[Early diagnosis of brain tumors (author's transl)].
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The authors have added selenium tablets to the diet of 15 patients with malignant brain tumors. In twelve patients with glioblastoma multiforme this treatment didn't prolong the postoperative survival. Further clinical observations are necessary to precise the usefulness of selenium in cases of low-grade gliomas.
A relationship between radiation dose and reduction rate of tumor volume was studied in 10 patients with germinoma, nine with malignant lymphoma, and seven with medulloblastoma, in order to evaluate the effect of irradiation on these tumors. Germinomas showed either mono- or biphasic reduction of the volume with increased radiation dose in semi-logarithmic expression, irrespective of their size. All patients are well without relapse except for one that was lost because of transfer. The reduction rate of tumor volume was slightly less in malignant lymphomas and medulloblastomas than that in germinomas and the former two showed less uniformity of response to irradiation according to each case. Malignant lymphomas tended to regrow during irradiation period or early after the period and the effect of irradiation seemed to be related to the size of the tumor. Medulloblastomas did not completely disappeared during irradiation period, but delayed effect of irradiation was recognized after the period.
Three children with known primary brain neoplasms and leptomeningeal disease were evaluated with MR imaging. Two of the patients had medulloblastoma and one had pineoblastoma. The presence of leptomeningeal tumor spread was established by positive CSF cytopathology in conjunction with compatible contrast-enhanced CT findings. Contrast-enhanced CT, nonenhanced MR, and Gd-DTPA-enhanced MR studies were then compared. In two cases, leptomeningeal lesions were seen better with Gd-DTPA-enhanced MR than with contrast-enhanced CT. In all three cases, Gd-DTPA MR imaging revealed lesions that were not identified on noncontrast MR. Gd-DTPA-enhanced MR imaging is useful when searching for intracranial leptomeningeal tumor deposits in pediatric patients at risk for this condition.
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Cyclic 3-5-adenosine-monophosphate and 3-5-guanosinemonophosphate concentrations were studied in the bioptate of brain tumors, examined during neurosurgical operation and in normal brain tissues. The correlations between cyclic nucleotides in the tumors appeared to be significantly decreased in comparison to the intact tissue, being a characteristic signs for all types of tumors. There were significant fluctuations in the level of cyclic nucleotides both in the tumours and nontumorous brain tissues. There were no correlations found between the level of cyclic adenosine-monophosphate and cyclic guanosine-monophosphate on the one hand and the duration of the disease, localization of the tumor, degree of the brain oedema and the type of narcosis on the other.
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The purpose of the study was to establish the influence exerted by a supratentorial brain tumour on the EEG correlates of sleep, and to compare the results before and after operation. Five patients were studied (aged 38 to 59 years) who were treated surgically for supratentorial expanding lesions: two cases of meningioma (in left parietal area), two cases of glioma (right parietal area and occipital area) and one case of intracerebral haematoma. The control group comprised 5 patients operated upon for lesions of the peripheral nerves of extremities. In the patients with supratentorial brain tumours and after their removal the following sleep parameters were unchanged: total sleep duration, number of awakening during sleep, latency time of the first REM phase and stage 3 NREM (deep and superficial sleep). The amount of REM sleep increased after tumour removal. REM-sleep density was selectively and permanently disturbed. In presence of tumour REM-sleep density was found in traces only, after tumour removal it increased but showed a permanent high-grade deficit in relation to controls.
Previous reports of intracranial neoplasms from Africa have all shown a very low incidence of acoustic schwannomas (neuromas). In this series a group of 11 cerebellopontine angle solid tumours from black Africans were studied. On conventional histological examination only 3 had the features of a schwannoma. However, by using immunohistochemistry, a further 3 examples were identified. As controls, the same antisera were also applied to known schwannomas and meningiomas. During the period of the study, 163 patients with primary intracranial neoplasms were seen and thus acoustic schwannomas accounted for 3.7%. Although this figure is low by world standards, it still represents a far higher figure than has previously been reported from Africa. This study therefore emphasises the value of immunohistochemistry in the diagnosis of brain tumours and, furthermore, shows that acoustic schwannoma must be considered in the appropriate clinical setting, even in a group previously regarded as low-risk.
Twelve cases of lung cancer with brain metastasis, which comprised 20% of all lung cancer patients complicated with brain metastasis in the same period in our hospital, underwent resection of both lung and brain lesions. There were 9 men and 3 women. The ages ranged from 29 to 65. The site of metastasis was supratentorial in 11 patients and on the right side in 8. The interval between thoracotomy and craniotomy was 18 days-5 years. There was no operative death. Six patients have survived for more than one year. Surgical approach to lung cancer with brain metastasis has proved to be better in comparison with other methods of treatment. Obviously, adjuvant therapy after surgery may play an important role in improving survival. Whether craniotomy or thoracotomy is first performed depends on the presence or absence of life-threatening neurological symptoms. If the patient's condition allows, the second operation should be performed as soon as possible. It is emphasized that in lung cancer patients, pre- and postoperative routine CT scan of the brain should be regularly done for early detection of brain metastasis. Meanwhile, a timely, planned, staged operation may improve survival.
From 1973 to 1984, 119 patients presented to the Department of Neurosurgery, Royal Victoria Hospital, Belfast, with brain metastases, the primary sites of which remained unknown in 33 cases one month after discharge. About half of these cases were solitary and neurological lateralising signs were the commonest presentation. Of those cases in which surgery was performed, the majority remained improved one month after surgery. The one month mortality rate was only 3%. This study shows that with aggressive and appropriate treatment including surgical excision or decompression in solitary cases, an improved quality of life in the immediate postoperative period can be achieved in this particular group of brain metastases. A small number of patients remained alive and well after 6 months.
Malignant tumours of the central nervous system are the second most frequent type of cancer in childhood and also cause significant morbidity in the adult population. All tumours require surgical biopsy to enable accurate histological characterization and optimization of adjuvant nonsurgical therapy.
Fifty-six brain tumors of neuroectodermal origin were sampled by computed tomographic stereotactic needle biopsy. Crush preparations prepared from tiny tissue fragments displayed distinctive cytologic characteristics of different tumor types in 77% of the cases. The adjunctival value of crush preparations to frozen section diagnosis is discussed, and the cytologic features of different types of neuroectodermal brain tumors in crush preparations are illustrated.
Three cases of congenital brain tumours are reported, which presented with signs of increased intracranial pressure soon after birth, giving rise to the suspicion of a cerebral haemorrhage or of hydrocephalus. Correct diagnosis of tumour was established by computerised tomography, which additionally demonstrated a concomitant haematoma in each case. Two of the newborns had a primarily fatal course, with no specific treatment of the tumours being feasible. The remaining child underwent two operations, experiencing an unhindered neurologic and mental development thereafter. The histologic diagnoses were spongioblastoma and medulloblastoma in the first two cases, and ganglioneuroblastoma in the last. A conspicuous clinicopathologic feature of this neuroblastoma was the marked change in its growth pattern, revealing a higher degree of histologic differentiation and less malignant biological behaviour when tumour regrowth occurred. The diagnostic, therapeutic, and prognostic implications for this special clinicopathologic condition are discussed, with a review of the relevant literature.
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Differential diagnosis between the sino- and otogenic brain complications and tumor is the most difficult task in otology and neurosurgery. These difficulties are even greater in purulent intracranial complications of sinusitis and otitis giving the same symptoms as cerebral tumors. The illustrative case reports were described.
In part I of this article, we reviewed the general aspects of childhood brain tumors. In part II, we present the most common neoplasms and their treatment. The quality of the surgical resection appears to be of first importance in the prognosis. Progress in radiotherapy and chemotherapy have contributed to the improvement of long-term results. However, they are responsible of late deleterious effects. Further progress in therapy must be assessed with in view a critical evaluation of the quality of life.
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