International Journal of Neurology and Neurosurgery

Aim: To analyze the clinical profile, radiological and pathological findings and factors influencing outcome in thalamic gliomas. Materials and methods: A retrospective analysis of the case records of 39 patients with thalamic glioma, operated since Jan 2000 over a period of six years. Variables analysed include: age, sex, surgical procedures, and histology. Results: The study group included 24 males and 15 females. Raised intracranial pressure was the commonest mode of presentation in 29 (74%) patients followed by hemiparesis, visual deficit and dysphasia. Radiological features varied with the grade of the gliomas and four patients were found to have bilateral thalamic involvement. A radical decompression was attempted in 14 patients while the rest underwent a less radical surgery or biopsy of the tumor. 23 (59%) of the tumors were categorized as high-grade gliomas, and 16 (41%) as low grade. All patients received radiotherapy postoperatively. Of the 32 patients available for follow up, tumor progression/recurrence was observed in all of the high grade and five (12.8%) of the low-grade neoplasms. At the time of last follow up 69.6 % of the patients who underwent decompressive surgery had a good outcome compared to only 37.5 % of those who underwent biopsy. Conclusion: Age and sex did not influence outcome in our study. Patients with thalamic
gliomas who underwent radical cytoreductive surgery followed by adjuvant radiotherapy had a prolonged median survival with acceptable morbidity. High-grade tumors carry a dismal prognosis whatever be the radicality of tumor decompression.. 

Key words: Thalamus, gliomas, Magnetic resonance imaging

We present a case of a primary leptomingeal fibrosarcoma in a patient, who had previously undergone radical resection of a liposarcoma of the chest and abdominal wall 18 years prior. In the year following resection of his intracranial fibrosarcoma and treatment with adjuvant radiotherapy, the patient was diagnosed with an in-situ recurrence of his original chest and abdominal wall liposarcoma. Primary intracranial fibrosarcomas are rare, particularly in the setting of a previous metachronous systemic sarcoma. Moreover this case is of particular interest since the patient was being treated for diabetes with agents that inhibit peroxisome proliferator-activated receptors (PPARs) and recent reports have suggested a potential relationship between these nuclear receptors and the development of fibrosarcomas and liposarcomas. With reference to the current case report, we briefly review the current guidelines for the management of intracranial fibrosarcoma and discuss the postulated relationship between PPAR agonists and sarcomas.  

Key words: Primary intracranial fibrosarcoma, liposarcoma, PPAR, thiazolidinedione.  

Primary plasmacytomas are rare and not many cases have been reported in literature. These are characterized by solitary bony lesions, neoplastic plasma cells, less than 5 % plasma cells in the bone marrow, less than 2.0gm/dL monoclonal protein in serum and a negative Bence Jones test for urine. These primary plasmacytomas involving the skull base are rare, as compared to surface bones of the skull and only 4-5 cases have been reported. We report a primary plasmacytoma involving the skull base producing lower cranial nerve deficit and trigeminal neuralgia.

Keywords: plasmacytoma, primary, skull base, neuralgia. 

Neurosurgeons have to perform fine and accurate procedures in microneurosurgery. If supporting places for their hands and arms are prepared adequately, it is possible to stabilize their hands and arms and then to reduce their tremor. To answer to this request, freely movable armrest (FMA) which can follow operator’s arm motion has been developed. Although some FMAs have been already commercially available, the FMA has not widely been used yet. We have made an original FMA and investigated the system with basic examinations. The efficacy and the limitation of the system were discussed. Materials and methods: A FMA, consisted of an arm holder, a flexible holding arm and a stand, was made. It can be freely moved and follow the operator’s motion. With a task of stitching an incised vessel model, effect of the FMA was evaluated for three factors: 1) performance time to complete 10-stitch suturing, 2) subjective fatigue and 3) subjective maneuverability. Subjective evaluations were scored in 1-10 scale (1: the least fatigue and the worst to perform, 10: the most fatigue and the best to perform). Results: The simulated surgery was successfully performed without technical and mechanical errors. Mean performance time with the FMA (790.8 seconds) was significantly shorter than that without the FMA (P=0.038). Mean fatigue score with the FMA (4.33) was smaller than that with the FMA (6.17), and mean maneuverability score with the FMA (6.33) was larger than that without the FMA (4.00). Conclusions: Installing a freely movable armrest, which can follow the operator’s motion, into microneurosurgery has a possibility to reduce operator’s fatigue and to improve maneuverability.

Key words: Freely movable armrest, microneurosurgery operator’s fatigue