Abolghassem Sepehrnia

The adjustable proGAV shunt: a prospective safety and reliability multicenter study.

OBJECTIVETo evaluate the reliability of the gravitation-assisted adjustable proGAV shunt system with a prospective multicenter study conducted in 10 German hospitals. METHODSEnrollment for this observational study began in April 2005 and concluded in February 2006. The protocol required re-examinations 3 and 6 months postoperatively and fixed the endpoint of follow-up at 12 months after implantation. Patients with different types of adult, juvenile, and pediatric hydrocephalus were included and 165 patients were enrolled; 9 died and 12 had incomplete follow-up. RESULTSOf the assessable 144 patients, 130 completed the protocol after 12 months, whereas 14 failed because of the need to explant the device, mainly because of infection. In 12 patients, components of the shunt, not the valve, were revised. In 65 of the 144 patients, there were 102 readjustments of the valve in 67 incidences because of underdrainage and in 35 because of overdrainage. In 1 case, readjustment was not possible. Determination of pressure level with the verification instrument was safe and corresponded to the required x-ray controls after adjustments. No unintended readjustments were noted. CONCLUSIONThe proGAV is a safe and reliable device.

Preservation of the Olfactory Tract in Bifrontal Craniotomy for Various Lesions of the Anterior Cranial Fossa

OBJECTIVE Preservation of the olfactory tract during use of the bifrontal approach for the treatment of lesions located in the frontal cranial base and the supra- and parasellar regions has not been previously investigated. METHODS In our study, 12 patients underwent surgery, via the basal subfrontal route, for treatment of various lesions. All patients were observed prospectively, and olfactometry was performed pre- and postoperatively by an independent otorhinolaryngologist. RESULTS We obtained complete preservation of the olfactory tracts and normal postoperative olfaction in all 12 cases. CONCLUSION The bifrontal approach yields a bilateral wide operative field with excellent orientation and views of important structures. The shortcomings of this method, i.e., damage to the olfactory tracts and postoperative anosmia, can be overcome.

MGMT promoter methylation status in anaplastic meningiomas

Anaplastic meningioma [World Health Organization (WHO) grade III] is characterized by aggressive biological behavior and recurrent tumor growth [1]. Radiation therapy is commonly employed after both total and subtotal resection, but effective chemotherapeutic regimens are lacking [2]. Hypermethylation of the O-methylguanine-DNA methyltransferase (MGMT) promoter is an important prognostic marker and also predicts response to therapy with alkylating agents (e.g., temozolomide) in patients with malignant gliomas [3]. While in benign meningiomas (WHO grade I) MGMT promoter methylation is rare or absent [4, 5] and temozolomide lacked efficiency in a small series of grade I meningiomas refractory to treatment [6], in anaplastic meningiomas, i.e., those neoplasms most likely to be considered for adjuvant treatment, MGMT methylation status has only been assessed in one and three cases, respectively [4, 5] and the role of temozolomide remains unclear. We thus aimed to examine MGMT methylation status in a large series of anaplastic meningiomas. Formalin-fixed paraffin-embedded tissue samples from all anaplastic meningiomas diagnosed from 1989 to 2009 were retrieved from the archives of the Institute of Neuropathology, Münster. In addition, available samples of formerly grade II or recurrent grade III tumors of these patients were also retrieved. All samples were reviewed neuropathologically according to WHO criteria [1]. After isolation and bisulfite conversion (EZ DNA Methylation-Gold Kit; Zymo Research, Orange, CA), DNA from representative tumor material was subjected to methylation-specific polymerase chain reaction (PCR) as described previously [7]. Controls included clones representing methylated and unmethylated bisulfite converted DNA [8] as well as enzymatically methylated human genomic DNA (Zymo Research). Using the above approach, a total of 55 samples from 30 patients could be examined. The median age of the 17 females and 13 males was 66 years (range 33–92 years). Eighty-five percent of the tumors were of supratentorial location. As shown in Fig. 1, MGMT promoter methylation status was negative in all cases except for a single specimen. This 57-year-old male suffered from recurrent grade III meningioma, showing hypermethylation of the MGMT promoter region on repeated analyses. Using the same methodology, MGMT promoter methylation status was positive in 90 out of 194 malignant astrocytic tumors (46%, data not shown). B. Brokinkel S. Peetz-Dienhart W. Paulus M. Hasselblatt (&) Institute of Neuropathology, University Hospital Münster, Domagkstraße 19, 48149 Münster, Germany e-mail: hasselblatt@uni-muenster.de

Osteoplastic Lateral Suboccipital Approach for Acoustic Neuroma Surgery: Technical Note

OBJECTIVE Persistent headache remains a significant problem in a small group of patients after acoustic neuroma surgery via the lateral suboccipital approach. We describe a modified technique of osteoplastic lateral suboccipital craniotomy for surgery of the cerebellopontine angle. This simple and elegant technique provides a superior cosmetic result and a significant reduction in patients’ symptoms. METHODS We report on our series of 75 patients who underwent surgery for acoustic neuroma. The maximal follow-up period was 4 years. RESULTS No patients reported headache postoperatively. Cerebrospinal fluid fistulae were not observed. CONCLUSION This modified approach minimizes cerebellar retraction, and the neural and vascular structures can be preserved under direct visualization of the tumor. This lateral suboccipital approach is a useful modification of previous approaches in acoustic neuroma surgery. It provides successful tumor resection and excellent functional results.

Intraneural perineurioma of the viiith cranial nerve : Case report

OBJECTIVEThe authors describe the clinical and pathological features of the second reported case of an intraneural perineurioma involving a major intracranial nerve and the first case of this entity involving the VIIIth cranial nerve. CLINICAL PRESENTATIONA 59-year-old woman presented with a long history of dizziness, tinnitus, hearing loss, and unstable gait. A magnetic resonance imaging scan revealed a small intrameatal lesion, which showed no clear progression from 2000 to 2006. INTERVENTIONAs a result of worsening symptoms and a suspected vestibular schwannoma, an attempt of tumor resection through a retrosigmoid approach was performed. This revealed diffusely infiltrated and fusiform enlarged vestibular and cochlear nerves, with no identifiable border between the main tumor mass and normal nerve. An en bloc nerve-tumor mass excision was performed. The pathological findings confirmed the diagnosis of an intraneuronal perineurioma. CONCLUSIONThe experience with this unique case and the experience of others with the management of extracranial intraneural perineuriomas lead the authors to conclude that the most reasonable surgical management of this tumor at this location is a nerve-tumor cross-section resection.

Extent of surgical resection but not myxopapillary versus classical histopathological subtype affects prognosis in lumbo-sacral ependymomas

Francisco Esteban Miguel Angel Gonzalez-Moles David Castro Maria del Mar Martin-Jaen Maximino Redondo Isabel Ruiz-Avila Miguel Muñoz Department Otolaryngology, Hospital Virgen del Rocio, University of Seville, Seville, Department of Oral Medicine, School of Dentistry, Granada University, Granada, Department of Pathology, Hospital de Valme, Seville, Biopathology Department, Hospital Costa del Sol, Marbella, Malaga, Department of Pathology, Hospital General de Jaen, Jaen, and Paediatric Intensive Care Unit, Hospitales Universitarios Virgen del Rocio, Seville, Spain

Results of Surgical Treatment of Meralgia Paresthetica

Meralgia paresthetica, a common nerve entrapment syndrome [14], is an isolated disturbance of the sensation in the distribution area of the lateral femoral cutaneous nerve. This syndrome, characterized by pain, burning, tingling, numbness, and/or a variety of other paresthesias in the anterolateral area of the thigh, was first described by Bernhardt in 1895 [2] and named meralgia paresthetica by Roth in the same year [19]. Also in the same year, Sigmund Freud [7], who suffered from meralgia paresthetica, described his own affliction.

O.105 Survival rate and reliability of the ProGAV adjustable CSF shunt: Results of the German prospective multicenter observational study

Introduction: Surgical treatment of chronic hydrocephalus in an adult requires use of a shunt system that combines low-pressure opening with the absence of overdrainage phenomena. We present the preliminary results of a prospective multicentre study involving 13 hospitals in Spain of treatment of normal pressure hydrocephalus (NPH) with a gravity assisted shunt (GAV; Aesculap), the main purpose of which was to evaluate its efficacy and safety, as well as analyse possible factors influencing patient evolution. Material and Method Design: This prospective, multicentre study of clinical practice with a common protocol for treatment of adult idiopathic hydrocephalus included 136 patients (59% men; age: 73.4±6.4). Of these, six-month follow-up data are available for 62 patients and twelve months for 33. Data were recorded on epidemiological details, symptoms, evolution time, neuroradiological findings, vascular risk factors, and rout/ICP records. The main outcome variables were symptoms associated with hydrocephalus, measured with the NPH scale (gait, sphincter control and cognitive function). Secondary outcome variables included evolution according to radiological parameters and post-surgical complications. Statistics: ANOVA tests. Results: A significant improvement was noted in all the parameters of the NPH scale (gait: 3.2±1.0 vs 2.5±1.1 vs 2.2±1.1; cognitive function: 2.1±0.9 vs 1.8±0.9 vs 1.7±0.9; sphincter control: 2.9±1.2 vs 2.5±1.3 vs 2.4±1.3; p<0.05) highly evident in the third month and slightly less so in the sixth month, with a tendency to stabilise after 12 months. No association was found between improvement and demographic data, evolution time, vascular risk factors, rout value or radiological findings. The complications were less than 5%. Conclusion: The GAV shunt system proves highly efficient for the treatment of hydrocephalus, with a low rate of complications. Most patients showed improvement within six months.

Radial Nerve Lesions Associated with Fractures of the Humerus or Radius: Results of Surgical Treatment

Components of the radial nerve arise from the spinal segments C5-T1. After its course through the axilla the radial nerve traverses the spiral groove of the humerus. It then turns abruptly forward round the lateral aspect of the humerus to pierce the lateral intermuscular septum. At the elbow, the radial nerve divides into two branches: the sensory superficial branch and the motoric deep branch [6,8].