Stereotactic brain biopsies in presenile dementia

Early detection and precise diagnosis of presenile dementias are important since they determine subsequent medical care. Presently the only way to classify these syndromes is by neuropathological examination. Between 1972 and 1987, 222 stereotactic serial brain biopsies were performed in 25 selected demented patients. Comparison between preoperative clinical diagnosis and histological finding gives the following results: in 32% the clinical diagnosis has been confirmed, in 60% the diagnosis has been corrected or specified and in 8% the stereotactic brain biopsies only showed unspecific pathological gliosis.     

CT-guided stereotactic surgery for evacuation of hypertensive intracerebral hematoma

During the last 3 years, 46 cases of hypertensive intracerebral hemorrhage were treated by CT-guided stereotactic surgery. Our present report is concerned with the evaluation of this procedure in the treatment of hypertensive intracerebral hematoma, in terms of the rate of aspirated hematoma and follow-up study of patients. It is difficult to draw any definite conclusion about the operative indications. CT-guided stereotactic aspiration, however, can be evaluated as a less invasive and more definitive treatment of intracerebral hematoma in the basal ganglia and thalamus.     

New diagnostic and therapeutic tools in stereotaxy

A definitive pathoanatomic diagnosis was achieved in 14 biopsies of deep cerebral tumors in which the Laitinen CT adapter was utilized. In 5 patients, a third-ventricular colloid cyst was aspirated or resected by stereotactic endoscopy, with excellent results after a mean follow-up time of 2.5 years. Several instruments, including a diagnostic ultrasound probe, an ultrasonic aspirator, a combination laser and an endoscope can be used stereotactically when mounted on a special instrument carrier. Integration of the Laitinen stereotactic device and the CT adapter was developed to allow noninvasive stereotactic radiotherapy in a conventional fractionation schedule by a standard linear accelerator. Technical experiences using this radiosurgical system in over 30 sessions for treating inoperable cerebral arteriovenous malformations are promising, but the follow-up time is too short for evaluating the clinical effect.     

Experience using two CT-guided stereotactic biopsy methods

15 patients had intracranial CT-guided stereotactic biopsies. Biopsies were performed either with a Riechert-Mundinger stereotactic frame modified for use in the CT or by using the CT scan to establish the relationship of the intracranial lesion to identifiable bony landmarks, and subsequently performing the biopsy in a standard stereotactic frame. Both systems provided safe and accurate methods for obtaining intracranial tissue.     

牛脊柱畸形综合征检测方法的建立与应用

牛脊柱畸形综合征(Complex vertebral malformation, CVM)是近年来新发现的致死性牛常染色体隐性遗传缺陷病。由于编码UDP-N-乙酰葡糖胺载体的SLC35A3基因发生G→T的突变而引起本病的发生, 可引起胎牛死胎、流产、早产。为了解我国正常的荷斯坦牛(黑白花奶牛)的CVM携带和发生情况, 建立、应用创造酶切位点PCR(Created restriction site PCR, CRS-PCR)、等位基因特异性PCR(Allele-specific polymerase chain reaction, AS-PCR)检测方法检测了表型正常的436头荷斯坦母牛和93头荷斯坦公牛, 检测到3头CVM携带者, 其中杂合母牛1头, 杂合公牛2头, 携带率分别为0.60%、2.20%。此方法简便、可靠, 为奶牛CVM有害基因的分型和筛选提供了新的方法和思路, 为我国奶牛的分子选育提供了可靠的理论依据。     

Stereotactic CT scanning for the biopsy of intracranial lesions and functional neurosurgery

This report describes a system for incorporation of stereotactic CT scanning data, stereotactic arteriographic data and a computer-generated stereotactic atlas into a three-dimensional matrix utilizing an operating room computer. 86 patients have undergone computer-assisted stereotactic biopsies of intracranial lesions without mortality or neurologic morbidity. Neuroablative and neuroaugmentative procedures have been performed on 5 patients using the CT stereotactic atlas with good correlation with target points determined by ventriculography and microelectrode recording.     

High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients

OBJECTIVE: To investigate the diagnostic accuracy and current role of intraoperative cytologic smears of central nervous system tumors. STUDY DESIGN: Retrospective analysis of 4,172 patients operated on during 1985-1999, with 3,541 intraoperative smears performed during open procedures and 631 during stereotactic biopsies. RESULTS: Complete correlation with the final diagnosis was achieved in a mean of 89.8% (range, 83-93.7% per year). Diagnostic accuracy increased to 95% on average (range, 91.5-96.7% per year) when cases of partial correlation, mainly due to grading deviations, were included. The most accurate intraoperative diagnoses were obtained in cases of meningioma (97.9%), metastasis (96.3%) and glioblastoma (95.7%). A significant reduction in diagnostic accuracy was observed in cases of oligodendroglioma (80.9%) and ependymoma (77.7%). Besides diagnosis and grading, smear cytology provided resection guidance in cases of well-delineated tumors. CONCLUSION: Intraoperative smears in neurosurgery are easy to obtain and inexpensive and have high diagnostic accuracy. In addition to stereotactic biopsy procedures, intraoperative smears permit reliable intraoperative guidance during lesion targeting and resection.     

Accuracy of cytologic diagnosis of central nervous system neoplasms in sterotactic biopsies

The cytohistologic correlation is reported for 112 of the 128 consecutive sterotactic aspiration biopsies performed on patients with clinical and neuroradiologic evidence of brain tumors investigated at the Neurosurgery Department, Karolinska Hospital, from 1976 to 1979. The cytodiagnostic accuracy of benign and malignant tumors was 87% when adequate cell material was obtained. In 17 benign tumors of the sellar region, the diagnostic rate was 88%; cytologic examination independent of histologic biopsy is feasible in this area. The cytodiagnostic accuracy for 95 malignant central nervous system (CNS) tumors was 87% after adjusting for the appreciable sampling error inherent in the use of a stereotactic procedure during the early phase of the study. Two histopathologically proven infectious lesions were reported cytologically as benign. The main microscopic problems were the recognition of highly differentiated astroglial neoplasms and the differential diagnosis between poorly differentiated brain neoplasms and metastases to the CNS. Cytodiagnostic accuracy of CNS tumors can be increased by technical improvements in the stereotactic device, diagnostic experience and immunochemical staining.     

Thalamic abscess: a stereotactically treatable lesion

A 69-year-old man developed abdominal pain, fever, shaking chills and acute hemiplegia. Computed tomography (CT) scanning demonstrated a hematoma within a thalamic space-occupying lesion having the radiological characteristics of a malignant glioma. Low-grade fever and leukocytosis persisted and follow-up CT scanning showed ring enhancement of the thalamic lesion and ependymitis suggesting a cerebral abscess. Stereotactic aspiration achieved drainage of the abscess and relief of mass effect and provided pus from which a causative organism was identified and treated with appropriate antibiotics. Contrast-enhanced CT scan should be obtained in cases of hemorrhage within mass lesions and tissue diagnosis should be achieved even in deep brain regions, as this can be accomplished safely using stereotactic techniques.     

Cytopathology of the central nervous system. Part I. Utility of crush smear cytology in intraoperative diagnosis of central nervous system lesions

OBJECTIVE: To evaluate the utility of rapid intraoperative crush smear cytologic diagnosis of central and peripheral nervous system lesions and to determine the accuracy and relevance of the accuracy of the intraoperative cytologic diagnosis when compared to the final paraffin section diagnosis. STUDY DESIGN: The crush (squash) smear technique was introduced at Sher-i-Kashmir Institute of Medical Sciences in May 2003. The 8 months of 2003 were used for standardization of the procedure. In 2004, 151 patients with open neurosurgical specimens or stereotactic biopsies were diagnosed intraoperatively by crush smears, and the diagnosis was compared with final diagnosis on paraffin sections of the same tissue samples. No supplementation of frozen sections was used. RESULTS: Of 151 cases, 144 were diagnosed accurately intraoperatively by crush smear cytology when compared with the respective paraffin section diagnoses. The diagnostic accuracy attained was 95.36%. Each case was diagnosed within 10 minutes after receipt of sample. Neurosurgical procedure (open or stereotaxy) did not affect diagnostic accuracy. CONCLUSION: In the expert hands of a pathologist with good exposure neurosurgical specimens, crush smear cytology is an accura and reliable procedure for the intraoperative diagnosis central nervous system tumors.     

Treatment of low malignancy brain neoplasms by means of stereotactic interstitial radiotherapy

The authors report their results of 37 patients with low malignancy brain tumors seated in deep or highly functional areas not amenable to traditional surgery, nor to conventional radiochemotherapy. In the past 5 years these patients were treated by means of stereotactic interstitial radiotherapy. The isotope employed in all cases was 125I. Stereotactic radioisotope implants were always preceded by multiple stereotactic biopsies affording precise histological diagnoses. A 6-month to 5-year follow-up shows a survival rate of 72.6% (29 patients), and of these patients, 80.9% (26 out of 29) had complete social reentry.     

Computer-assisted stereotactic biopsy of intracranial lesions

The use of a computer program that allows the integration of stereotactically gathered CT, MRI and digital angiographic data in the planning of a biopsy trajectory is described. This system has been used to perform 447 stereotactic biopsies in 439 patients. Intracranial hemorrhages occurred in three patients; combined morbidity and mortality was less than 1%. Incorporation of angiographic data and visualization of the surgical trajectory enhances the safety and accuracy of stereotactic biopsy of intracranial lesions.     

荷斯坦奶牛脊柱畸形综合征的研究进展

荷斯坦奶牛脊柱畸形综合征是近年新发现的一种常染色体隐性遗传病,该病对纯合子胎儿是致死性的。当荷斯坦牛的育种核心群中携带者达到一定比例,脊柱畸形综合征就会对奶业造成巨大损失。文章综述了脊柱畸形综合征的主要症状和影响、致病基因及检测方法的研究进展以及我国潜在的荷斯坦奶牛脊柱畸形综合征携带者的状况。     

Accuracy of CT scans in identifying tumor tissue

The authors present their experience with stereotactic biopsy of brain tumors. Biopsies were obtained sequentially at different depths from the center of the tumor according to coordinates derived from computerized tomography (CT). Biopsies were obtained from 23 brain tumors: 17 gliomas, 5 metastases, and 1 lymphoma. In all a total of 137 biopsies were studied from both enhancing and nonenhancing areas. The tumor yield from these biopsies was 68 and 73%, respectively. It appears that tumor tissue may be obtained from both the enhancing periphery as well as the nonenhancing center of tumors.     

Automated stereotactic positioning system

An automated stereotactic machine has been interfaced to a surgical computer to complete a totally interactive surgical system capable of locating tumor volumes. Stepper motors, activated by the host computer, drive a three-dimensional slide to position the patient's head with respect to a fixed arc, locating the surgical target. Linear encoders on each axis create a closed-loop positioning system and a digital display for visual inspection of the slide's position. The 160-mm arc directs all instrumentation to its isocenter, regardless of the two angular settings, providing maximum freedom in selecting a safe trajectory to the target. Phantom test points compatible with computerized tomographic and magnetic resonance imaging were repeatedly scanned to determine the overall system accuracy, which approached 0.6 mm, depending on the spatial resolution of the image. This stereotactic device may be used to perform stereotactic laser craniotomies, biopsies, 192Ir implants for interstitial radiation, third ventriculostomies and functional procedures.     

Increase of β2-integrin on adhesion of THP-1 cells to collagen vitrigel membrane

When human monocyte-derived leukemia (THP-1) cells, which are floating cells, are stimulated with lipid peroxides, or Streptococcus suis, these cells adhere to a plastic plate or endothelial cells. However, it is unclear whether or not non-stimulated THP-1 cells adhere to collagen vitrigel membrane (CVM). In this study, firstly, we investigated the rate of adhesion of THP-1 cells to CVM. When THP-1 cells were not stimulated, the rate of adhesion to CVM was high. Then, to identify adhesion molecules involved in adhesion of THP-1 cells to CVM, expressions of various cell adhesion molecules on the surface of THP-1 cells adhering to CVM were measured. β-actin, β-catenin, and β1-integrin expressions did not change in non-stimulated THP-1 cells cultured on CVM compared with those in cells cultured in a flask, but β2-integrin expression markedly increased.     

Evaluation of the Inheritance of the Complex Vertebral Malformation Syndrome by Breeding Studies

To investigate the congenital complex vertebral malformation syndrome (CVM) in Holstein calves, two breeding studies were performed including 262 and 363 cows, respectively. Cows were selected from the Danish Cattle Database based on pedigree and insemination records. Selected cows were progeny of sires with an established heterozygous CVM genotype and pregnant after insemination with semen from another sire with heterozygous CVM genotype. Following calving the breeders should state, if the calf was normal and was requested to submit dead calves for necropsy. In both studies, significantly fewer CVM affected calves than expected were obtained; a finding probably reflecting extensive intrauterine mortality in CVM affected foetuses. The findings illustrate increased intrauterine mortality as a major potential bias in observational studies of inherited disorders.     

A true 'advanced imaging assisted' skull-mounted stereotactic system

A stereotactic system has been designed based upon a series of interlocking discs secured to the skull with self-tapping screws. Unlike previous skull-mounted systems, this system is a true, advanced imaging based stereotactic device with the capabilities and accuracy of more traditional, frame based devices. It has been used in a range of applications, from simple biopsies to interstitial radiation implant procedures. Well tolerated by the patient, it allows reaccess to the intracranial target without rescanning. It is convenient for the physician to utilize, both mechanically and timewise, is adaptable to MRI, DSA, and conventional X-ray techniques without modification, and is affordable.     

Intervention studies in breast diseases

Based on results of comprehensive examination of 20,000 females with different breast diseases in a specialized mammological room, the paper presents the most informative invasive techniques that combine diagnostic and therapeutical potentialities, such as ductography, cystography using various sclerosing solution, various types of needle biopsies under X-ray guidance, stereotactic computer devices, ultrasound study, and various labeling modes for nonpalpable formation before surgery. It shows in expedient to make a comprehensive examination under the conditions of a mammological room where the advantages of this or that invisable intervention, including those without a dosage load, are rationally, without duplicating, used depending on the diseases detected, which increases the significance of preoperative diagnosis up to 95-98%, including that of nonpalpable formations by substantially reducing the proportion of surgical interventions into the breast.