ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen and a potent inducer of vascular permeability. In this study, we determined whether expression of VEGF is correlated with in vivo measurements of the capillary permeability and vascular volume of primary human brain tumors.METHODS:Tumor samples (seven glioblastomas, one anaplastic astrocytoma, two low-grade astrocytomas, one pilocytic astrocytoma, and three primary cerebral lymphomas) were stereotactically obtained from 14 patients. A semiquantitative polymerase chain reaction was used to quantify the relative expression of VEGF messenger ribonucleic acid in the tumors. VEGF protein was demonstrated in tissue sections by immunohistochemical techniques. A two-compartment dynamic computed tomographic method was used to quantitatively measure the aforementioned parameters in the regions from which the biopsies were obtained.RESULTS:In glial tumors, there was significant correlation of VEGF messenger ribonucleic acid levels with capillary permeability (P< 0.05) and vascular volume (P< 0.01). Although all primary cerebral lymphomas showed considerable increases in capillary permeability and vascular volume, VEGF expression was only slightly upregulated in these tumors.CONCLUSION:Our findings are consistent with the hypothesis that VEGF may be responsible for endothelial cell proliferation and vascular permeability in glial tumors. This relationship has implications for clinical applications, i.e., assessment of delivery of water-soluble drugs, treatment of edema, and antiangiogenesis therapy based on inhibition of VEGF function.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Hyperostosis associated with intracranial meningiomas is a well-described entity. The cause, management, and prognosis of these bony changes have long been a point of controversy. Some authors have postulated that hyperostotic changes are secondary to the formation of the tumor and do not constitute invasion of the tumor into the bone. Determining this point has direct implications in the treatment of these patients, especially regarding surgical considerations. To more thoroughly evaluate this question, a study correlating the morphology to the radiology is necessary.METHODS:In this study, 51 patients underwent resection for meningiomas involving the cranial base. Preoperative radiographic evaluation using magnetic resonance imaging and/or computed tomography was performed, and areas of hyperostosis were identified. During the resection of the tumor, biopsies from these hyperostotic regions were sent for histological evaluation regarding the presence or absence of tumor invasion of the bone.RESULTS:Preoperative neuroradiological assessment identified 26 patients with radiographic evidence of hyperostosis. Histological examination of the resected bone showed tumor invasion in 35 patients, including the area of radiographically identified hyperostosis in 25 of the 26 patients. The floor of the middle fossa was a specific area of low sensitivity for preoperative assessment of associated hyperostosis.CONCLUSION:These results indicate that hyperostosis associated with meningiomas involving the cranial base are caused by tumor invasion of the bone histologically.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Intracranial suppurative disorders (abscesses and empyemas) continue to be common neurosurgical emergencies in South Africa. Cranial extradural empyema (EDE) occurs less frequently than its subdural counterpart but remains a potentially devastating disease process. We present our 15-year experience with this condition in the era of computed tomography.METHODS:Of the 4623 patients with intracranial sepsis who were admitted to the neurosurgical unit at Wentworth Hospital (Durban, South Africa) during a 15-year period (1983-1997), 76 patients with EDEs were identified. An additional six patients who were identified from our outpatient records were treated nonsurgically. Analyses were performed with respect to clinical, radiological, bacteriological, surgical, and outcome data. All information for this study was obtained from the computerized databank for the unit. Statistical analyses of the related pre- and postoperative clinical data were performed.RESULTS:The 76 patients with EDEs accounted for 1.6% of the total number of patients admitted for treatment of intracranial sepsis during the study period. Thirteen patients (15.8%) had infratentorial pus collections. Male patients predominated by a ratio of 2:1, and 66 patients were between the ages of 6 and 20 years (mean age, 16.56 ± 9.87 yr). The origins of the sepsis were paranasal sinusitis for 53 patients (64.6%), mastoiditis for 16 patients, trauma for 5 patients, dental caries for 1 patient, and miscellaneous causes for 7 patients. The most common clinical presenting features were fever, neck stiffness, and periorbital edema. Surgery was performed in the form of burrholes for 21 patients, small craniectomies for 39 patients, and craniotomies for 5 patients. The additional five patients, while having drainage of their infected paranasal sinuses, had simultaneous drainage of their extradural pus collections by the ear, nose, and throat surgeon. The majority of patients (81 patients) experienced good outcomes (Glasgow Outcome Scale scores of 4 or 5). A single patient died after surgery (mortality rate, 1.22%).CONCLUSION:EDEs occur less frequently than subdural empyemas and are associated with better prognoses. Surgical drainage (burrholes), simultaneous eradication of the source of sepsis, and high-dose intravenous antibiotic therapy remain the mainstays of treatment. Selective nonsurgical management of small EDEs is possible, provided the source of sepsis is surgically eradicated. It is our opinion that EDE is a disease that should be managed without morbidity or death.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Symptomatic dissections of the cervical carotid artery (CCA) can be spontaneous or secondary to trauma and may be associated with pseudoaneurysms. Surgical treatment is often difficult or unavailable. We report the successful use of endovascular stents in the treatment of symptomatic dissection of the CCA.METHODS:Five consecutive patients with symptomatic CCA dissection were seen at our institution. There were four female patients and one male patient, ranging in age from 19 to 56 years. One dissection was spontaneous. The others were secondary to a gunshot wound (one patient), blunt neck trauma (two patients), and endovascular treatment of atherosclerotic carotid bifurcation disease (one patient). Balloon-expandable and self-expanding stents were placed via a transfemoral approach.RESULTS:Success in restoring the carotid lumen with two to five stents in each patient was angiographically demonstrated. There were no procedure-related complications. All patients experienced significant clinical improvement within the first 24 hours and complete long-term recovery.CONCLUSION:Symptomatic dissections of the CCA can be successfully treated by using endovascular stents.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID