Alessandro Carteri

Cerebral cavernous angiomas in the first year of life.

Two rare cases of cerebral cavernous angiomas in two infants, 9 and 6 months old, respectively, are reported and the other 11 cases in the literature concerning patients in the first year of life are reviewed. Cavernous angiomas of the brain occur rarely in the first year of life and present with seizures and head enlargement. On computed tomographic scan they typically appear as large, hyperdense, unenhanced masses, with large cysts and must be differentiated from tumors more common in infants, such as teratomas, ependymomas, and mixed tumors. Total removal is often possible, even with large lesions, because of the small amount of bleeding and the well-defined limits of the mass.

Autologous hemodonation in the corrective surgery of craniostenosis

Homologous transfusions are mandatory in most surgical procedures for correcting craniofacial malformations in infancy. A program of preoperative and intraoperative auto-hemodonation was developed and carried out in eleven infants. Although homologous transfusion could have been avoided in only 7 patients, we think that further experiences and minor corrections of our program may improve these results.

Choroid plexus and aquaporin-1 : A novel explanation of cerebrospinal fluid production

Aquaporins are selective water channel proteins that play a central role in the homeostasis of human body water. The choroid plexus (CP) is considered to be the main cerebrospinal fluid (CSF)-producing structure. In this study, six specimens of normal human CP obtained during surgery were analyzed by immunohistochemistry techniques for aquaporin-1 (AQP1) expression and distribution. Intense, uniformly distributed AQP1 immunostaining was observable in the apical but not the basolateral side of cuboid cells of the CP. Moreover, this polarized expression of AQP1 was weakly detectable in the endothelial cells of choroid microvessels and, with a different pattern, in the cells lining the tubules shaped into crypts. Selective AQP1 expression on the surface of the normal human CP might explain the role of CSF production by this complex structure.

Multidisciplinary treatment of medulloblastoma: A 5-year experience with the SIOP trial

A 5-year experience of the multidisciplinary treatment of pediatric medulloblastoma with the SIOP (International Society of Pediatric Oncology) trial is presented. 33 eligible patients finally reduced to a total of 30 evaluative cases were treated with major surgical resection, extensive irradiation, and combined chemotherapy (vincristine + CCNU). The overall survival rate without recurrence was encouraging, and the actuarial survival rate is satisfactory. At follow-up controls, most of the patients showed a good performance status and a promising neurological stage. However, the problem concerning quality of life remains unsolved: morbidity and sequelae following high-dose radiotherapy and concomitant antiblastic treatment were noticeable.

Active singling out of shunt independence

The availability of telemetric devices for intracranial pressure (ICP) measurements in line with a multipurpose valve (MPV) was shown to be the ideal condition for safe investigation of the problem of shunt independence in 21 patients. After percutaneous closure of the shunt, all but 4 patients developed some degree of intracranial hypertension. The time lapse between blockade of the MPV and appearance of the morphology, in the tracing, that suggests ICP is different for each patient and could reflect individual conditions such as the residual pathways of CSF, ventricular size and complicance of the system.

The CSF myelin basic protein in pediatric hydrocephalus

Concentrations of myelin basic protein (MBP) in ventricular and lumbar cerebrospinal fluid (CSF) of 20 pediatric hydrocephalic patients were reviewed. Raised values were found to be particularly significant in children aged more than 1 year. Control measurements after shunt placement showed an important drop in the MBP concentration, which could therefore be considered a marker for correct functioning of the shunt. The dosage of MBP could play a role in assessing the activity of an hydrocephalic process. Preliminary data gained from monitoring of MBP in the lumbar CSF in posthemorrhagic neonatal hydrocephalus could yield further criteria for indication of a shunt operation.

Immunobiology of Primary CNS Tumors in Infancy and Childhood

The authors report their experience on the immunological monitoring of children with posterior fossa medulloblastomas. The most important findings concerning humoral and cell-mediated immunity in this kind of patient are discussed. Among the main immunobiological pictures, the authors stress the remarkable failure of the T-cell dependent immune response, generally correlated to the degree of malignancy of the tumor, and the characteristic appearance of cells with natural cytotoxic activity, whose precise outlining is, at present, in progress. The B-cell dependent pool, mostly investigated through immunofluorescence studies, turned out to be very close to normal.

Immunobiology of paediatric intracranial tumours a preliminary report

SummaryPreliminary findings in the evaluation of the immune response of children with primary neoplasms of the CNS, mainly medulloblastomas, are reported and discussed.A broad scheme for the monitoring of B- and T-cell-dependent immunity and of delayed hypersensitivity reactions in this type of patient is presented. The most important immunobiological findings are discussed. Special attention is given to the striking failure of the T-cell-dependent pool (currently identified by “active” RFC and blastigenesis tests) and to the remarkable decrease of hypersensitivity reactions (depressed skin-test response), both of which seem to be related to the degree of malignancy of the tumour.A very peculiar feature,i.e., the appearance of cells with natural cytotoxic activity, is dealt with in some detail.Our present knowledge concerning the immunobiology of primary CNS neoplasms is still very incomplete, but seems to suggest a possible role for immunotherapy in paediatric neurosurgery.

Cyclic nucleotides in medulloblastomas: correlative study of tumoral and cerebrospinal fluid levels

The tumoral and cerebrospinal fluid (CSF) levels of cyclic nucleotides and of the main adrenergic metabolites (homovanillic acid and 5-hydroxyindoleacaetic acid) were investigated in a group of children with posterior fossa medulloblastomas. A longitudinal evaluation of CSF change of cyclic adenosine monophosphate (cAMP), cyclic guanosine monophosphate (cGMP), and adrenergic metabolites before and after surgical removal of the tumor mass is presented. Some preliminary patterns concerning correlative levels in the neoplastic tissue are discussed. The relevant increase of cGMP in medulloblastoma specimens and in CSF samples operation and the rapid decrease in the CSF after surgical removal of the tumor seem to suggest a possible role of cyclic nucleotides in the neoplastic growth of these tumors. (Neurosurgery, 7: 359-362, 1980).

CSF levels of cyclic nucleotides in primary intracranial neoplasms: A preliminary report

SummaryRecent evidence indicates that cyclic nucleotides are of importance for general and neurosurgical oncology, especially with respect to the contact-inhibition mechanisms and tumour cell growth.This preliminary report deals with the CSF levels of c-AMP and c-GMP in primary neoplasms in children and to problems related to the blood-brain barrier. Some cases of medulloblastoma were studied as well as a few cases of brain stem glioma and cystic astrocytoma.The importance of some rather unusual findings seems undebatable,i.e., the marked increase in c-GMP values usually observed in medulloblastoma and the decrease of c-AMP, that is fairly common in all malignant neoplasms. The main changes in the c-AMP/c-GMP ratio are also discussed.