[Usually good prognosis in meningiomas].
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Female↗
Biomedical subjects
Eirik Helseth
Publications and source records attributed to Eirik Helseth.
Fluorescence in situ hybridization (FISH) on touch preparations: a reliable method for detecting loss of heterozygosity at 1p and 19q in oligodendroglial tumors.
Combined loss of heterozygosity (LOH) on 1p and 19q is reported in 50% to 90% of oligodendroglial tumors and has emerged as a strong and favorable prognostic factor. Fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) are the most widely used techniques. The aim of this study was to evaluate the reliability of FISH to predict LOH at 1p and 19q when performed on touch preparations from 40 oligodendroglial tumors, even if the majority of the nuclei showed chromosomal imbalance. PCR was used as the gold standard. The presence of none or one target signal was reported as FISH-LOH, whereas all other losses were defined as FISH-imbalance. The sum of nuclei with FISH-LOH and imbalance was calculated in each case (FISH-sum) and cut-off values were defined as the mean FISH-sum value in controls plus 3 standard deviations; 27.7% for 1p and 33.2% for 19q. These corresponded well with the optimal cut-off values for our data, calculated using the minimum error rate classification procedure (35.6% for 1p and 33.1% for 19q). Concurrent FISH and PCR results were encountered in 95% for 1p and 87.5% for 19q. FISH-sum was the best and simplest discriminating variable for correct classification of LOH status. Under these conditions, even a dominant population of nuclei showing FISH-imbalance represented an LOH status in the tumor cells. FISH on touch preparations is a quick and reliable method for 1p/19q testing, does not require normal DNA and can be easily performed in an immunohistochemistry unit.
Adult↗
[Chronic whiplash syndrome is no indication for craniocervical fixation].
Throughout many years, a large number of publications have focused on structural changes in soft tissues in the cervical spine in patients with whiplash associated disorders I-II. In recent years the development in MRI techniques have made it possible to visualize the small ligaments in the craniocervical junction; a small number of publications have investigated the association between signal changes in these ligaments and whiplash associated disorders I-II. The results are, however, not conclusive, and no prospective studies have demonstrated any causal connection between type of whiplash injury and signal changes in these ligaments. Craniocervical fixation is major surgery with a moderate level of perioperative complications. There is also a theoretical risk of increasing the degenerative process in the level below the fixation. The indications for craniocervical fixation are now serious conditions like instability caused by rheumatic arthritis, tumours and fractures. The scientific evidence for introducing a new indication for craniocervical fixation is lacking, and craniocervical fixation in WAD I-II must be considered experimental surgery.
Bone Screws↗
[Brain metastases in adults].
BACKGROUND AND METHODS: Brain metastases are far more common than primary central nervous system tumours. Based on our own clinical experiences and relevant literature published over the last decade (Medline), we present an overview of diagnosis and treatment. RESULTS: Brain metastases are caused by haematogenous spread from extracranial tumours, most frequently from cancers in the lung, breast, melanoma, renal carcinomas and colorectal carcinomas. Three out of four patients present with multiple brain metastases. Cerebral MR is the most sensitive investigation. The most important prognostic factors for survival are Karnofsky score, age < 65, well controlled primary cancer and absence of systemic cancer disease. INTERPRETATION: Some patients are offered neurosurgical treatment (surgery or gamma knife), depending on their clinical status, the number and location of brain metastases, and the histology and degree of systemic involvement of the primary tumour. The gamma knife is the treatment of choice with multiple and solitary tumours smaller than 3 cm that lie deep within the brain or within eloquent areas, whereas surgery is the treatment of choice with solitary metastases larger than 3-3.5 cm that are surgically accessible and cause significant mass effects. Solitary lesions without significant mass effect can be treated with either technique, as their documented efficacies are similar. However, the gamma knife is often preferred since this method is rapid, less invasive, has low morbidity and shortens the hospital stay.
Adult↗
[Intracranial tumors in children].
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Brain Neoplasms↗
[Intracranial tumors in adults].
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Adult↗
[Treatment of hydrocephalus with endoscopic third ventriculocisternostomy].
BACKGROUND: Endoscopic third ventriculocisternostomy has gained widespread use in the treatment of hydrocephalus. MATERIALS AND METHODS: In 1999 and 2000 endoscopic third ventriculostomy was performed in 120 patients (60 males) at Rikshospitalet, Oslo, Norway. Median age was 3.3 years (range 0.0 to 71.7). 69 procedures were done as primary treatment of hydrocephalus and 51 procedures for shunt failure. RESULTS: After one year, 62% of the patients older than 6 months at time of treatment and 8% of the patients younger than 6 months were successfully treated for their hydrocephalus with ventriculostomy only. The success rate for patients with hydrocephalus secondary to aqueductal stenosis or a space-occupying lesion in the posterior fossa was 72% and 31% for patients with other causes of hydrocephalus. The success rate of endoscopic third ventriculostomy as primary treatment of hydrocephalus was 55%; for the procedure at time of shunt failure 45%. The overall likelihood of success was significantly correlated to age, cause of hydrocephalus, and whether the procedure was done as primary treatment of hydrocephalus or at time of shunt failure. INTERPRETATION: Endoscopic third ventriculostomy seems to be effective in treating hydrocephalus caused by aqueductal stenosis or a space-occupying lesion in the posterior fossa in patients older than 6 months. The procedure should not be routinely attempted on patients younger than 6 months.
Adolescent↗
[Occult spinal dysraphism].
BACKGROUND: Spinal dysraphism is a group of congenital anomalies of the spine characterized by a midline defect affecting the nervous tissue and its bony and soft tissue coverings. Closed spinal dysraphism, spina bifida occulta, refers to skin-covered lesions. However, there are a number of cutaneous stigmata or other physical signs that serve as indicators of an underlying dysraphic malformation of the lower spinal canal. MATERIAL AND METHODS: Based upon relevant literature, we present a review of occult spina bifida. RESULTS AND INTERPRETATION: The cutaneous stigmata that may indicate an underlying dysraphism are particularly hairy patches, subcutaneous lipomas, capillary hemangiomas, dorsal dermal sinuses and sacral cutaneous pits. The clinical examination of a child with lumbosacral cutaneous stigmata should focus on neurological signs and symptoms, urological disturbances and orthopaedic deformities in the lower limbs. Spinal MRI is the imaging modality of choice in children presenting with features consistent with occult spinal dysraphism. Children with occult spinal dysraphism should be referred to a neurosurgical unit.
Child↗
Differences in quantitative characteristics of intracranial pressure in hydrocephalic children treated surgically or conservatively.
This study reports the results of quantitative analysis of continuous intracranial pressure (ICP) recordings in 33 hydrocephalic children. The aim of the study was to compare the exact numbers of increases in ICP during sleep or the awake state in hydrocephalic children who were treated either surgically or conservatively. At the time of ICP monitoring, the ICP curves were assessed by the calculation of mean ICP and visual inspection for the detection of plateau waves. Quantitative analysis was performed with the software Sensometrics Pressure Analyser, which presented the ICP curve as a matrix of numbers of ICP elevations of different levels (20-40 mm Hg) and durations (0.5-20 min). In each case, the numbers of ICP elevations were standardized to 10 h of recording time, providing the opportunity for comparisons of ICP curves between individuals. Compared to the surgery group, there was a rather high number of ICP elevations of 20 mm Hg of various durations in the nonsurgery group, e.g. ICP elevations of 20 mm Hg lasting 10 min occurred in 13 of 19 children (68%) in the nonsurgery group. There was no apparent relationship between ICP and age or between the size of the cerebral ventricles and ICP. In children with hydrocephalus, the presentation of the ICP data as a matrix of ICP elevations of different levels and durations may enhance the informative value of continuous ICP monitoring, as compared to the calculation of mean ICP and visual detection of plateau waves.
Adolescent↗
Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0-19 years): report of 110 consecutive cases.
UNLABELLED: The objective of this retrospective study was to present long-term follow-up data for 110 consecutive children and young adults treated for a benign cerebellar astrocytoma at our institution between 1960 and 2001. Mean age at presentation was 8.9 years. The total surgical mortality was 9%, but declined from 16% in 1960-1977 to 0% in 1988-2001. At the close of the study 97/110 patients were still alive. Nine deaths were surgery related, 2 patients died of shunt-related causes and 2 patients died due to tumor recurrence. Five-, 10- and 25-year survival were 90, 89 and 85%, respectively. Multiple Cox regression analysis showed that tumor infiltration of the brain stem and the time period of surgery were the only explanatory variables significantly associated with survival. Five-year survival improved from 79% in the time period of 1960-1977 to 100% in the time period of 1988-2001. Tumor recurrence after total tumor resection was observed in 5 of 76 (7%) evaluable patients. Growth of residual tumor after subtotal tumor resection was observed in 7 of 26 (27%) evaluable patients. Recent followup MR revealed regression of residual tumor in 14 of 16 patients. Only 5 of these patients had received radiotherapy. Thus, spontaneous regression of residual tumor is a more frequent event than growth of residual tumor. The functional outcome was favorable in 82% of the patients [Karnofsky performance index (KPI) > or = 90]. Eighteen percent of the patients had moderate to severe disabilities (KPI 50-80). CONCLUSIONS: Benign cerebellar astrocytoma is a surgical disease where the prognosis with respect to both survival and functional outcome is favorable. Spontaneous regression of residual tumor is frequently encountered, allowing for observation of residual tumors instead of performing a second resection in cases where a second resection carries a high risk of neurological sequelae.
Adolescent↗
Assessment of continuous intracranial pressure recordings in childhood craniosynostosis.
In this study, we explored two strategies of assessing continuous intracranial pressure (ICP) recordings in children with craniosynostosis, namely either by computation of the mean ICP or by computation of the accurate numbers of ICP elevations of different durations. The ICP recordings of 121 consecutive patients with a tentative diagnosis of craniosynostosis who underwent continuous ICP monitoring were examined. The relationship between mean ICP and numbers of ICP elevations was defined. The distribution of numbers of ICP elevations between patients either undergoing surgery or conservative treatment was also compared, since the choice of treatment was heavily dependent on the results of ICP monitoring. At the time of ICP monitoring, calculation of mean ICP was the main parameter for assessment of ICP curves. After a median observation period of 16 months, the ICP curves were reexamined by means of the software Sensometrics Pressure Analyser, which presents the ICP curve as a matrix of numbers of ICP elevations of different levels (20-40 mm Hg) and durations (0.5- 20 min). Since the recording period differed between the cases, the numbers were standardized to a given recording time of 10 h, to allow for comparisons between patients. Cases with a borderline mean ICP during sleep (mean ICP 10-15 mm Hg) constituted 40.5% of the 121 patients. In this group, a rather weak relationship between mean ICP and the number of ICP elevations above 20 mm Hg was found, as well as a relatively high number of ICP elevations above 20 mm Hg of various durations. As compared to the patients undergoing surgery, a rather high number of ICP elevations above 20 mm Hg of various durations was found in patients undergoing conservative treatment. The study confirmed our hypothesis that in children with craniosynostosis, calculation of mean ICP does not describe the ICP curve in a reliable way. Decision-making should also include the computation of the distribution of numbers of ICP elevations, since this procedure represents a more sensitive strategy of detecting intracranial hypertension.
Child↗
Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood.
UNLABELLED: Traditionally, the cerebral hemispheres have been regarded as the region of the brain responsible for cognitive functions, while the cerebellum has been considered to be primarily involved in motor functions. Recent studies focus also on the possible involvement of the cerebellum in neurocognitive functions. The aim of this study was to determine the neuropsychological profile of young adults treated for a posterior fossa tumor in childhood and look for possible support for the presence of the so-called 'cerebellar cognitive affective syndrome' in these patients. Two groups of young adults were studied. The astrocytoma group (n = 12) had been treated for a low-grade cerebellar astrocytoma with surgery alone (mean age at surgery was 8.6 years and mean age at neuropsychological testing was 23.5 years). The medulloblastoma group (n = 11) had been treated with surgery followed by radiotherapy and chemotherapy (mean age at surgery was 6.1 years and mean age at neuropsychological testing was 23.1 years). The neuropsychological test battery comprised measures of intelligence, motor function, attention, psychomotor speed, verbal memory and visual memory. The medulloblastoma group performed poorer than the astocytoma group on all neuropsychological measures except one. Nonetheless, the astrocytoma group also had impaired scores compared with standard norms on measures of motor speed, attention and executive function. No significant correlation between age at time of treatment and grade of neuropsychological impairment was found in the astrocytoma group, though there was a tendency that young age at time of treatment correlated with better outcome on IQ measures. In the medulloblastoma group, age was significantly correlated with outcome, for both IQ and degree of neuropsychological impairment. For this group, young age at time of treatment indicated a worse outcome. CONCLUSIONS: Persistent cognitive dysfunction was detected in patients treated for posterior fossa medulloblastoma and cerebellar astrocytoma. The astrocytoma group was treated with surgery alone, indicating that a cerebellar lesion can result in cognitive dysfunction. Thus, this study gives support to the existence of the cerebellar cognitive affective syndrome. Follow-up of all patients treated for posterior fossa tumor in childhood should include an extensive neuropsychological testing at regular intervals. This may be of benefit for school planning and later work planning.
Adolescent↗