Die Medizin unterliegt einem fortwährenden Entwicklungsprozess, sodass alle Angaben, insbesondere zu therapeutischen Verfahren, immer nur dem Wissenstand zur Zeit der Drucklegung der Leitlinie entsprechen können. Hinsichtlich der angegebenen Empfehlungen zur Therapie wurde die größtmögliche Sorgfalt beachtet. Der Benutzer selbst bleibt verantwortlich für jede diagnostische und therapeutische Applikation, Medikation und Dosierung.

Conventional malignant glioma therapy (surgery, radiation therapy and chemotherapy) does not yield satisfying results. The prognosis of the glioma patient depends more on the histological grading of the tumor and patient's age than on the therapy. Especially the adjuvant chemotherapy failed to date to influence survival time in glioma patients significantly. To improve results in malignant glioma therapy additional therapeutic regimes are necessary. In an earlier study we were able to show a significant reduction on perifocal edema by an extract from gum resin (EGR) accompanied with a clinical improvement in patients with malignant glioma. Also a decrease of urinary LTE4-excretion as a metabolite of leukotriene synthesis in brain tumors was observed. Furthermore we had found a proliferation inhibiting activity of the extract form EGR, the boswellic acids in cell cultures. The purpose of this experimental study was to elucidate the effects of the boswellic acids, which are constituents of an extract from gum resin on tumor growth in vivo. Female wistar rats weighing 200-250 g were treated with the drug 14 days after inoculation of C6 tumor cells into their right caudate nucleus and randomization into 4 groups. The treatment groups received different dosages and were compared to a control group without any additional treatment. Survival time of the rats in the highest dosage group (3 x 240 mg/kg body weight) was more than twice as long as in the control group (P < 0.05). In a second experiment the inhibition of tumor cell proliferation was examined. The C6 tumor cells were implanted into the caudate nucleus. Drug treatment was started immediately after implantation and stopped after 14 days. The animals were sacrificed and the brains were examined microscopically. Comparing low and high dosage of EGR treatment a significant difference in tumor volume was detected (P < 0.05). The proportion of apoptotic tumor cells in animals with high dose treatment was significantly larger than in the low dose (treatment) group (P < 0.05). These data demonstrate an influence of EGR in rat glioma growth and might represent a new therapeutic option on glioma treatment in man in future. Further experimental work on human gliomas is needed to definitively answer this question.

In previous studies, it had been shown that human gray and white matter tissue slices have the capacity to synthesize large amounts of cysteinyl-leukotrienes (cysteinyl-LT) in vitro. This study was initiated to investigate cysteinyl-LT formation by tissue slices from intracranial tumors in comparison with cyclooxygenase products such as prostaglandin (PG) F2 alpha and thromboxane (TX) B2. Tissue slices from meningiomas and astrocytomas were found to release large amounts of cysteinyl-LT spontaneously and even higher amounts after ionophore A 23187 stimulation, which could not be accounted for by blood possibly remaining in the tissue slices. Cysteinyl-LT were identified by their immunoreactive characteristics, their biological activity in the guinea pig ileum bioassay, and their retention time on reversed-phase HPLC. With increasing malignancy, astrocytomas were shown to have an increasing biosynthetic capacity for cysteinyl-LT and TXB2 in vitro. In comparison with meningioma patients, malignant astrocytoma patients had an enhanced urinary excretion of LTE4, the major urinary metabolite of cysteinyl-LT in humans, which dropped in level within 7 days after operation by 79%. A correlation exists between the in vivo cysteinyl-LT production in patients with malignant astrocytomas and that observed under basal conditions in the tissue slices in vitro. The results provide evidence that in malignant astrocytoma patients, the tumor tissue produces large amounts of cysteinyl-LT, which may be detected in the patients' urine.

In 12 operatively (stereotactic aspiration and recombinant tissue-type plasminogen activator, rTPA) and 5 conservatively treated patients with spontaneous intracerebral hemorrhage the amounts of cysteinyl-leukotriene (cys-LT) released by blood-brain cell contact were measured by the urinary excretion of their metabolites during treatment. The mean cys-LT release before treatment was 14.51 ± 1.13 pg/mg creatinine/ml hematoma volume. The urinary cys-LT excretion at the end of the measurements was significantly lower in the operatively treated group than in the patients with conservative therapy (p < 0.05). We also found a significant correlation between the perifocal edema volume and the amount of cys-LT measured in patients’ urine (p < 0.01). In an additional animal experiment using dissociated rat brain cells plasmin was excluded as an activator for cerebral cys-LT formation, which emphasizes that rTPA did not influence cys-LT formation.

Elderly patients with idiopathic trigeminal neuralgia are commonly referred to percutaneous treatment if medical therapy has failed. Due to elaborated microsurgical techniques and perioperative care, minimal invasive neurosurgical operations like microvascular decompression (MVD) can be offered increasingly to elderly patients. We operated upon 8 elderly patients (median 70.5 years) suffering from trigeminal neuralgia using MVD in a one-year period (1995). Seven patients were free of pain at release. At a two year follow-up, 2 patients reported of slight dull pain in the trigeminal area, one of these had been pretreated with retrogasserian glycerol rhizolysis and an initial MVD procedure four years before this decompression. All patients were still off medication (analgetics and anticonvulsants), indicating that all patients experienced an excellent (6/8) or a good (2/8) result two years after MVD. One CSF fistula requiring reoperation was the only complication. After failure of medical therapy for symptomatic trigeminal neuralgia, we encourage elderly patients to undergo MVD if the general medical condition is stable and complete pain relief without medication is the requested aim of treatment.