The fourth edition of the World Health Organization (WHO) classification of tumours of the central nervous system, published in 2007, lists several new entities, including angiocentric glioma, papillary glioneuronal tumour, rosette-forming glioneuronal tumour of the fourth ventricle, papillary tumour of the pineal region, pituicytoma and spindle cell oncocytoma of the adenohypophysis. Histological variants were added if there was evidence of a different age distribution, location, genetic profile or clinical behaviour; these included pilomyxoid astrocytoma, anaplastic medulloblastoma and medulloblastoma with extensive nodularity. The WHO grading scheme and the sections on genetic profiles were updated and the rhabdoid tumour predisposition syndrome was added to the list of familial tumour syndromes typically involving the nervous system. As in the previous, 2000 edition of the WHO ‘Blue Book’, the classification is accompanied by a concise commentary on clinico-pathological characteristics of each tumour type. The 2007 WHO classification is based on the consensus of an international Working Group of 25 pathologists and geneticists, as well as contributions from more than 70 international experts overall, and is presented as the standard for the definition of brain tumours to the clinical oncology and cancer research communities world-wide.

https://link.springer.com/content/pdf/10.1007%2Fs00401-007-0243-4.pdf

The 2007 WHO Classification of Tumours of the Central Nervous System

Co-Planar Stereotaxic Atlas of the Human Brain—3-Dimensional Proportional System: An Approach to Cerebral Imaging, J. Talairach, P. Tournoux. Georg Thieme Verlag, New York (1988), 122 pp., 130 figs. DM 268

The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.

/pdf/guidelines-for-the-prevention-of-stroke-in-patients-with-4s66xf1dte.pdf

Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association

To assess the efficacy of surgical resection of brain metastases from extracranial primary cancer, we randomly assigned patients with a single brain metastasis to either surgical removal of the brain tumor followed by radiotherapy (surgical group) or needle biopsy and radiotherapy (radiation group). Forty-eight patients (25 in the surgical group and 23 in the radiation group) formed the study group; 6 other patients (11 percent) were excluded from the study because on biopsy their lesions proved to be either second primary tumors or inflammatory or infectious processes. Recurrence at the site of the original metastasis was less frequent in the surgical group than in the radiation group (5 of 25 [20 percent] vs. 12 of 23 [52 percent]; P less than 0.02). The overall length of survival was significantly longer in the surgical group (median, 40 weeks vs. 15 weeks in the radiation group; P less than 0.01), and the patients treated with surgery remained functionally independent longer (median, 38 weeks vs. 8 weeks in the radiation group; P less than 0.005). We conclude that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.

A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain

The Blood-Brain Barrier in Health and Chronic Neurodegenerative Disorders

A Role for Gz in Pancreatic Islet β-Cell Biology

Computer assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.

Specimens of anterior or posterior iliac crest bone in 12 cases of active and 1 case of surgically arrested Cushing's syndrome were studied by microradiography. Bone formation and bone resorption were measured quantitatively as a percentage of the total bone surface in bone samples (Jowsey method). Compared with control data obtained from normal bone from similar skeletal sites, all cases had depressed bone formation; increased bone resorption was observed in 7 of the 12 cases. The level of bone resorption could not be correlated with the severity or duration of hypercortisonism or with the dietary calcium intake. The patient whose Cushing's syndrome had been arrested by adrenalectomy displayed a high level of bone formation. It seems likely that it is the combination of decreased bone formation and increased bone resorption which accounts for the severity and rapid progression which characterize the osteoporosis of hypercortisonism.

Quantitative microradiographic study of bone remodeling in Cushing's syndrome.

The authors compared the effects of decreased loading, increased loading, and baseline loading on the early (six weeks) and intermediate (12 weeks) healing of tibial fractures treated with an external fixator in adult dogs. The different loading conditions were verified by gait studies. Periosteal bone in the increased-loading fracture site was significantly increased compared with the decreased-loading site at both time intervals, and with the baseline-loading site at six weeks. The mechanical variables of energy absorption and angle of rotation at six weeks were significantly increased in the increased-loading fracture site compared with the decreased-loading site and baseline-loading site. Blood flow to the increased-loading fracture site was significantly higher than that to the decreased-loading fracture site at six weeks. Five dogs were studied at 12 weeks to compare the effects of decreased loading to increased loading. The increased-loading fracture showed significantly increased rotation, torque, and energy absorption to failure. Blood flow was not measured in the 12-week animals.

Experimental study of the effect of weight bearing on fracture healing in the canine tibia.

In patients with medically intractable complex partial seizures of temporal lobe origin, stereotactic amygdalohippocampectomy can now provide excellent results. Target structures can be accurately identified and completely resected with use of a carbon dioxide laser. In a series of 18 patients who underwent this computer-interactive procedure, all experienced a cessation or dramatic reduction in frequency of seizure activity. Because the inferior optic radiations are disrupted with use of the posterolateral approach, nondisabling postoperative visual field deficits always ensue. In addition, two of our patients who underwent left-sided procedures had transient minor speech problems, perhaps attributable to postoperative swelling of the lateral temporal lobe. Patients in whom a surface electroencephalogram discloses a posterior temporal focus of seizure activity are candidates for stereotactic amygdalohippocampectomy.

https://www.mayoclinicproceedings.org/article/S0025-6196(12)61877-1/pdf

Patrick J. Kelly

Papers

A Role for Gz in Pancreatic Islet β-Cell Biology

Computer assisted stereotactic biopsy and volumetric resection of pediatric brain tumors.

Quantitative microradiographic study of bone remodeling in Cushing's syndrome.

Experimental study of the effect of weight bearing on fracture healing in the canine tibia.

Magnetic Resonance Imaging-Based Computer-Assisted Stereotactic Resection of the Hippocampus and Amygdala in Patients With Temporal Lobe Epilepsy