Combined surgical treatment of aneurysmal bone cyst in the lumbar spine

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, , Helsinki - .

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. Index Medicus. , , . , et al.

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vSUMMARY: , (.. Papadopoulos A.). , . index medicus. ( 250 ), .

57

M - 2007, 14, 2

() ............................................................................................................. 59. , . , . , . 1, . , . , . , . , .

(SPECT) 99mTc-Tetrofosmin .................................................................................................................................................... 68.. , . , . , . , . , . , . , . , . , .

Gamma knife E. 1 - ............................................................................................................ 77M. Torrens, . , . , . , . , . , .

Oy . ............................................................................................................................ 84. , . , . , . , . , .

........................................................................................................... 89. , . , . , . , .

.................................................. 96. , . ,

. ............................................................................................................................................................ 101

. ............................................................................................................................................................. 102

58

HELLENIC NEUROSURGERYMAY - UGUST 2007, Volume 14, Number 2

CONTENTS

CLINICAL STUDSGenetic association study of multiple interleukin genes polymorphisms and outcome after traumatic brain injury .......................................................................................................................................... 59Dardiotis E., Paterakis K., Dardioti M., Aggelakis K., Komnos A., Tsimourtou V., Tasiou A., Karantanas A., Hadjigeorgiou G.

Evaluation of brain tumor by 99mTc-tetrofosmin SPECT .......................................................................................... 68Alexiou G., Tsiouris S., Fotopoulos A., Goussia A., Papadopoulos A., Kyritsis A., Doukas M., Zigouris A., Voulgaris S., Polyzoidis K.

Gamma knife radiosurgery in Greece. Part 1 - Results of the technique in patients with malignant brain tumors ....................................................................................................................................... 77Torrens M., Chrissikopoulos C., Stergiou C., Lampropoulos K., Seferis C., Stroggilos C., mikos P.

CASE REPORTSSkull perforation by an arachnoid cyst. Case report and review of the literature ................................................ 84Miliaras G., Mihalenas N., Zikou A., Sarmas I., Karamanakos P., Polizoidis K.

Combined surgical treatment of aneurysmal bone cyst in the lumbar spine ....................................................... 89Tsitsopoulos P.Ph., Anagnostopoulos I., Karakosta E., Xantzidis P., Tsitsopoulos Ph.

Complete removal of a cauda equina lipoma with a modified surgical technique .............................................. 96Sakellaridis N., Savvanis G.

TO THE EDITORG. Stratzalis ................................................................................................................................................................. 101

V. atsaridis ................................................................................................................................................................ 102

-, . . 215 . - , . - IL-1(-31C/T), IL-1(+3953C/T), IL-1(-889C/T), IL-1ra(+2018C/T), IL-2 (+114G/T) IL-2(-384G/T). t-test, Fishers exact test 2 - (logistic regression) (odds ratios). 2 IL-1ra (+2018) , G IL-2 (+114) GCS . -. . , .

: , GCS, GOS, , , , ,

,

1, 2, 1, 1, 3, 1, 2, 4, 1

1 , ... , , , 2 , ... , , 3 4 CT/MRI

:. , 22, 412 22 : 6972862909, . : 2410 682789, 2410 682301, 2410 682320e-mail: [email protected]

()

2007, 14(2):59-67HELLENIC NEUROSURGERY 2007, 14(2):59-67

CLINICAL STUDY

60 , . 14, 2, 2007

, - - . (IL), , 26.

- -. 4 , , - 40. , IL-1ra10, IL-625, IL-139 IL-132 .

- . 26. , - , - 30.

IL-1 3 -: IL-1, IL-1 IL-1ra (interleukin 1 receptor antagonist), . IL-1 IL-1 - . , IL-1ra IL-1 IL-14. IL-2 - , 1.

- , ,

.

O-M 215 (

SD = 39.8 21,11, = 35 [16,2%]) - 2002 2004. 18 . .

- (Glasgow Coma Score [GCS])35 - GCS (3-8, 9-12, 13-15)36. , () , , ( , -, , , , ). MRI - , , , -, , . (- , , ) ABC/29.

, .

6 (Glasgow Outcome Scale [GOS])14 ( ) GCS ,

E 61

H-W

(p >0,05) - . - .

30 215 6 (GOS: 1-3). 17 -, 4 9 (GOS:1). - - 1. GCS 2. . 2 IL-1ra (+2018) (p=0,03 GCS 3-8 GCS 9-12 p=0,01 GCS 13-15) GOS (p=0,02) . , G IL-2 (+114) GCS (p=0,02 GCS 3-8 GCS 9-12 p=0,01 GCS 13-15) (p=0,57). , IL-1 (-31), IL-1 (+3953), IL-1 (-889) IL-2 (-384) - . IL-ra (+2018) IL-2 (+114) ( t-test) (. 3).

-

. -

. 18 - . - : ( GOS: 4-5) (GOS: 1-3)22,36.

DNA

. IL-1 (-31 C/T)6, IL-1 (+3953 C/T)16, IL-1 (-889 C/T)24, IL-1ra (+2018 C/T)17, IL-2 (+114 G/T)20 IL-2 (-384 G/T)15 PCR/RFLP (Polymerase Chain Reaction/Restriction Fragment Length Polymorphism) - . .

Hardy-Weinberg (H-W)

exact test GENPOP. ( GCS) ( GOS) t-test, Fisher exact test 2 . (logistic regression) (odds ratio) 95% (95% con-fidence intervals) (, , , - , , , ). GCS 10,36. - SPSS v.11 (Chicago, IL) SAS v.6.12 (Cary, NC). p 0.05 .

62 , . 14, 2, 2007

1. n=215 (%) (%)

IL-1ra (+2018 C/T) 1,1 (%) 1,2 (%) 2,2 (%) 1(%) 2 (%)129 (60,00) 68 (31,63) 18 (8,37) 129 (60,00) 86 (40,00)

IL-1b (-31C/T) 1,1 (%) 1,2 (%) 2,2 (%) 1(%) 2 (%)73 (33,95) 118 (54,88) 24 (11,17) 264 (61,39) 166 (38,61)

IL-1b (+3953 C/T) 1,1 (%) 1,2 (%) 2,2 (%) 1(%) 2 (%)125 (58,14) 68 (31,63) 22 (10,23) 318 (73,95) 112 (26,05)

IL-1a (- 889 C/T) CC (%) CT (%) TT (%) C (%) T (%)107 (49,77) 84 (39,07) 24 (11,16) 208 (69,30) 132 (30,70)

IL-2 (+114 G/T) TT (%) GT (%) GG (%) T (%) G (%)110 (51,16) 84 (39,07) 21 (9,77) 304 (70,70) 126 (29,30)

IL-2 (-384 G/T) 1,1 (%) 1,2 (%) 2,2 (%) 1 (%) 2 (%)85 (39,53) 130 (60,47) 0 300 (69,77) 130 (30,23)

- ( ) , - . , , . - .

IL-1 - . - (mRNA 15min 1h)8. , IL-1 13,23. , IL-1 . 34.

IL-1,

(-31) 5 (+3953) IL-1. IL-1 (-31 C/T) IL-1 C 6, 2 IL-1 (+3953 C/T) IL-128. - , , 6,16. 39, . , - , (n=69) .

IL-1 IL-1 IL-1 , IL-1 - 4. IL-1 IL-1 19,27. IL-1

E 63

2. GCS

. 2 (%) . 2 (%) OR (95%CI) pIL-1ra (+2018C/T)

(n=215) 86 (40,00) 129 (60,00) (n=185) 80 (43,24) 105 (56,76) 1 (n=30) 6 (20,00) 24 (80,00) 0.31 (0.11-0.80)+ 0,02+

GCS 3-8 (n=64) 34 (53,13) 30 (46,87) 1GCS 9-12 (n=27) 8 (29,63) 19 (70,37) 0,43 (0,16-0,96)* 0,03*GCS . 13-15 (n=124) 44 (35,48) 80 (64,52) 0,44 (0,24-0,85)* 0,01*

IL-1b(-31C/T) (n=215) 142 (66,05) 73 (33,95) (n=185) 123 (66,49) 62 (33,51) 1 (n=30) 19 (63,34) 11 (36,66) 0.85 (0.43-1.89)+ 0,63+

GCS 3-8 (n=64) 42 (65,62) 22 (34,38) 1GCS 9-12 (n=27) 16 (59,25) 11 (40,75) 0,74 (0,29-1,94)* 0,58*GCS . 13-15 (n=124) 84 (67,75) 40 (32,25) 1,13 (0,55-2,09)* 0,76*

IL-1b(+3953 C/T) (n=215) 90 (41,86) 125 (58,14) (n=185) 76 (41,08) 109 (58,92) 1 (n=30) 14 (46,67) 16 (53,33) 1,23 (0,55-2,74)+ 0,58+

GCS 3-8 (n=64) 26 (40,62) 38 (59,38) 1GCS 9-12 (n=27) 13 (48,14) 14 (51,86) 1,12 (0,52-3,37)* 0,53*GCS . 13-15 (n=124) 51 (41,13) 73 (58,87) 1,04 (0,56-1,87)* 0,93*

IL-1a(- 889 C/T) (n=215) 108 (50,23) 107 (49,77) (n=185) 92 (49,72) 93 (50,28) 1 (n=30) 16 (53,33) 14 (46,67) 1,13 (0,52-2,54)+ 0,73+

GCS 3-8 (n=64) 30 (46,87) 34 (53,13) 1GCS 9-12 (n=27) 18 (66,66) 9 (33,34) 1,41 (0,56-3,47)* 0,47*GCS . 13-15 (n=124) 60 (48,39) 64 (51,61) 1,15 (0,62-2,13)* 0,62*

IL-2 (+114 G/T) (n=215) 105 (48,84) 110 (51,16) (n=185) 89 (48,11) 96 (51,89) 1 (n=30) 16 (53,33) 14 (46,67) 1,21 (0,53-2,69)+ 0,57+

GCS 3-8 (n=64) 41 (64,06) 23 (35,94) 1GCS 9-12 (n=27) 10 (37,04) 17 (62,96) 0,36 (0,23-0,86)* 0,02*GCS . 13-15 (n=124) 54 (43,54) 70 (56,46) 0,40 (0,21-0,73)* 0,01*

IL-2 (-384 G/T) (n=215) 130 (60,47) 85 (39,53) (n=185) 113 (61,09) 72 (38,91) 1 (n=30) 17 (56,67) 13 (43,33) 0,81 (0,37-1,84)+ 0,64+

GCS 3-8 (n=64) 36 (56,25) 28 (43,75) 1GCS 9-12 (n=27) 17 (62,97) 10 (37,03) 1,33 (0,51-3,35)* 0,57*GCS . 13-15 (n=124) 77 (62,10) 47 (37,90) 1,25 (0,67-2,36)* 0,47*

(*) , , , , , , .(+) GCS .IL= , OD= , CI= , GCS= , GOS ( ): 4-5 GOS: 1-3

64 , . 14, 2, 2007

19,27. - IL-1.

-889 IL-1 - . - 5. 32. . IL-1

. IL-1ra (interleukin 1 receptor antagonist)

IL-1 IL-1 IL-1. IL-1ra IL-1 IL-1 , , 37. 31. , - .

VNTR (variable number of tandem repeats - -) 2 IL-1ra33 IL-1 IL-1ra. 2 IL-1 - IL-1ra, - 2. 2 2. - 2 IL-1ra (VNTR) 10.

+2018 2 - IL-1ra - (linkage disequilibrium) IL-1ra VNTR 3. 2 - ( GCS ) ( 2 3). - , , . 2 (. 2). , 2, , - , - ,

3. (GCS ) t-test.

n=215 GCS [meanSD] p*

IL-1ra (+2018 C/T) . 2 10,053,81 . 2 11,363,94 p=0,02

IL-1b (-31C/T) . 2 10,553,81 . 2 10,673,95 p=0,43

IL-1b (+3953 C/T) . 2 11,593,61 . 2 11,483,87 p=0,41

IL-1a (- 889 C/T) . 11,503,67 . 11,553,86 p=0,46

IL-2 (+114 G/T) . G 11,043,81 . G 12,003,65 p=0,03

IL-2 (-384 G/T) . 2 11,643,67 . 2 11,333,91 p=0,27

(*) , , , , , , - .GCS: , mean= , SD= .

E 65

. , , : 18. IL-1 - , Ca2+, - , 7,11. IL-1 -, , , , . , , - 29.

, IL-2 . IL-2 - - . (natural Killer) Th1 (T-helper 1)1. - IL-2. IL-2 1. IL-2 38.

IL-2 . -

-384 15, IL-212 - 21. O +11420. , . -384 , G IL-2 (+114) (. 2 3). - , , (linkage disequilibrium) .

-

. - . . IL-1ra 30. , , - , - .

SUMMARY

Genetic association study of multiple interleukin genes polymorphisms and outcome after traumatic brain injury

Dardiotis E.1, Paterakis K.2, Dardioti M.1, Aggelakis K.1, Komnos A.3, Tsimourtou V.1, Tasiou A.2, Karantanas A.4, Hadjigeorgiou G.1

1University Hospital of Larissa, Dpt of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, 2University Hospital of Larissa, Dpt of Neurosurgery, University of Thessaly, Larissa, 3General

Hospital of Larissa, ICU, Larissa, 4General Hospital of Larissa, CT/MRI unit, Larissa, Greece

Interleukins, which are the main mediators of inflammation, were found to play a central role in the patho-

66 , . 14, 2, 2007

1. Amick JE, Yandora KA, Bell MJ, et al. The Th1 versus

Th2 cytokine profile in cerebrospinal fluid after severe traumatic brain injury in infants and children. Pediatr Crit Care Med 2:260-264, 2001.

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physiology of traumatic brain injury (TBI). We conducted a prospective study to investigate possible influ-ence of genetic polymorphisms of the interleukin genes in the clinical severity and outcome of TBI patients. 215 patients with TBI successively admitted to the neurosurgical unit were evaluated. Initial neurological status was assessed by means of the Glasgow Coma Score, while we defined patients six-month outcome us-ing the Glasgow Outcome Scale. We genotype for IL-1b (-31C/T), IL-1b (+3953C/T), IL-1a (-889C/T), IL-1ra (+2018C/T), IL-2 (+114G/T) and IL-2 (-384G/T) polymorphisms. Possible associations were examined using the t-test, the Fishers exact test and the 2 test. Odds ratios with the corresponding 95% confidence intervals were also calculated using logistic regression analysis. Compared with non-carriers, IL-1ra (+2018) allele 2 carriers were found to have more severe clinical presentation at admission, but better 6 month outcome, while IL-2 (+114) allele G carriers were associated with lower GCS at admission. No statistically significant difference was found with the other polymorphisms. Our study provides evidence of an implication of genetic factors in the outcome of TBI patients. However, further studies are needed to confirm these associations and investigate underlying pathogenetic mechanisms.

Key words: Genetic association study, GCS, GOS, inflammation, interleukin, outcome, polymorphism, traumatic brain injury, traumatic head injury.

E 67

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(SPECT) 99mTc-Tetrofosmin - . 60 (27 , 33 , 57,8 ), ( , ). - (SPECT) , , (Ki-67/MIB-1) . - : 19 ( 3 ), 14 , 2 , 3 , 3 (grade II), 1 , 3 , 8 , 1 , 1 , 1 -, 1 , 3 . SPECT . , , MIB-1 SPECT . SPECT 99mTc-Tetrofosmin - - , . .

: , MIB-1, , SPECT, 99mTc-Tetrofosmin

. 1, 2, 2, 3, 2, 4, 3, 1, 1, 1

1 , 2 , 3 , 4 ,

: 103, , 45500.: 2651048795, 6945626740E-mail: [email protected] - [email protected]

(SPECT) 99mTc-Tetrofosmin


CLINICAL STUDY

O Y H 99mTc-TETROFOSMIN O A 69

(single-photon emission tomogra-phy SPECT) - . -201 (201Tl) - 10. , 201Tl , -, , - -99m (99mTc)21,24. , 99mTc-Sestamibi .

99mTc-Tetrofosmin (99mTc-TF) - , 201Tl 19. - , 6. -, 99mTc-TF , - . - . , 99mTc-TF , , - . , , 6,11,12.

- SPECT 99mTc-TF, - . , - , ,

, - - , , .

-

1/3/2005 1/3/2007, () - () . 60 (27 , 33 , 57,8 ). (SPECT) 99mTc-TF. , . - (49/60), (11/60) . . -- , 60 , 19 (3/15 ), 14 , 2 , 3 , 3 (grade II), 1 - , 3 , 8 , 1 , 1 , 1 -, 1 3 ( 1). - (Ki-67/MIB-1).

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SUMMARY

Evaluation of brain tumor by 99mTc-tetrofosmin SPECT

Alexiou G.1, Tsiouris S.2, Fotopoulos A.2, Goussia A.3, Papadopoulos A.2, Kyritsis A.4, Doukas M.3, Zigouris A.1, Voulgaris S.1, Polyzoidis K.2

Departments of Neurosurgery, Nuclear Medicine, Pathology, and 4Neurology, University of Ioannina School of Medicine, Ioannina, Greece

The noninvasive functional characterization of an intracranial lesion represents a major goal, substantially enhancing the neuromorphological information obtained by conventional radiology. We set out to evaluate the contribution of technetium-99m Tetrofosmin (99mTc-TF) SPECT in the evaluation of brain tumors. Sixty patients (27 male, 33 female, mean age 57,8 years) were prospectively enrolled in the study. The diagnosis was meningioma (19), glioblastoma (14), anaplastic astrocytoma (2), anaplastic oligodendroglioma (3), low grade astrocytoma (3), low grade oligondroglioma (1), radiation necrosis (3), intracerebral hematoma (8), hemangioblastoma (1), colloid cyst (1), swannoma (1), pituitary adenoma (1) and metastasis (3). All patients underwent SPECT imaging and within a week surgical excision was performed. From the surgical excision specimens Ki-67 antigen was assessed with the MIB-1 immunostaining method. The tumour tracer uptake intensity on visual qualitative image assessment ranged from profound to very faint (in a low-grade fibrillary astrocytoma). 99mTc-TF brain SPECT managed to differentiate tumor recurrence from radiation necrosis and neoplastic from non-neoplastic intracerebral hemorrhage. Furthermore, there a was a linear clear positive correlation between the 99mTc-TF uptake and Ki-67 antigen in gliomas and in meningiomas. Imaging by 99mTc-Tetrofosmin provides useful information on the lesions functional nature and could be implemented in the diagnostic workup.

Key words: glioma, MIB-1, prognosis, SPECT, 99mTc-Tetrofosmin

1. Barai S, Bandopadhayaya GP, Julka PK, et al. Evaluation

of single photon emission computerised tomography (SPECT) using Tc99m-tetrofosmin as a diagnostic mo-

dality for recurrent posterior fossa tumours. J Postgrad Med 49:316-320, 2003.

76 , . 14, 2, 2007

2. Chiang M, Chang C, Chen M, et al. Nuclear multiparameter flow cytometric DNA analysis of human brain tumors: correlation of DNA content with tumor histology and clinical behavior. Surg Neurol 50:65-72, 1998.

3. Choi JY, Kim SE, Shin HJ, et al. Brain tumor imaging with 99mTc-tetrofosmin: comparison with 201Tl99mTc-MIBI, and 18F-fluorodeoxyglucose. J Neurooncol 46:63-70, 2000.

4. Di Chiro G, Oldfield E, Wright DC, et al. Cerebral necrosis after radiotherapy and/or intraarterial chemotherapy for brain tumors: PET and neuropathologic studies. AJR Am J Roentgenol 150:189-197, 1988.

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7. Gerdes J, Becker MH, Key G, et al. Immunohistological detection of tumour growth fraction (Ki-67 antigen) in formalin-fixed and routinely processed tissues. J Pathol 168:85-86, 1992.

8. Ho DM, Hsu CY, Ting LT, et al. Histopathology and MIB-1 labeling index predicted recurrence of meningiomas: a proposal of diagnostic criteria for patients with atypical meningioma. Cancer 94:15381547, 2002.

9. Kasuya H, Kubo O, Tanaka M, et al. Clinical and radiologi-cal features related to the growth potential of meningioma. Neurosurg Rev 29:293-296, 2006.

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11. Le Jeune N, Perek N, Denoyer D, et al. Study of monoglu-tathionyl conjugates TC-99M-sestamibi and TC-99M-tetrofosmin transport mediated by the multidrug resist-ance-associated protein isoform 1 in glioma cells. Cancer Biother Radiopharm 20:249-259, 2005.

12. Le Jeune N, Perek N, Denoyer D, et al. Influence of glutathione depletion on plasma membrane cholesterol esterification and on Tc-99m-sestamibi and Tc-99m-tetrofosmin uptakes: a comparative study in sensitive U-87-MG and multidrug-resistant MRP1 human glioma cells. Cancer Biother Radiopharm 19:411-421, 2004.

13. Minutoli F, Angileri FF, Cosentino S,et al. 99mTc-MIBI

SPECT in distinguishing neoplastic from nonneoplas-tic intracerebral hematoma. J Nucl Med 44:1566-1573, 2003.

14. Nagamachi S, Jinnouchi S, Nabeshima K, et al. The cor-relation between 99mTc-MIBI uptake and MIB-1 as a nuclear proliferation marker in glioma--a comparative study with 201Tl. Neuroradiology 43:1023-1030, 2001.

15. Nakaguchi H, Fujimaki T, Matsuno A, et al. Postoperative residual tumor growth of meningioma can be predicted by MIB-1 immunohistochemistry. Cancer 85:22492254, 1993.

16. Nakasu S, Hirano A, Shimura T, et al. Incidental menin-giomas at autopsy study. Surg Neurol 27:319322, 1987.

17. Oriuchi N, Tamura M, Shibazaki T, et al. Clinical evalu-ation of thallium-201 SPECT in supratentorial gliomas:relationship to histologic grade, prognosis and proliferative activities. J Nucl Med 34:2085-2089, 1993.

18. Ricci PE, Karis JP, Heiserman JE, et al. Differentiating recurrent tumor from radiation necrosis: time for re-evaluation of positron emission tomography? AJNR Am J Neuroradiol 19:407-413, 1998.

19. Rigo P, Leclercq B, Itti R, et al. Technetium-99m-tetrofos-min myocardial imaging: a comparison with thallium-201 and angiography. J Nucl Med 35:587-593, 1994.

20. Soler C, Beauchesne P, Maatougui K, et al. Technetium-99m sestamibi brain single-photon emission tomography for detection of recurrent gliomas after radiation therapy. Eur J Nucl Med 25:1649-1657, 1998.

21. Sallinen PK, et al. Prognostication of astrocytoma patient survival by Ki-67 (MIB-1), PCNA, and S-phase fraction using archival paraffin-embedded samples. J Pathol 174:275-282, 1994.

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23. Wakimoto H, Aoyagi M, Nakayama T, et al. Prognostic significance of Ki-67 labeling indices obtained using MIB-1 monoclonal antibody in patients with supratentorial astrocytomas. Cancer 77:373-380, 1996.

24. Yamamoto Y, Nishiyama Y, Toyama Y, et al. 99mTc-MIBI and 201Tl SPET in the detection of recurrent brain tumors after Radiation therapy. Nucl Med Commun 23:1183-1190, 2002.

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1. Andrews DW, Scott CB, Sperduto PW, et al. Whole brain

radiation therapy with or without radiosurgery boost for patients with one to three brain metastases; phase III results of the RTOG 95-08 randomised trial. Lancet 363: 1665-1672, 2004.

2. Curran WJ. Recursive partitioning analysis of prognos-tic factors in three radiation oncology group malignant glioma trials. J Nat Cancer Inst 5:704-710, 1993.

3. Duma C. Differentiation of GBM cells into a mobile phe-notype and the implication for leading edge radiosurgery. Proc 13th Internat Meeting, Leksell Gamma Knife Society, pp 11, Seoul 2006.

4. , . 1378, 5 . 2005 19291-2, . 4/ 100760.

5. Hsieh PC, Chandler JP, Bhangoo S, et al. Adjuvant Gamma Knife stereotactic radiosurgery at the time of tumor progression potentially improves survival for patients with glioblastoma multiforme. Neurosurgery 57:684-692, 2005.

6. Lorenzoni J, Devriendt D, Massager N, et al. Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys 60: 218-224, 2004.

7. Mehta MP, Tsao MN, Whelan TJ, et al. The American Society for Therapeutic Radiology and Oncology (AS-

SUMMARY

Gamma knife rariosurgery in Greece. Part 1 - Results of the technique in patients with malignant brain tumors

Torrens M., Chrissikopoulos C., Stergiou C., Lampropoulos K., Seferis C., Stroggilos C., mikos P.Department of Radiosurgery and Neurosurgery, Hygeia Hospital, Marousi

This paper records the technique and results of radiosurgical treatment of 115 patients over 2.5 years at the Gamma Knife Department of DTKA Hygeia. The techniques used are those established by international guidelines. The results conform to those previously reported in other centers. Salvage radiosurgery for ma-lignant glioma allows a 50% 2 year survival probability, compared with 20% for historical controls. Treatment of metastases provides 100% control of size at 3 months, 82% control at 6 months, 69% control at 9 months and 42% control at one year, even in cases where prior radiotherapy and chemotherapy have failed. Death in our series was not significantly related to progression of cerebral metastases.

Key words: gamma knife, melignant brain tumors

TRO) evidence based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys, 63: 37-46, 2005.

8. Muacevic A. surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary cerebral metastases of small diameter. J Neurosurg 91: 35-43, 1999.

9. N , , , . GAMMA KNIFE , 31 , , 2004.

10. Shaw E, Scott C, Souhami L, et al. Single dose radiosurgi-cal treatment of recurrent previously irradiated primary brain tumours and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47:291-98, 2000.

11. Tsao MN, Mehta MP, Whelan TJ, et al. The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence based review of the role of radiosurgery for malignant glioma. Int J Radiat Oncol Biol Phys 63:47-55, 2005.

12. Ulm AJ, Friedmann WA, Bradshaw P, et al. Radiosurgery in the treatment of malignant gliomas: The Florida ex-perience. Neurosurgery 57:512-517, 2005.

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CASE REPORT

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SUMMARY

Skull perforation by an arachnoid cyst. Case report and review of the literature

Miliaras G.1, Mihalenas N.1, Zikou A.2, Sarmas I.3, Karamanakos P.1, Polizoidis K.1

University General Hospital of Ioannina 1Neurosurgical Department, 2Department of Radiology, 3Neurological Department

We present the case of a patient with an arachnoid cyst and perforation of the skull. A 52 year old female presented with epileptic seizures. The imaging investigation revealed an arachnoid cyst in the parasagital frontoparietal region compressing the adjacent cortex, and perforating the skull above it. The patient was operated on by excision of the cyst through a craniotomy. The pathologic examination revealed no other tissue than the presence of an arachnoid membrane. In this article the incidence, the mechanisms of growth and indications of surgical treatment of intradiploic arachnoid cysts are reviewed.

Key words: Arachnoid cyst, intradiploic arachnoid cyst, seizure, skull perforation

1. Amirjamshidi A, Abbassioun K, Sadeghi Tary A. Growing

traumatic leptomeningeal cyst of the roof of the orbit with unilateral exophthalmos. Surg Neurol 54:178-181, 2000.

2. Branan R, Wilson CB. Arachnoid granulation simulating osteolytic lesions of the calvarium. AJR Am J Roentgenol 127: 523-5 1976.

3. Chan R, de Tilly LN, Bilbao J. Magnetic resonance appear-

ance of a giant cystic arachnoidal granulation presenting as an osteolytic parietal bone lesion: case report. Can Assoc Radiol J 50:126-9, 1999.

4. Chaundary RR, Woodrow PK, Pinck RL. CAT scan ap-pearance of arachnoid granulations: case report. Comput Radiol 8:25-7, 1984.

5. Gacek RR Arachnoid granulation cerebrospinal f luid

88 , . 14, 2, 2007

otorrhea. Ann Otol Rhinol Laryngol 99:854-62, 1990. 6. Gorqulu A, Albayrak BS. Giant intradiploic leptomenin-

geal cyst of the posterior fossa. Acta Neurochir (Wien) 148:923-4, 2006.

7. Hayashi Y, Futami K, Munemoto S, et al. Congenital arachnoid cyst mimicking meningocele. Pediatr Neurosurg 36:324-8, 2002.

8. Iplikcioqlu AC, Dinc C, Bikmaz K, et al. Non traumat-ic intradiploic arachnoid cyst. Acta Neurochir (Wien) 148:659-62, 2006.

9. Krupp W, Dohnert J, Kellermann S, et al. Intradiploic

arachnoid cyst with extensive deformation of craniofacial osseous structures: case report. Neurosurgery 44:868-70, 1999.

10. Nakada M, Hasegawa M, Sakuda K, et al. The cluster of arachnoid diverticula in the occipital bone: report of two cases with literature review. Acta Neurochir (Wien) 140:647-50, 1998.

11. Santamarta D, Morales F, Sierra JM, et al. Arachnoid cysts: entrapped collections of cerebrospinal fluid vari-ably communicating with the subarachnoid space. Minim Invasive Neurosurg 44:128-34, 2001.

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SUMMARY

Combined surgical treatment of aneurysmal bone cyst in the lumbar spine

Tsitsopoulos P.Ph.1, Anagnostopoulos I.1, Karakosta E.1, Xantzidis P.2, Tsitsopoulos Ph.11Department of Neurosurgery, Hippokrateio General Hospital, Aristotle Uviversity, Thessaloniki, Greece and

2Department of Orthopedic Surgery, Hippokrateio General Hospital, Thessaloniki, Greece

Aneurysmal bone cysts are benign vascular bone lesions characterized by the presence of multiple thin-walled cavities filled with blood. Children and young adults are affected more frequently. The treatment of aneurysmal bone cysts shows many peculiarities due to the potential of instability, pathological fractures and neurological impairment. A case of an aneurysmal bone cyst involving the L2 vertebra in a 17-year-old female is presented. This patient was treated successfully with complete removal of the lesion. A ventrolateral and posterior spinal fusion was performed at a later stage. The surgical management is analyzed and a review of the literature is carried out.

Key words: aneurismal bone cyst, fusion, lumbar spine, spinal column

1. Ameli NO, Abbassioum K, Saleh H, et al. Aneurysmal

bone cysts of the spine. Report of 17 cases. J Neurosurg 63:695-690, 1985.

2. Boriani S, De lure F, Campanacci L, et al. Aneurysmal bone cyst in the mobile spine: report of 41 cases. Spine 26:27-35, 2001.

3. Campanacci M, Cervellati C, Donati U, et al. Aneurysmal bone cyst (a study of 127 cases, 72 with long term follow-up). Ital J Orthop Traumatol 2:341-353, 1976.

4. Chan MS, Wong YC, Yuen MK, et al. Spinal aneurysmal bone cyst causing acute spinal cord compression without vertebral collapse: CT and MRI findings. Pediatr Radiol 32:601-604, 2002.

5. Codd P, Riesenburger R, Klimo P, et al. Vertebra plana due to an aneurysmal bone cyst of the lumbar spine. J Neurosurg (6 Suppl Pediatrics) 105:490-495, 2006.

6. Cottalorda J, Kohler R, De Gauzy S, et al. Epidemiology of aneurysmal bone cyst in children: a multicenter study and literature review. J Pediatr Orthop 13:389-394, 2004.

7. De Kleuver M, van der Heul RO, Veraart BE. Aneurysmal bone cyst of the spine: 31 cases and the importance of the surgical approach. J Pediatr Orthop 7:286-292, 1998.

8. Deo S, Fairback J, Wilson-Macdonald J, et al. Aneurysmal bone cyst as a rare cause of spinal cord compression in a young child. Spine 30:E80-E82, 2005.

9. Gupta VK, Gupta SK, Khosta VK, et al. Aneurysmal bone cysts of the spine. Surg Neurol 42:428-432, 1994.

10. Hay MC, Paterson D, Taylor TK. Aneurysmal bone cysts of the spine. Br J Bone Joint Surg 60:406-411, 1978.

11. Jaffe H, Lichtenstein L. Solitary unicameral bone cyst with emphasis on the roentgen picture, the pathologic appearance

and the pathogenesis. Arch Surg 44:1004-1025, 1942. 12. Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: con-

cept, controversy, clinical presentation, and imaging. AJR 164:573-580, 1995.

13. Liu K, Brockmeyer D, Dailey A, et al. Surgical management of aneurysmal bone cysts of the spine. Neurosurg Focus 15:1-5, 2003.

14. Mankin H, Hornicek F, Ortzi-Cruz E, et al. Aneurysmal bone cyst: A review of 150 patients. J Clin Oncol 23:6756-6762, 2005.

15. Mehdian H, Weatherley C. Combined anterior and pos-terior resection and spinal stabilization for aneurysmal bone cyst. Eur Spine J 4:123-125, 1995.

16. Ozaki T, Halm H, Hilmann A, et al. Aneurysmal bone cysts of the spine. Arch Orthop Trauma Surg 119:159-162, 1999.

17. Pang D, Tomita T, Byrd S, et al. A 14-year-old young woman with a five-year history of back pain. Pediatr Neurosurg 32:100-108, 2000.

18. Papagelopoulos PJ, Currier BL, Shaughnessy WJ, et al. Aneurysmal bone cyst of the spine. Management and outcome. Spine 23:621-628, 1998.

19. Ramirez AR, Stanton RP. Aneurysmal bone cyst in 29 children. J Pedatr Orthop 22:533-539, 2002.

20. Sciot R, Dorfman H, Brys P, et al. Cytogenetic-morphologic correlations in aneurysmal bone cyst, giant cell tumor of bone and combined lesions. A report from the CHAMP study group. Mod Pathol 13:1206-1210, 2000.

21. Turker RJ, Mardjetko S, Lubicky J. Aneurysmal bone cysts of the spine: excision and stabilization. J Pediatr Orthop 18:209-213,1998.

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CASE REPORT

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SUMMARY

Complete removal of a cauda equina lipoma with a modified surgical technique

Sakellaridis N., Savvanis G.KAT National Hospital, Attica, Greece

A 62 years old woman was operated for a cauda equina lipoma, causing progressive paraparesis. We have achieved its removal by using exclusively the ultrasonic aspirator and leaving only a thin lipoma tissue around each root. No new permanent postoperative neurological deficits were observed. Postoperative MRI has shown complete lipoma removal.

Key-words: cauda equina, lipoma, total removal

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