In this article the authors discuss the development of neurosurgical approaches and the advances in science and technology that influenced this development throughout history. They provide a broad overview of this interesting topic from the first attempts of trephination by ancient cultures to the work of the pioneers of neurosurgery and the introduction of microsurgery.
Malte Ottenhausen, Imithri Bodhinayake, Alexander I. Evins, Matei Banu, John A. Boockvar and Antonio Bernardo
Anne-Marie Bleau, Brian M. Howard, Lauren A. Taylor, Demirkan Gursel, Jeffrey P. Greenfield, H. Y. Lim Tung, Eric C. Holland and John A. Boockvar
Brain tumor stem cells (TSCs) hypothetically drive the malignant phenotype of glioblastoma multiforme (GBM), and evidence suggests that a better understanding of these TSCs will have profound implications for treating gliomas. When grown in vitro, putative TSCs grow as a solid sphere, making their subsequent characterization, particularly the cells within the center of the sphere, difficult. Therefore, the purpose of this study was to develop a new method to better understand the proteomic profile of the entire population of cells within a sphere.
Tumor specimens from patients with confirmed GBM and glioma models in mice were mechanically and enzymatically dissociated and grown in traditional stem cell medium to generate neurospheres. The neurospheres were then embedded in freezing medium, cryosectioned, and analyzed with immunofluorescence.
By sectioning neurospheres as thinly as 5 μm, the authors overcame many of the problems associated with immunolabeling whole neurospheres, such as antibody penetration into the core of the sphere and intense background fluorescence that obscures the specificity of immunoreactivity. Moreover, the small quantity of material required and the speed with which this cryosectioning and immunolabeling technique can be performed make it an attractive tool for the rapid assessment of TSC character.
This study is the first to show that cryosectioning of neurospheres derived from glioma models in mice and GBM in humans is a feasible method of better defining the stem cell profile of a glioma.
Christoph P. Hofstetter, Benjamin J. Shin, Lynn Mubita, Clark Huang, Vijay K. Anand, John A. Boockvar and Theodore H. Schwartz
The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactin-, growth hormone (GH)–, and adrenocorticotropic hormone (ACTH)–secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria.
The authors reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined according to the most recent consensus criteria.
The majority of functional adenomas (62.8%) were classified as macroadenomas (> 1 cm in maximum diameter), and 20.9% of lesions had invaded the cavernous sinus (CS) at the time of surgery. A gross-total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion.
This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.