Critical reviews in neurosurgery : CR最新文献

The primitive neuroectodermal tumors (PNETs) of Hart and Earle constitute an important fraction of pediatric brain tumors that are clinically characterized by their aggressive behavior. In 1983, Rorke expanded the term "PNET" to include all small cell embryonal neoplasms of neuroectodermal origin, regardless of the location of the tumor. More recently, Dehner also proposed the terms "central" and "peripheral" PNETs, and the provocative concept of "PNET" has now come to encompass a diverse group of tumors in both the central and peripheral nervous systems. The acronym "PNET" has thus become a confusing and controversial term in the diagnosis and classification of pediatric embryonal tumors. We reviewed ten papers concerning the various aspects of PNETs.

Seven recent papers are reviewed for outcomes following epilepsy surgery. The criteria of outcome assessment are analyzed and compared. All studies agree in indicating that the combination of the classic evaluation of seizure frequency with that of quality of life is required for a comprehensive view of the surgical outcome. However, the assessment modalities and outcome scales proposed present relevant differences. The need for standardization is apparent. A surgical outcome scoring system using multiple measures is recommended. The outcome evaluation should be performed not sooner than 2 years after surgery. The most relevant of the many variables of the outcome should be selected in such a way as to permit assessment of the epileptological response to surgery as well as the changes in the quality of life.

Guglielmi detachable coils (GDCs) provide an endovascular means for aneurysm treatment; however, their role has yet to be defined. This article reviews the most recent clinical series regarding efficacy, safety, and clinical outcomes in both the acute and nonacute setting. Successful treatment was possible in the majority of cases and included cases of complete aneurysm obliteration and with only a small neck remnant. Patients with a neck remnant often received additional treatments although some patients went on to complete obliteration without further treatment. Successful treatment provided protection from rebleeding in a follow-up period of 2 years. Success depended on operator experience as well as width of the aneurysm ostium. Recurrence and incomplete obliteration were more common with giant or large aneurysms and aneurysms with a wide base. Major procedure-related complications predominantly resulted from intraprocedural rupture and thromboembolic events. These could both be treated via endovascular means at the time of the procedure. Thromboembolic events occurred more frequently with acutely ruptured aneurysms, especially aneurysms with a wide base. Vasospasm rates were not found to vary significantly from those found in surgical series when corrected for Fisher grouping. Morbidity and mortality rates as well as Glasgow outcome scores were at least as good as what would be expected from surgery during both the acute and nonacute setting. The papers reviewed indicate that the GDC provides safe and efficacious treatment for most berry aneurysms in both the acute and nonacute setting relative to surgical results.

The p53 tumor supressor gene is the most frequently mutated gene in human cancers. Approximately 40% of astrocytic tumors have alterations of the p53 gene, which are considered to play an important role in tumorigenicity and malignant progression. Since the main functions of normal p53 are cell-cycle regulation and induction of apoptosis, p53 mutations are considered to be associated with rapid tumor growth and resistance to radiation and chemotherapy. Although in certain cancers, p53 mutations are considered a poor prognostic factor, the predictive role in astrocytic tumors is not clear. Immunohistochemical studies have shown conflicting results, probably because this technique fails to provide a reliable p53 gene status. Mutation analyses have shown the association between p53 mutations and shorter survival of high-grade gliomas only in pediatric patients, but not in adults. This may suggest that p53 mutations have a relatively lower impact on the survival of malignant astrocytomas than other gene alterations, which pediatric tumors rarely harbor.

The different interventional neuroradiological procedures are continually developing. New fields such as fibrinolytic therapy or intracranial stent treatment of vascular stenosis have become the object of interest. The analysis of the results of intravascular procedures has become more refined, with a critical evaluation of the quality of results and complication rates. A more solid scientific evaluation of these procedures is taking the place of the intial enthusiasm, offering a better basis for patient selection for neuroradiological procedures. In this analysis we present papers dealing with complications, analysis and treatment; results (follow-up of giant aneurysms treatment); use of stent in the internal carotid artery territory; and intra-arterial thrombolytic therapy (results and patient selection).