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Loyal Davis, John Martin, Frank Padberg and Robert K. Anderson

operation. Preoperative symptoms varied from 1 month to 6 years and 2 patients complained of convulsive seizures only. A wide surgical resection was performed in all of these cases. Three of the tumors were solid, and 2 were multicystic. Two of the patients were able to lead useful lives; one managed his farm and worked vigorously for 12 months, and the other worked productively for 27 months. The patient who survived 30 months had a wide, but incomplete, resection of a left parietal lobe tumor. He received 5,544 r in air of x-ray irradiation postoperatively and was

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Donald D. Matson and Michael J. Jerva

sinus tract extending all the way from the sacral area to the conus medullaris. This lesion had been identified and completely excised prior to any meningeal infection. In 5 of the 6 children with recurrent meningitis a previous incomplete resection of a dermal sinus tract had been carried out in another hospital. Five of these 6 children eventually proved to have an intrathecal dermoid cyst at the inner terminus of the sinus tract; the other patient with recurrent meningitis proved to have an intradural extension of the sinus tract ending at the level of the filium

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Alexander Gol and George M. Faibish

human subject proved to be far less satisfactory than in the animal, and was characterized by incomplete resection and fairly marked damage to the overlying neocortex of the temporal lobe. Fig. 1. Retractors for transventricular hippocampectomy. Hippocampectomy was next attempted by means of lesions produced by coagulation, with stereotaxic approaches made through the posterior parietal lobe and the trigone of the ventricle, and with the electrode running along the medial wall of the temporal horn in the hippocampus to the tip of the temporal horn

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Burton L. Wise, Jacob L. Mathis and Ernest Jawetz

of Meningitis Treatment Outcome Comment 1 2½ F Compound skull fracture, burr holes Scalp wound infection Intrathecal Polymyxin B; 1 week—relapse 3 weeks—cure Cure Reported in ref. 8 2 3 F Cerebellar astrocytoma incomplete resection Wound dehiscence with CSF leak Intramuscular penicillin & terramycin Intrathecal Polymyxin B, 3 doses Death Meningitis present about 3 weeks before therapy begun 3 10 F Cerebellar astrocytoma, incomplete resection Indwelling lumbar intrathecal catheter Intramuscular penicillin

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Gerald D. Silverberg

presenting with a mural nodule and a large cyst at surgery. Note the similarity to Fig. 4 . H & E, × 256. The benign course and occasional unexplained remissions seen in cerebellar astrocytomas suggest the possibility that these tumors may sometimes undergo spontaneous degeneration. Although most cerebellar astrocytomas will recur following incomplete removal, usually within 3 years, Bucy and Thieman 6 have recently reported five patients with survivals up to 36 years following incomplete resection of their tumors. In several of these cases operation was limited

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George M. Kleinman, William C. Schoene, Thomas M. Walshe III and Edward P. Richardson Jr.

✓ The authors give follow-up information on Case 59 of Cushing's 1931 series of cerebellar astrocytomas. The patient died with a malignant cerebellar astrocytoma 48 years after partial removal of a previously benign astrocytoma at the same site. Including the present one, there have been only five reported cases in which this has occurred. Ordinarily, juvenile pilocytic astrocytomas are of extremely benign character, and it is well established that even with incomplete resections patients have survived for years without progression of the tumor. Not all of the cases so reported can be wholly accepted as representing malignant transformation of the tumor, but may instead be instances of recurrence of an inherently benign glioma since the presence of features such as endothelial hyperplasia or nuclear atypicality in a juvenile pilocytic astrocytoma does not warrant its being classified as malignant. Features truly suggestive of malignancy are hypercellularity, frequent mitoses, necrosis, and, in some instances, a diffusely infiltrative growth pattern; all of these features were found in the present case.

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José M. Cabezudo, Jesús Vaquero, Eduardo Areitio, Roberto Martinez, Rafael García de Sola and Gonzalo Bravo

, 33 After the initial reports of the beneficial effect of radiotherapy (RT) in the treatment of this theoretically radioresistant tumor, 6 controversy has arisen between the proponents 1–4, 16, 17, 22, 30, 32, 38, 39, 44 and opponents of this mode of treatment. 12, 19, 25, 28, 33 In the Puerta de Hierro and Ruber Clinics, we have treated 45 patients with craniopharyngiomas during the last 14 years. The aim in all of these cases was to achieve as complete a resection as possible. In some of the incomplete resections and in most cases of recurrences, RT was

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Harvey G. Thomas, Clarisse L. Dolman and Kenneth Berry

✓ The records of 15 patients with a diagnosis of malignant meningioma were reviewed. In one of these patients, in whom invasion of the brain and pituitary gland was the only unusual feature, the tumor was reclassified as benign. Seven tumors, four hemangiopericytomas and two transitional and one syncytial meningioma, were considered to be only borderline-malignant despite necrosis and invasion of the brain, because of few mitoses and regular architecture. Of this group of patients, four men and three women, two are alive and well, three died after incomplete resections, and two succumbed to recurrent tumor that had become inoperable. The other seven patients, six men and one woman, had lesions classified as histologically frankly malignant, on the basis of marked anaplasia and numerous mitoses. These comprised three hemangiopericytomas and three syncytial and one fibrous meningioma. One of these patients is alive and well and the others are dead, three as a result of metastases. The initial clinical course of malignant meningiomas tends to be short but is otherwise indistinguishable from that of benign meningiomas. The chances of recurrence and eventual death are high, and extracranial metastases are not rare. The tumors are most often hemangiopericytomas, but not exclusively so, and men are particularly at risk.

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Ronald F. Shallat, Michael S. Taekman and Richard C. Nagle

dosages are in the range of 6000 to 8000 rads. Objective evidence of tumor regression is rarely seen, and therefore the effect of radiation on these slow-growing neoplasms is difficult to assess other than by the diminution of pain. 13 Had our patient been irradiated after incomplete resection 16 years ago (which she was not), it would have been tempting to attribute the long interval before recurrence to the radiation. The prognosis for chordomas in general is poor, due to the difficulty of surgical excision, their relative radioresistance, and their biological

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Narayan Sundaresan, Gerald Rosen, Joseph G. Fortner, Joseph M. Lane and Basil S. Hilaris

an entire anatomical compartment along with the tumor. 5, 7, 13 For paraspinal neoplasms that extend to the periosteum, such resections should include portions of the spine. In the past, the two major criteria precluding curative resection have been involvement of major blood vessels or the vertebral column. 3 Local recurrence following incomplete resections is inevitable, and carries the threat of cord compression. More recently, combined-modality approaches have been used to improve the local control rate, and ultimately improve the prospects for cure. These