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Biomedical subjects

R Mastrostefano

Publications and source records attributed to R Mastrostefano.

18 recordsLinked to original sources
PubMed1997

[Intracranial meningiomas in the elderly].

BACKGROUND: Since the introduction of CT and then MRI in the clinical practice, the number of elderly patients with intracranial meningiomas observed in neurosurgical departments has increased to three/four times. Considering that some patients die because of their meningioma and others die with their meningioma, the neurosurgeon should not only be able to eradicate surgically the lesion, but also to decide if that benign tumor should be treated or not. MATERIALS AND METHODS: Forty-three patients with intracranial meningioma, aged over 65 were operated upon between 1989 and 1995. They constitute about one fourth of all the meningioma-patients operated upon in that period at our Department. Main symptoms were focal deficits, psychorganic syndrome, and seizures. Mean duration of symptoms was 15 months, with 30% of the histories lasting less than 3 months. Associate pathologies were those typical of the elderly population with hypertension and senile cardiopathy at the first places. Two patients had insulin-dependent diabetes, 2 prostatic carcinoma, and 8 were obese. MRI was useful either in depicting the location of the tumor or in helping the surgeon to give a correct operative indication and risk evaluation. MRI criteria for risk evaluation were severe edema and venous vascular infiltration. Forty-five operations were performed. Their duration was not a risk factor by itself, it only reflected the difficulty of the removal, due to the location of the tumor. Dissection of tumor remnants from main arteries or veins was never attempted in this group of patients; total removal was achieved in 75.5% of the cases. RESULTS: Immediate postoperative results were good in 71% of cases. Four patients died (9%). Long term results were evaluated in 29 patients (mean follow-up period: 35 months). Twenty-two patients (76%) had excellent or good results, 5 (17%) fair, and 2 (7%) had severe neurological dysfunctions and needed continuous assistance. CONCLUSIONS: Surgical risk factors typical of this age group were identified: cranio-spinal location, damage to the cortical or deep venous system, severe peritumoral edema, and poor neurological preoperative conditions. Systemic risk factors were insulin-dependent diabetes and obesity.

Age Factors↗
PubMed1995

Clinical relevance of 111In-octreotide scans in CNS tumors.

Sixty-six patients with a clinical and neuroradiological diagnosis of CNS tumors were evaluated by 111In-octreotide scintigraphy. Planar images were acquired at 2-4 and 24 hours after the injection of 111-185 MBq of 111In-octreotide (Octreoscan, Byk-Gulden). In the positive scans the tumor/non-tumor ratio was evaluated using a standard ROI method, and an uptake index (U.I.) of the lesion was determined. In vitro binding assays were performed on frozen sections from surgical specimens from 17 patients. All 32 meningiomas demonstrated a positive 111In-octreotide scan with a high U.I. Only 13 of 21 gliomas showed a positive scan, but the U.I. was significantly lower (p < 0.001 by "t"-test); one lymphoma showed a faint tracer uptake. All the other histotypes evaluated yielded negative scans. In all cases the receptorial pattern shown by the immunohistochemical staining technique was concordant with the scintigraphic results. 111In-octreotide scintigraphy allowed a differential diagnosis of meningioma versus other CNS tumors in 6 patients (4 neurinomas, 1 brain metastasis of melanoma, 1 lymphoma). In conclusion, 111In-octreotide scintigraphy is a promising tool to evaluate the SS receptorial pattern of CNS tumors and to increase the diagnostic specificity of conventional imaging providing useful information in selected cases for the therapeutic strategy.

Brain Neoplasms↗
PubMed1993

The transdural extension of gliomas.

The extraneural spreading of gliomas is an infrequent occurrence which is not necessarily related to either tumor histology or site. This paper reports two cases, a glioblastoma and an oligodendroglioma, both presenting extradural diffusion. In the first case, where there was severe intracranial hypertension, the tumor found its way out from the neurocranium, far from the site of the operation, perforating the dura and the bone of the cranial base. In the second case, the operation may have facilitated the extraneural invasion. This unusual behaviour of glial tumors is probably less rare than presumed. It may go unnoticed if the attention is concentrated on the usually severe neurological syndrome which is present in these patients.

Adult↗
PubMed1990

Mucocele of neurosurgical interest: clinical considerations on five cases.

The authors present five patients with mucocele, submitted to neurosurgery. Two had mucoceles spreading from the frontal and/or the anterior ethmoidal sinuses and had only compressive mass symptoms, either on the ocular globe or on the frontal lobe or on both. Three patients had mucoceles growing from the sphenoid and/or posterior ethmoidal sinuses. In these latter, the mass symptoms were less evident. All the patients suffered excruciating retro-ocular pain and two presented cranial nerve damage. The correct diagnosis in these cases is crucial to avoid a too aggressive treatment since these patients are generally sent to a neurosurgeon for a suspected cranial base malignancy or an invasive pituitary adenoma. The principles of a correct differential diagnosis and of operative treatment are outlined based on an analysis of the literature and the authors experience.

Adult↗
PubMed1987

CT iopamidol cisternographic diagnosis of coexisting partial empty sella and pituitary adenoma. Report of two cases.

In the last 3 years 86 patients were referred for suspected primary intrasellar pathology. Two of them had coexisting pituitary adenoma and partial empty sella. This situation has been diagnosed pre-operatively thanks to CT Iopamidol cisternography. The pre-operative diagnosis of this common anatomic condition allows safer operations, preventing intra-operative CSF fistulas.

Adenoma↗
PubMed1987

Multiple sclerosis plaque simulating cerebral tumor: case report and review of the literature.

Multiple sclerosis rarely may present as a focal cerebral mass with clinical features and computed tomographic scan appearances of cerebral tumor. Distinguishing between these can be difficult or impossible. We report a case of a multiple sclerosis plaque involving the parietal lobe with mass effect; clinical and radiological features had led to a diagnosis of cerebral tumor.

Adult↗
PubMed1985

[Primary empty sella. Clinico-radiologic considerations in 18 cases].

18 patients with "primary empty sella" were reviewed for this study. In 3 of them the sellar enlargement was discovered occasionally by performing skull radiographs for other reasons. The galattorrhea-dismenorrhea or amenorrhea syndrome and obesity were the most common clinical features. Endocrinological tests were normal in ten patients and abnormal in eight. Slight elevation of serum PRL was the most common record. 12 patients had enlarging of the sella turcica; in 4, only the floor was asymmetric and in 2 the sella was quite normal. In 5 patients C.T. without intra-thecal contrast was sufficient to discover the E.S. In 13 patients we performed C.T. cysternography by injecting in the lumbar subarachnoid space 8-10 ml of Iopamidolo 200. This is an excellent and safe technique to perform C.T. cysternography.

Adolescent↗
PubMed1981

Spinal chordomas in infancy. Report of a case and analysis of the literature.

Chordomas are extremely rare among the spinal tumors in pediatric age. The sacrococcygeal region is the typical site of such a lesion. A case of spinal chordoma in a child 4 years old, at the T12-L1 level, is reported. The tumor was surgically removed and a local radiotherapy was performed, but 9 months later spreading of lung metastases was observed. The unusual site along the vertebral column and the metastatic potential of this tumor are discussed. The very few cases reported in the literature were analyzed.

Child, Preschool↗
PubMedDate not supplied

The role of immunocytochemical assays in the diagnosis of stereotactic biopsies from intracranial tumors.

A selected panel of monoclonal antibodies (MoAbs) directed to distinct tumor associated antigens (TAA) has been tested to define the capability of these reagents to differentiate among metastatic carcinoma, lymphoma and primary brain tumor on cytologic specimens obtained with stereotactic techniques. Results obtained on 50 patients bearing either single or multiple brain lesions demonstrated that immunocytochemical (ICC) methods can distinguish between primary brain tumor and brain metastasis suggesting, in 90% of patients with cryptic primary neoplasia, the site of origin of the tumor.

Antibodies, Monoclonal↗
PubMedDate not supplied

Lonidamine in the combined treatment of malignant gliomas. A randomized study.

Lonidamine (LND) is a drug that interferes with energy metabolism of cancer cells, principally inhibiting aerobic glycolytic activity, by its effect on mitochondrially-bound hexokinase (HK). In such way LND could impair energy-requiring processes, as recovery from potentially lethal damage, induced by radiation treatment and by some cytotoxic drugs. A randomized study started in November 1983, to evaluate the efficacy of LND in association with radiotherapy as first line treatment in malignant gliomas, after surgical procedure. LND was also used in association with Lomustine (CCNU) at the moment of documented clinical and neuroradiological recurrence. At the present time 60 patients entered the study, and 47 are evaluable. Present preliminary results are not statistically significant, however indicate that LND tends to prolong the median survival time and the rate of one year survivors.

Adult↗
PubMedDate not supplied

Cystic appearance of meningiomas: considerations on a series of 12 patients.

Twelve patients affected with meningiomas with a fluid component are reviewed. Six presented with intratumoral cysts and 6 with extratumoral fluid collections that in 3 cases were of clear CSF. The formation mechanism of the two types are quite different. Intratumoral cysts are caused by biological changes within the tumor, while the extratumoral ones appear to be secondary to local hydrodynamic changes and CSF reabsorption disturbances. The CT (computerized tomography) scan may be equivocal either for the diagnosis of the meningioma or, once the meningioma is suspected, for identifying the type of cyst involved. The angiography is useful for a correct preoperative diagnosis that, once suspected, can be frequently made.

Adult↗
PubMedDate not supplied

Methodology of stereotactic biopsy.

The great technological improvement in the neurosurgical tools and in the neuroradiological imaging has brought about the diffusion of the stereotactic techniques. They are crucial for the diagnosis and treatment of intracranial expanding lesions of small dimensions or located in sites inaccessible to conventional techniques. The Authors describe the most common systems and methodologies for the stereotactic biopsy. They stress the importance of performing serial explorations which can provide evidence of the heterogeneity of the neoplastic lesion and of the infiltration of the brain adjacent to the tumor.

Biopsy↗
PubMedDate not supplied

Bilateral temporal lobectomy for late radionecrosis after radiotherapy for acromegaly. A case report.

A patient with right temporal radionecrosis was submitted to temporal lobectomy for acute intracranial hypertension developed two years after radiotherapy for a GH-secreting pituitary adenoma. Eight months later, a partial left temporal lobectomy was performed because of further radionecrosis. In both instances the cerebral radionecrosis had the clinical and radiological characteristics of a space-occupying lesion. Bilateral temporal lobectomy was followed by a particular psycho-neurological syndrome with bilateral cortical deafness.

Acromegaly↗
PubMedDate not supplied

Acute intracranial hypertension syndrome due to ketamine in a patient with delayed radionecrosis simulating an expansive process.

Reported is the case of a delayed cerebral necrosis in a patient with an eosinophil pituitary adenoma who had undergone radiation therapy. Neuroradiological tests were performed in order to verify the possible existence of a lateral sellar extension of the neoplasm. The administration of ketamine before this examination, presumably caused the onset of an acute temporal syndrome. Surgery was performed without delay, and a delayed cerebral necrosis of the right temporal lobe was found.

Acute Disease↗