 13.9 months for the BCNU wafer-treated group and 11.6 months for the placebo-treated group (log-rank P -value stratified by country = 0.03), with a 29% reduction in the risk of death in the treatment group. When adjusted for factors affecting survival, the treatment effect remained positive with a risk reduction of 28% ( P = 0.03). Time to decline in KPS and in 10/11 neuroperformance measures was statistically significantly prolonged in the BCNU wafer-treated group ( P

The likelihood of rupture of unruptured intracranial aneurysms that were less than 10 mm in diameter was exceedingly low among patients in group 1 and was substantially higher among those in group 2. The risk of morbidity and mortality related to surgery greatly exceeded the 7.5-year risk of rupture among patients in group 1 with unruptured intracranial aneurysms smaller than 10 mm in diameter.

Tumour associated epilepsy (TAE) is a poorly understood manifestation of many gliomas, meningiomas and metastatic brain tumours that has important clinical and social implications. Etiological mechanisms underlying tumour associated epilepsy include theories invoking peritumoural amino acid disturbances, local metabolic imbalances, cerebral oedema, pH abnormalities, morphological changes in the neuropil, changes in neuronal and glial enzyme and protein expression and altered immunological activity. It has also been suggested that the pathology involves perturbations in distribution and function of the NMDA subclass of glutamate receptors. The often capricious response of the seizure disorder following removal of the causative neoplasms suggests multiple factors are involved. Further understanding about the pathogenesis of TAE will await the development and characterisation of suitable animal models that demonstrate the clinical manifestations and physiological changes comparable to those seen in human cerebral tumours. With such a model it is hoped that progress may one day be made in understanding and subsequently treating this debilitating clinical problem.

While the fMRI test-retest reliability has been mainly investigated from the point of view of group level studies, here we present analyses and results for single-subject test-retest reliability. One important aspect of group level reliability is that not only does it depend on between-session variance (test-retest), but also on between-subject variance. This has partly led to a debate regarding which reliability metric to use and how different sources of noise contribute to between-session variance. Focusing on single subject reliability allows considering between-session only. In this study, we measured test-retest reliability in four behavioural tasks (motor mapping, covert verb generation, overt word repetition, and a landmark identification task) to ensure generalisation of the results and at three levels of data processing (time-series correlation, t value variance, and overlap of thresholded maps) to understand how each step influences the other and how confounding factors influence reliability at each of these steps. The contributions of confounding factors (scanner noise, subject motion, and coregistration) were investigated using multiple regression and relative importance analyses at each step. Finally, to achieve a fuller picture of what constitutes a reliable task, we introduced a bootstrap technique of within- vs. between-subject variance. Our results show that (i) scanner noise and coregistration errors have little contribution to between-session variance (ii) subject motion (especially correlated with the stimuli) can have detrimental effects on reliability (iii) different tasks lead to different reliability results. This suggests that between-session variance in fMRI is mostly caused by the variability of underlying cognitive processes and motion correlated with the stimuli rather than technical limitations of data processing.

Although descriptive classifications of meningioma subtypes are well established, there has been inconsistency in the categorization of meningiomas into benign, atypical and anaplastic groups. The aim of this study was to reassess the incidence of atypical (grade II) meningiomas over a 10-year period by applying the World Health Organization (WHO) 2000 classification system. A secondary aim was to determine if grade II and III tumours were becoming more common. Sections of 314 meningiomas resected between 1994 and 2003 were retrieved from the archives of the Western General Hospital's neuropathology unit in Edinburgh. They were reassessed and graded by using the WHO 2000 classification system. The reviewers were blind to the original classification and grading. There was a gradual increase in the numbers of meningiomas being resected annually over the 10-year period. On reclassification, 78% of the meningiomas were classified as grade I, 20.4% as grade II and 1.6% as grade III. With regard to grade II meningiomas classified by using the WHO 2000 classification system, 38.1% had originally been classified as grade I prior to 2000, whereas 13.6% had originally been classified as grade I after 2000. In most cases, reclassification was due to formal counts of mitotic figures. Atypical meningiomas are diagnosed more frequently under the current WHO classification system than they were under the previous classification systems. Although the current WHO (2000) classification is more prescriptive than its predecessors, interobserver variability is likely to remain because of the subjective nature of some of the criteria.