William E. Ballinger

Cavernous angioma: a review of 126 collected and 12 new clinical cases.

The histopathological, clinical, and radiological features of the intracranial cavernous angioma are reviewed, based on an analysis of 138 symptomatic, histologically verified cases. Twelve of the cases are from our own series and 126 were collected from appropriately documented reports in the modern literature. The analysis indicated that, at the time of diagnosis, one-third of the patients (49 cases) were being evaluated for seizures, one-third (40 cases) for clinical evidence of hemorrhage, and one-third (49 cases) for mass lesions. Unlike the other two groups, the group presenting with clinical evidence of hemorrhage was distinguished by a dominant age at the time of diagnosis (41% were diagnosed during the 4th decade of life), by a high incidence of prior neurological evaluation (43%), by a higher rate of diagnosis at autopsy (28%) than at operation, and by the absence of microscopic calcification within the lesion.

The meningioma controversy: Postoperative radiation therapy

Total surgical excision is the main goal of therapy for intracranial meningiomas. The controversy today involves the efficacy of postoperative radiation therapy. To evaluate this question, 132 patients with benign intracranial meningiomas, treated between October 1964 and April 1985, were evaluated. All patients had a minimum 2-year follow-up. The actuarial local control rates at 10 years for the three treatment groups were as follows: subtotal excision alone, 18%; subtotal excision plus postoperative radiation therapy, 82%; and total excision alone, 77%. The actuarial determinate survival rates at 10 years were 49%, 81%, and 93%, respectively. Postoperative radiation therapy was also effective for patients treated at the time of the first recurrence, with an actuarial local control rate at 10 years after salvage treatment of 30% for patients treated with surgery alone and 89% for patients receiving postoperative radiation therapy at the time of salvage. This analysis suggests that radiation therapy has a significant role in the treatment of subtotally excised and recurrent intracranial meningiomas.

Long-term follow-up of radiotherapy for pituitary adenoma: The absence of late recurrence after ≥ 4500 cGy

Abstract Recent literature has suggested that late recurrence of pituitary adenoma after radiotherapy is common. We hypothesized that late failures might be a result of inadequate dose ( 64 months after radiotherapy, with 31 patients (none with bromocriptine) observed 10 to 21 years. We conclude that treatment of pituitary adenoma with ≥ 4500 cGy in 25 fractions can result in a high (≥ 90%) probability of stable long-term control.

Primary lymphoma of the central nervous system. Computerized tomography scan characteristics and treatment results for 12 cases

A retrospective analysis of 12 patients with primary central nervous system non‐Hodgkins lymphoma seen from 1958 to 1980 was carried out with emphasis on diagnostic evaluation and treatment results. Computerized tomography (CT) scans were found to be the most valuable diagnostic tool both for initial evaluation as well as follow‐up. Characteristic CT scan features were identified and are discussed. Three patients had a history of previous immunosuppression; two had preceding and concurrent uveitis. Nine of the 12 patients were treated primarily with radiation therapy. Three patients were diagnosed at autopsy and had not received definitive therapy. Size of lesion proved to be the most important prognostic factor and appeared to be related to location. Gross total excision of tumor did not appear to improve survival. Two patients were alive with no evidence of disease at 38 and 48 months, respectively. Recurrences were noted from 1 to 33 months after diagnosis (median, 14 months), suggesting the advisability of long‐term follow‐up prior to presumption of cure. From these results and a review of the literature, possible treatment approaches are presented. Cancer 52:1993‐2000, 1983.

Intramedullary spinal tuberculoma.

A case report of intramedullary spinal tuberculomas presenting as cervical myelopathy is described. The rarity of these lesions in North America make this case unique. The use of modern neurodiagnostic and microsurgical techniques as well as the use of postoperative antituberculous drugs resulted in a good outcome. The first known description of magnetic resonance imaging of intramedullary spinal tuberculomas is presented. The gross and microscopic appearances of the lesion are given.

Hemorrhage into Pituitary Adenomas

The clinical and pathologic features of pituitary apoplexy were evaluated within the last 100 consecutive pituitary tumors surgically treated at this institution. From this group, ten tumor specimens exhibited pathologically verifiable hemorrhagic necrosis, including six with classic apoplectic onset; the hemorrhage in four patients was asymmetric. The tumors of symptomatic patients were large, with suprasellar and parasellar extension readily identifiable by neuroradiologic examination. All tumors within this group were chromophobic adenomas by light microscopy, and each of these tumors microscopically exhibited a sinusoidal arrangement with very prominent vascularity. Comparatively, those tumors with asymptomatic hemorrhage were all intrasellar and were encountered in younger patients who had exhibited prior endocrine disturbances. By light microscopy, two of these asymptomatic lesions were chromophobic and two were acidophilic adenomas. In contrast with larger tumors, however, increased vascularity or sinusoidal patterns were not a prominent feature within this group. Our experience suggests hemorrhage within pituitary tumors is a common event, but symptomatic bleeding generally occurs in older patients whose larger tumors contain a pathologic vascular predisposition. Urgent surgical decompression (usually transsphenoidal) in symptomatic patients produced great neurologic improvement in each case.

Regeneration in peripheral nerve grafts to the cat spinal cord

Peripheral nervous system grafts have long been known to promote CNS axonal elongation in the rodent. To investigate whether these principles also apply to a higher order animal, more suitable for physiologic studies, we performed autogenous sciatic nerve grafts to the adult cat spinal cord. This report is a brief, initial study of these grafts. In an effort to study both descending and ascending fibers as separately as possible, laminectomies were performed at both thoracic (T2-T9) and lumbar (L2-L4) levels. Aspiration lesions were made in the left side of the cord and the sciatic grafts were introduced. Three cats were studied with standard histological techniques, confirming previous reports of glial scar formation, collagen deposition, and cyst formation at the graft-CNS junction. In 7 other animals, at 146-179 days after the initial operation, the axonal origins were traced retrogradely using horseradish peroxidase and the tetramethyl benzidine technique. Reinnervation of the graft was found by intrinsic spinal cord neurons and dorsal root ganglia neurons. The number of reinnervating neurons was found to be greater than previously reported in the rodent. There was, however, no evidence of regeneration from brainstem nuclei when the grafts were placed at spinal levels where this has been seen in the rat. This may support an absolute maximum for regenerative distances vs a relative one. Although the amount of data was limited, it did support previous reports that peripheral axotomy enhances the regenerative response seen in primary sensory neurons.

Superficial Siderosis: A Cause of Leptomeningeal Enhancement on Computed Tomography

A case of superficial siderosis of the central nervous system proven by brain biopsy is described. The diagnosis was made antemortem, the first such case reported in the English language literature. Postcontrast material cerebral CT demonstrated widespread meningeal enhancement. The differential diagnosis is discussed.

Primary leptomeningeal glioma mimicking an acoustic neuroma: case report with review of the literature.

Primary leptomeningeal gliomas are rare. Historically, they have been found in the spinal canal more frequently; however, in the recent literature nearly all have been found within the cranium. In the only cadaveric study of leptomeningeal glial nests, the most frequent site was the medulla and pons. Until now, no leptomeningeal glioma has been found at this site. We report what we believe to be the first such case mimicking an acoustic neuroma.

Generalized nonsuppurative myositis with staphylococcal septicemia

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