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H Beck

Publications and source records attributed to H Beck.

At least 19 recordsLinked to original sources
PubMed2003

Blocker-resistant Ca2+ currents in rat CA1 hippocampal pyramidal neurons.

Ca(2+) currents resistant to organic Ca(2+) channel antagonists are present in different types of central neurons. Here, we describe the properties of such currents in CA1 neurons acutely dissociated from rat hippocampus. Blocker-resistant Ca(2+) currents were isolated by combined application of N-, P/Q- and L-type Ca(2+) current antagonists (omega-conotoxin GVIA 2 microM; omega-conotoxin MVIIC 3 microM; omega-agatoxin IVA 200 nM; nifedipine 10 microM) and constituted approximately 21% of the total Ba(2+) current. The blocker-resistant current showed properties similar to R-type currents in other cell types, i.e. voltages of half-maximal inactivation and activation of -76 and -17 mV, respectively, and strong inactivation during the test pulse. In addition, blocker-resistant Ca(2+) currents in CA1 neurons displayed a characteristically rapid deactivation. Application of mock action potentials revealed that charge transfer through blocker-resistant Ca(2+) channels is highly sensitive to action potential shape and changes in resting membrane voltage. Pharmacological experiments showed that these currents were highly sensitive to the divalent cation Ni(2+) (half-maximal block at 28 microM), but were relatively resistant to the spider toxin SNX-482 (8% and 52% block at 0.1 and 1 microM, respectively). In addition to the functional analysis, we examined the expression of pore-forming and accessory Ca(2+) channel subunits on the messenger RNA level in isolated CA1 neurons using quantitative real-time polymerase chain reaction. Of the pore-forming alpha subunits encoding high-threshold Ca(2+) channels, Ca(v)2.1, Ca(v)2.2 and Ca(v)2.3 messenger RNA levels were most prominent, corresponding to the high proportion of N-, P/Q- and R-type currents in these neurons. In summary, CA1 neurons display blocker-resistant Ca(2+) currents with distinctive biophysical and pharmacological properties similar to R-type currents in other neuron types, and express Ca(2+) channel messenger RNAs that give rise to R-type Ca(2+) currents in expression systems.

Animals↗
PubMed2003

Molecular and functional changes in voltage-dependent Na(+) channels following pilocarpine-induced status epilepticus in rat dentate granule cells.

Status epilepticus (S.E.) is known to lead to a large number of changes in the expression of voltage-dependent ion channels and neurotransmitter receptors. In the present study, we examined whether an episode of S.E. induced by pilocarpine in vivo alters functional properties and expression of voltage-gated Na(+) channels in dentate granule cells (DGCs) of the rat hippocampus. Using patch-clamp recordings in isolated DGCs, we show that the voltage-dependent inactivation curve is significantly shifted toward depolarizing potentials following S.E. (half-maximal inactivation at -43.2+/-0.6 mV) when compared with control rats (-48.2+/-0.8 mV, P<0.0001). The voltage-dependent activation curve is significantly shifted to more negative potentials following S.E., with half-maximal activation at -28.6+/-0.8 mV compared with -25.8+/-0.9 mV in control animals (P<0.05). The changes in voltage dependence resulted in an augmented window current due to increased overlap between the activation and inactivation curve. In contrast to Na(+) channel voltage-dependence, S.E. caused no changes in the kinetics of fast or slow recovery from inactivation. The functional changes were accompanied by altered expression of Na(+) channel subunits measured by real-time reverse transcription-polymerase chain reaction in dentate gyrus microslices. We investigated expression of the pore-forming alpha subunits Na(v)1.1-Na(v)1.3 and Na(v)1.5-Na(v)1.6, in addition to the accessory subunits beta(1) and beta(2). The Na(v)1.2 and Na(v)1.6 subunit as well as the beta(1) subunit were persistently down-regulated up to 30 days following S.E. The beta(2) subunit was transiently down-regulated on the first and third day following S.E. These results indicate that differential changes in Na(+) channel subunit expression occur in concert with functional changes. Because coexpression of beta subunits is known to robustly shift the voltage dependence of inactivation in a hyperpolarizing direction, we speculate that a down-regulation of beta-subunit expression may contribute to the depolarizing shift in the inactivation curve following S.E.

Animals↗
PubMed2002

Mycobacterium tuberculosis gene-amplification in breath condensate of patients with lung tuberculosis.

The applicability of Mycobacterium tuberculosis-gene-amplification test (NAT) in breath condensate (BC) was examined in lung tuberculosis (TB). Ten patients with bacteriologically confirmed lung TB have been examined by ligase chain reaction (LCx). In BC the NAT were negative in all patients as well as the examination of acid fast smears and of solid phase or liquid media cultures were. This indicates that the use of NAT in BC can not replace or complement sputum or materials obtained invasively in patients with lung TB.

Adult↗
PubMed2002

Effect of phenytoin on sodium and calcium currents in hippocampal CA1 neurons of phenytoin-resistant kindled rats.

About 20-30% of patients with epilepsy continue to have seizures despite carefully monitored treatment with antiepileptic drugs. The mechanisms explaining why some patients' respond and others prove resistant to antiepileptic drugs are poorly understood. It has been proposed that pharmacoresistance is related to reduced sensitivity of sodium channels in hippocampal neurons to antiepileptic drugs such as carbamazepine or phenytoin. In line with this proposal, a reduced effect of carbamazepine on sodium currents in hippocampal CA1 neurons was found in the rat kindling model of temporal lobe epilepsy (TLE), i.e. a form of epilepsy with the poorest prognosis of all epilepsy types in adult patients. To address directly the possibility that neuronal sodium currents in the hippocampus play a crucial role in the pharmacoresistance of TLE, we selected amygdala-kindled rats with respect to their in vivo anticonvulsant response to phenytoin into responders and nonresponders and then compared phenytoin's effect on voltage-activated sodium currents in CA1 neurons. Furthermore, in view of the potential role of calcium current modulation in the anticonvulsant action of phenytoin, the effect of phenytoin on high-voltage-activated calcium currents was studied in CA1 neurons. Electrode-implanted but not kindled rats were used as sham controls for comparison with the kindled rats. In all experiments, the interval between last kindled seizure and ion channel measurements was at least 5 weeks. In kindled rats with in vivo resistance to the anticonvulsant effect of phenytoin (phenytoin nonresponders), in vitro modulation of sodium and calcium currents by phenytoin in hippocampal CA1 neurons did not significantly differ from respective data obtained in phenytoin responders, i.e. phenytoin resistance was not associated with a changed modulation of the sodium or calcium currents by this drug. Compared to sham controls, phenytoin's inhibitory effect on sodium currents was significantly reduced by kindling without difference between the responder and nonresponder subgroups. Further studies in phenytoin-resistant kindled rats may help to elucidate the mechanisms that can explain therapy resistance.

Animals↗
PubMed2002

The influence of timing on the functional and morphological result after nerve grafting: an experimental study in rabbits.

Clinical experience and experimental work in sheep have shown that a two-stage approach to restoring muscle function with a long nerve graft and free muscle grafting seems to be more beneficial than a one-stage approach. Based on a standardised experimental protocol, one-stage and two-stage nerve grafting approaches in rabbits were compared, and the actual differences in muscle force, together with morphological data, were calculated. In 20 rabbits the saphenous nerve was used as a 7 cm nerve graft. Animals were separated into two groups. In group 1, 10 rabbits underwent a one-stage approach to reinnervate the rectus femoris muscle. In the left hindlimb, the proximal end of the graft was coapted to the cut motor nerve branch of the vastus medialis muscle, and the distal end was coapted to the nerve branch of the rectus femoris muscle. In group 2, 10 rabbits underwent a two-stage approach, leaving the distal end of the nerve graft unconnected to the rectus femoris muscle in the first stage. In the second stage, this end was coapted to the freshly cut motor nerve branch of the rectus femoris muscle. After 15 months, the maximum tetanic tensions in the reinnervated rectus femoris muscle and the contralateral unoperated muscle were determined. The graft and the motor branch distal to the graft were biopsied in order to count the number of regenerated myelinated nerve fibres. The mean+/-s.d. maximum tetanic tensions in the reinnervated rectus femoris muscles were 10.6+/-4.9 N in group 1 and 21.4+/-1.1 N in group 2. Compared with the unoperated side, the muscle force following denervation and reinnervation was 38.3% in group 1 and 58.9% in group 2 (P=0.01). The mean+/-s.d. numbers of regenerated myelinated nerve fibres distal to the graft in the rectus femoris muscle branch were 737+/-340 in group 1 and 1487+/-1004 in group 2 (P=0.05). These results show that the neurotrophic effect of an immediately connected target organ is far outweighed by the adverse effect of the longer period of muscle denervation. Therefore, nerve grafting and muscle transplantation should not be performed in the same operation.

Animals↗
PubMed2002

[Execution of the animal protection law (section 16a TierSchG)].

The measures of execution as laid down in section 16 a of the animal protection law (TierSchG) are of great importance in the daily work of the state offices for veterinary affairs to put an end to conditions of animal treatment offending against the law. Compared to the other available legal means 1. the administrative offences (fines) and 2. the penal law (fines or imprisonment) they offer the advantage that the guilt of the animal holder (intent or negligence) need not be proved. A thorough documentation of the controls made at the respective controlled place which offers evidence even in a trial is the main condition for carrying through effective measures of execution. To issue an administrative order requires in particular 1. to observe the principle of precision, 2. to fulfill the obligation to exercise discretion and 3. to provide well-founded reasons to support the decision of immediate execution. To be successful in court, certain basic requirements must also be fulfilled when a fine is imposed or a complaint is made by the state offices of veterinary affairs.

Animal Rights↗
PubMed2001

Functional and molecular analysis of transient voltage-dependent K+ currents in rat hippocampal granule cells.

1. We have investigated voltage-dependent outward K+ currents of dentate granule cells (DGCs) in acute brain slices from young and adult rats using nucleated and outside-out patch recordings. 2. In adult DGCs, the outward current pattern was dominated by a transient K+ current component. One portion of this current (approximately 60%) was blocked by micromolar concentrations of tetraethylammonium (TEA; IC50 42 microM) and BDS-I, a specific blocker of Kv3.4 subunits (2.5 microM). A second component was insensitive to tetraethylammonium (10 mM) and BDS-I. The transient outward current could be completely blocked by 4-aminopyridine (IC50 296 microM). 3. The TEA- and BDS-I-sensitive and the TEA-resistant current components were isolated pharmacologically. The current component that was blocked by BDS-I and TEA showed a depolarized threshold of activation (approximately -30 mV) reminiscent of Kv3.4 subunits, while the current component resistant to TEA activated at more hyperpolarized potentials (approximately -60 mV). 4. In nucleated patches obtained by placing the patch pipette adjacent to the apical dendrite, only small Na+ currents and small BDS-I-sensitive transient currents were detected. Nucleated patches obtained from either the cell soma (see above) or the axon hillock showed significantly larger amplitude Na+ currents as well as larger BDS-I-sensitive currents, indicating that this current was predominantly localized within the axosomatic compartment. This result was in good agreement with the distribution of Kv3.4 protein as determined by immunohistochemistry. 5. Current-clamp as well as mock action potential-clamp experiments revealed that the BDS-sensitive current component contributes to action potential repolarization. 6. A comparison of the two age groups (4-10 days and 60-100 days) revealed a marked developmental up-regulation of the BDS-I-sensitive component. These functional changes are paralleled by a developmental increase in Kv3.4 mRNA expression determined by quantitative real-time RT-PCR, as well as a pronounced up-regulation of Kv3.4 on the protein level determined by immunohistochemistry. 7. These functional and molecular results argue that Kv3.4 channels located predominantly in the axosomatic compartment underlie a transient K+ current in adult DGCs, and that these channels are functionally important for regulating spike repolarization. The marked developmental regulation suggests an important role of Kv3.4 in neuronal maturation.

Animals↗
PubMed2001

Palmitoyl derivatives of GpMBP epitopes: T-cell response and peptidases susceptibility.

We report for the first time the immunoadjuvant effects of lipoconjugation of peptide antigens in an in vitro system by using CD4+ T-cells. The lipopeptides obtained by conjugating a palmitoyl moiety at the N(alpha)-terminal of Gln(74) or at the epsilon-NH(2) of Lys(75) of GpMBP(74-85) induced increased T-cell responsiveness compared to the native nonlipidated peptide. On the other hand, lipoderivatives of GpMBP(82-98) did not increase the T-cell response, demonstrating that the superagonist inducing effect of lipoconjugation is epitope-specific. Digestion of the two native peptides with cathepsin D and L, both implicated in antigen processing, and with a complete lysosomal fraction of a EBV-transformed B cell line shows that GpMBP(74-85) is resistant to cellular proteases, while GpMBP(82-98) is easily digested by these enzymes. These results suggest that the first prerequisite for increasing the T-cell response by lipoconjugation is the stability of the native peptide to peptidases, providing an important insight into the understanding of the immunoadjuvant effect of lipoderivative antigens.

Animals↗
PubMed2001

Slow recovery from inactivation regulates the availability of voltage-dependent Na(+) channels in hippocampal granule cells, hilar neurons and basket cells.

1. Fundamental to the understanding of CNS function is the question of how individual neurons integrate multiple synaptic inputs into an output consisting of a sequence of action potentials carrying information coded as spike frequency. The availability for activation of neuronal Na(+) channels is critical for this process and is regulated both by fast and slow inactivation processes. Here, we have investigated slow inactivation processes in detail in hippocampal neurons. 2. Slow inactivation was induced by prolonged (10-300 s) step depolarisations to -10 mV at room temperature. In isolated hippocampal dentate granule cells (DGCs), recovery from this inactivation was biexponential, with time constants for the two phases of slow inactivation tau(slow,1) and tau(slow,2) ranging from 1 to 10 s and 20 to 50 s, respectively. Both (slow,1) and tau(slow,2) were related to the duration of prior depolarisation by a power law function of the form tau(t) = a (t/a)b, where t is the duration of the depolarisation, a is a constant kinetic setpoint and b is a scaling power. This analysis yielded values of a = 0.034 s and b = 0.62 for tau(slow,1) and a = 24 s and b = 0.30 for tau(slow,2) in the rat. 3. When a train of action potential-like depolarisations of different frequencies (50, 100, 200 Hz) was used to induce inactivation, a similar relationship was found between the frequency of depolarisation and both tau(slow,1) and tau(slow,2) (a = 0.58 s, b = 0.39 for tau(slow,1) and a = 3.77 s and b = 0.42 for tau(slow,2)). 4. Using nucleated patches from rat hippocampal slices, we have addressed possible cell specific differences in slow inactivation. In fast-spiking basket cells a similar scaling relationship can be found (a = 3.54 s and b = 0.39) as in nucleated patches from DGCs (a = 2.3 s and b = 0.48) and non-fast-spiking hilar neurons (a = 2.57 s and b = 0.49). 5. Likewise, comparison of human and rat granule cells showed that properties of ultra-slow recovery from inactivation are conserved across species. In both species ultra-slow recovery was biexponential with both tau(slow,1) and tau(slow,2) being related to the duration of depolarisation t, with a = 0.63 s and b = 0.44 for tau(slow,1) and a = 25 s and b = 0.37 for tau(slow,2) for the human subject. 6. In summary, we describe in detail how the biophysical properties of Na(+) channels result in a complex interrelationship between availability of sodium channels and membrane potential or action potential frequency that may contribute to temporal integration on a time scale of seconds to minutes in different types of hippocampal neurons.

Action Potentials↗
PubMed2001

Cathepsin S and an asparagine-specific endoprotease dominate the proteolytic processing of human myelin basic protein in vitro.

The biochemical characterization of antigen degradation is an important basis for a better understanding of both the immune response and autoimmune diseases mediated by MHC class II molecules. In this study we used high-performance liquid chromatography and mass spectrometry to analyze the processing of myelin basic protein (MBP), a potential autoantigen implicated in the pathogenesis of multiple sclerosis. We resolved the kinetics of MBP processing by lysosomal extracts or purified endocytic proteases, identified the major cleavage sites during this process and assigned them to the activity of proteolytic enzymes. Proteolytic processing of MBP is mostly guided along the hydrophobic regions of the protein. It is initiated by two proteolytic steps (after N(92) and S(110)) that are performed by an asparagine-specific endopeptidase (AEP) and by cathepsin (Cat) S, respectively. The resulting processing intermediates are converted into more than 60 different species of 20-40-mers due to the activity of endopeptidases including CatS, D and L. The fragments thus generated are subsequently degraded by C- or N-terminal trimming. Strikingly, the initial cleavages during MBP processing affect two immunodominant regions of the potential autoantigen [MBP(85-99) and MBP(111-129)] in an inverse manner. CatS directly generates the N terminus of the epitope MBP(111-129) in large quantities during the initial phase of processing, which might explain the immunogenicity of this region in spite of its relatively poor binding to HLA-DR4. In contrast, the dominant cleavage by AEP mediates the destruction of MBP(85-99) unless the epitope is protected, e.g. by binding to HLA-DR. Our results thus characterize the proteolytic events during processing of MBP on a molecular level and suggest a biochemical basis for the immunogenicity of the immunodominant epitopes, which could serve as a guideline for future therapeutic strategies.

Amino Acid Sequence↗
PubMed2001

Early-stage ovarian carcinoma presenting with irritative voiding symptoms and urge incontinence.

The detection of ovarian cancer remains a major challenge for gynecologists, as the majority of cases are symptomatically silent until regional metastases or ascites have occurred. This report examines a case of early-stage ovarian adenocarcinoma presenting with irritative voiding symptoms and urge incontinence, all of which resolved fully following surgery. We also report on the frequency of lower urinary tract symptoms leading to the detection of early-stage ovarian cancer, within a cohort of 52 consecutive patients surgically treated at our institution. Lower urinary tract symptoms may trigger the diagnosis of early ovarian cancer in up to 11% of surgically managed patients at our institution. To our knowledge there are no previous reports of early ovarian cancer causing transient irritative voiding symptoms or urge incontinence. This report highlights the importance of considering ovarian neoplasm as a relatively uncommon but critically important etiology accounting for these common female urologic complaints.

Adenocarcinoma↗
PubMed2001

Cell type specific expression of vascular endothelial growth factor and angiopoietin-1 and -2 suggests an important role of astrocytes in cerebellar vascularization.

The vascularization of the central nervous system occurs by angiogenic sprouting, a process in which different factors like vascular endothelial growth factor (VEGF) and angiopoietin (Ang)-1/2 must act in a coordinated fashion. We investigated how these factors participate in capillarization of the cerebellum, an area experiencing marked reorganization processes during its postnatal development. VEGF and Ang-1 mRNA were predominantly expressed by astrocytes, while Ang-2 mRNA was specifically induced at the tip of invading endothelial cell cords. Similar to the cerebral cortex, vascularization of the cerebellum occurred in an inside-out pattern, following closely the generation and differentiation of each cerebellar layer. VEGF and Ang-1/2 expression patterns shifted in a similar inside-out fashion, supporting their proposed function in vessel growth and maturation.

Angiopoietin-1↗
PubMed2001

Synergism between vascular endothelial growth factor and placental growth factor contributes to angiogenesis and plasma extravasation in pathological conditions.

Vascular endothelial growth factor (VEGF) stimulates angiogenesis by activating VEGF receptor-2 (VEGFR-2). The role of its homolog, placental growth factor (PlGF), remains unknown. Both VEGF and PlGF bind to VEGF receptor-1 (VEGFR-1), but it is unknown whether VEGFR-1, which exists as a soluble or a membrane-bound type, is an inert decoy or a signaling receptor for PlGF during angiogenesis. Here, we report that embryonic angiogenesis in mice was not affected by deficiency of PlGF (Pgf-/-). VEGF-B, another ligand of VEGFR-1, did not rescue development in Pgf-/- mice. However, loss of PlGF impaired angiogenesis, plasma extravasation and collateral growth during ischemia, inflammation, wound healing and cancer. Transplantation of wild-type bone marrow rescued the impaired angiogenesis and collateral growth in Pgf-/- mice, indicating that PlGF might have contributed to vessel growth in the adult by mobilizing bone-marrow-derived cells. The synergism between PlGF and VEGF was specific, as PlGF deficiency impaired the response to VEGF, but not to bFGF or histamine. VEGFR-1 was activated by PlGF, given that anti-VEGFR-1 antibodies and a Src-kinase inhibitor blocked the endothelial response to PlGF or VEGF/PlGF. By upregulating PlGF and the signaling subtype of VEGFR-1, endothelial cells amplify their responsiveness to VEGF during the 'angiogenic switch' in many pathological disorders.

Animals↗
PubMed2001

Deletion of the hypoxia-response element in the vascular endothelial growth factor promoter causes motor neuron degeneration.

Hypoxia stimulates angiogenesis through the binding of hypoxia-inducible factors to the hypoxia-response element in the vascular endothelial growth factor (Vegf) promotor. Here, we report that deletion of the hypoxia-response element in the Vegf promotor reduced hypoxic Vegf expression in the spinal cord and caused adult-onset progressive motor neuron degeneration, reminiscent of amyotrophic lateral sclerosis. The neurodegeneration seemed to be due to reduced neural vascular perfusion. In addition, Vegf165 promoted survival of motor neurons during hypoxia through binding to Vegf receptor 2 and neuropilin 1. Acute ischemia is known to cause nonselective neuronal death. Our results indicate that chronic vascular insufficiency and, possibly, insufficient Vegf-dependent neuroprotection lead to the select degeneration of motor neurons.

Amyotrophic Lateral Sclerosis↗
PubMed2001

[Value of several examination systems in patients with carpal tunnel syndrome. Comparison of Dellon computer-assisted sensation test with Mellesi hand status and Levine examination scheme].

The goal of the presented carpal tunnel syndrome (CTS) follow-up study was to compare the clinical value of the Millesi hand function score with the "Pressure Specifying Sensory Device" (PSSD) introduced by A. L. Dellon using self-administered patient questionnaires. 25 patients (10 male, 15 female) with an electrodiagnostically confirmed CTS were enrolled in this study, performing one preoperative and five postoperative examinations over 24 weeks. 12 of the 25 patients underwent an "open" two-portal carpal tunnel release with two minimal incisions (group OT); the other 13 patients were treated with a two-portal endoscopic carpal tunnel release (group ET). Additionally, in eleven out of the twelve patients of group OT, an epineuriotomy of the median nerve was performed during the same session. Concerning preoperative data of the Millesi score and the PSSD, no statistically significant differences were found between group OT and ET. However, preoperative comparison with the contralateral hand demonstrated a reduction in hand function of 15% and an increase in the pressure perception threshold of 41% compared to normative data could be measured with the PSSD. The subjective functional value of the hand was objectively evacuated using the Levine score. In the second postoperative week, a significant decrease in hand function could be obtained with the Millesi score in group OT. In group ET, the decrease in hand function representing the operative trauma was significantly lower than in group OT. Data of the static one- and two-point pressure perception threshold revealed a statistically significant improvement of the sensibility in both groups. The results of the Millesi score recorded at the last examination in the 24th postoperative week showed an improvement in hand function in both groups compared to preoperative data. Concerning static one- and two-point measurements with the PSSD, distinct improvements compared to the preoperative data could also be detected in both groups although significant differences between group OT and ET were evident: Data of group OT regarding the whole postoperative course demonstrate a continuous improvement in sensibility of the index finger. In contrast, the analysis of the PSSD measurements in group ET revealed an increase in all the parameters starting in the sixth postoperative week and ending with significantly worse static one- and two-point threshold measurements than in group OT. On the other hand, data of self-administered patient questionnaires using the Levine Score revealed significant improvements in hand function and reduction in pain intensity in both groups compared to preoperative results. Differences between both groups at the end of the examination course were not evident. In conclusion, the Millesi hand score with its emphasis on the motor function proved to be a reliable method to record the severity of CTS preoperatively, the severity of the surgical trauma and changes in the course of rehabilitation of the affected hand. A good correlation was found between data obtained with the Millesi Score and the self-administered patient questionnaires according to Levine. But when compared with the PSSD, both methods could not directly document the preoperative status and postoperative changes of the median nerve. Preoperative static two-point pressure threshold measurements with the PSSD confirmed their status as a screening parameter as published by A. L. Dellon. In the postoperative course of group ET, a distinct worsening in the sensibility of the index and little finger could only be detected with the PSSD before the patients noticed the onset of related symptoms.

Adult↗
PubMed2001

Transverse sinus-tentorium splitting approach for pineal region tumors--case report.

A 15-year-old boy with a large pineal region mass was admitted to our institute. The tentative diagnosis was mixed germ cell tumor. Tumor resection was carried out via a transverse sinus-tentorium splitting approach. The tumor tissue was completely resected, and no operative complication other than transient vertical gaze paresis was noted. The histological diagnosis was mixed germ cell tumor composed of mature and immature teratoma, germinoma, and embryonal carcinoma. After three courses of chemotherapy, the patient underwent external irradiation. He remained asymptomatic with no signs of recurrence 42 months after the surgery. The combination of the infratentorial supracerebellar approach and the occipital transtentorial approach provides excellent views and work space above and below the tentorial notch. Transverse sinus section is not mandatory for this approach, but sectioning of the unilateral transverse sinus and the tentorium along the rectal sinus allows retraction of the falx and the underlying brain to the opposite side. Thus, a much wider horizontal and vertical projection is obtained. This approach enables safer and more extensive tumor removal for large pineal region tumors.

Adolescent↗