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BACKGROUND AND PURPOSE:There is controversy as to the best mode of treating MCA aneurysms. We report the results of a large endovascular series of patients treated at our center.

Tumour cytokinetics estimated in vivo as potential doubling times (T pot values) have been found to range in a variety of human cancers from 2 days to several weeks and are often related to clinical outcome. We have previously developed a method to estimate culture cycle times of short-term cultures of surgical material for several tumour types and found, surprisingly, that their range was similar to that reported for T pot values. As T pot is recognised as important prognostic variable in cancer, we wished to determine whether culture cycle times had clinical significance. Brain tumour material obtained at surgery from 70 patients with glioblastoma, medulloblastoma, astrocytoma, oligodendroglioma and metastatic melanoma was cultured for 7 days on 96-well plates, coated with agarose to prevent proliferation of fibroblasts. Culture cycle times were estimated from relative 3 H-thymidine incorporation in the presence and absence of cell division. Patients were divided into two groups on the basis of culture cycle times of p10 days and 410 days and patient survival was compared. For patients with brain cancers of all types, median survival for the p10-day and 410-day groups were 5.1 and 12.5 months, respectively (P ¼ 0.0009). For 42 patients with glioblastoma, the corresponding values were 6.5 and 9.0 months, respectively (P ¼ 0.03). Lower grade gliomas had longer median culture cycle times (16 days) than those of medulloblastomas (9.9 days), glioblastomas (9.8 days) or melanomas (6.7 days). We conclude that culture cycle times determined using short-term cultures of surgical material from brain tumours correlate with patient survival. Tumour cells thus appear to preserve important cytokinetic characteristics when transferred to culture.

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Our study supports a beneficial role for (1)H MRS in certain diagnostic intracranial dilemmas presenting to neurosurgeons. The information gleaned from preoperative (1)H MRS can be a useful adjunct to clinical and conventional MR imaging data in guiding the management of patients with intracranial pathologies, particularly high-grade tumour versus abscess, and high-grade versus low-grade glioma. Further larger prospective studies are needed to clearly define the utility of (1)H MRS in diagnostically challenging intracranial lesions in neurosurgery.

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