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With the goal to minimize the risk of sequelae in brainstem and spinal cord surgery, methods of intraoperative mapping using direct electrical stimulations were developed in the last decade. However, the current was delivered with a monopolar stimulator with risk of a spreading, or using a bipolar probe or silicone strip with 5 mm of precision. To improve the accuracy and easiness of the mapping, the authors describe in this work a new device with the following characteristics: bipolar probe without current diffusion; reduction of the space tips to 2 mm; building of a bent handle, improving the field of view and ergonomics under the microscope. This device has been used successfully in 6 consecutive patients, 4 harboring a brainstem lesion and 2 with a spinal cord tumor. This new device allows the surgeon to perform repetitive intraoperative brainstem and spinal cord electrical mapping under the microscope in a very simple, quick and accurate way all along the resection. Improvement of such a mapping first minimizes the risk of sequelae, second optimizes the quality of resection, and third may also give a prognostic value concerning the changes of postsurgical recovery in case of a preoperative deficit.

Overall patient pathway and radiotherapy OTT were longer than optimal, and areas of delay potentially amenable to modification were identified.

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The purpose of the present study was to investigate potential prognostic factors in low-grade oligodendrogliomas (LGOs), particularly 1p19q deletion, due to its proven prognostic significance in anaplastic oligodendrogliomas. We carried out a retrospective review of patients with a histological diagnosis of LGO between 1990 and 2000 in Auckland and Wellington, New Zealand. All cases underwent central histopathological review and FISH testing for 1p19q status. Univariate analysis of potential prognostic factors including 1p19q status, age, tumour size, tumour crossing midline, tumour enhancement, extent of surgery and seizures at diagnosis was carried out. Thirty-one patients were eligible and FISH testing was successful in 28 specimens (90%). Twenty-three specimens (82%) had 1p19q deletion; four (14%) had no 1p19q deletion; and one (4%) had 1p deletion alone. At a median follow-up of 87 months (0-147 months), median survival had not been reached and no significant difference in overall survival (OS) based on 1p19q status was detected (1p19q deletion OS 56%; 1p19q intact OS 0%; 1p deletion alone 100% (P = 0.38)). None of the other prognostic factors investigated reached statistical significance. We confirmed the high incidence (82%) of combined 1p19q deletion in LGOs and the feasibility of successful FISH testing in paraffin embedded specimens up to 10-years-old. Analysis of potential prognostic factors was limited by the lack of events during the follow-up period.

SUMMARYEsthesioneuroblastoma is a rare malignancy arising from the olfactory epithelium. We present a case history of a 75-year-old man who presented with a Kadish stage C esthesioneuroblastoma and underwent craniofacial surgery and adjuvant radiotherapy. Two years later he was found to have diffuse subdural deposits with distant bone and nodal metastases, treated with further radiotherapy. The patient's condition subsequently deteriorated and he died. Given this unusual pattern of failure, we review the recent published studies regarding the natural history, treatment and outcome for this tumour.

Both radiotherapy and brachytherapy utilization rates were below optimal and are being addressed. No formal surgical or chemotherapy utilisation estimates exist for comparison; however, the use of concurrent cisplatin chemotherapy was similar to other groups. A high rate of adjuvant (chemo)radiotherapy was noted in surgically treated Stage IB patients, suggesting a need for an increased consideration of primary chemoradiotherapy in these patients to avoid the unnecessary toxicity of trimodality therapy. Future outcome analysis is planned.

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