The Frozen Brain State of Cryptococcus gattii: A Globe-Trotting, Tropical, Neurotropic Fungus.

Initially reported in tropical regions, Cryptococcus gattii infection is now diagnosed globally. Methods: case report; Literature review. Although initial reports described outbreaks of pulmonary and central nervous system (CNS) disease in tropical regions such as Australia and New Guinea, it is now clear that Cryptococcus gattii is a global, neurotropic pathogen.

Surgical management of cerebral dural arteriovenous fistulae.

Dural arteriovenous fistulae are high flow, low resistance intracranial vascular malformations defined by an aberrant connection between an artery and dural vein or sinus. Symptomatology and presentation are highly dependent on location, generally categorized as supratentorial, tentorial, or infratentorial, and consist primarily of sequelae secondary to local venous hypertension, insufficiency, and cortical venous reflux. Surgery is generally reserved for high risk or persistently symptomatic lesions that are unamenable or unresponsive to endovascular therapy.

Developmental Regulation of Mitochondrial Apoptosis by c-Myc Governs Age- and Tissue-Specific Sensitivity to Cancer Therapeutics.

It is not understood why healthy tissues can exhibit varying levels of sensitivity to the same toxic stimuli. Using BH3 profiling, we find that mitochondria of many adult somatic tissues, including brain, heart, and kidneys, are profoundly refractory to pro-apoptotic signaling, leading to cellular resistance to cytotoxic chemotherapies and ionizing radiation. In contrast, mitochondria from these tissues in young mice and humans are primed for apoptosis, predisposing them to undergo cell death in response to genotoxic damage.

Fractionated radiation therapy for vestibular schwannoma.

Vestibular schwannomas are the most common tumors of the cerebellopontine angle. Multiple management paradigms exist for patients with these benign tumors, including observation, microsurgery, stereotactic radiosurgery, and fractionated radiation therapy, or some combination of these. While the proper course of management is controversial, the goals of therapy are to achieve excellent local tumor control and optimize functional outcomes with as little treatment-related morbidity as possible.

Skull base chordomas: clinical features, prognostic factors, and therapeutics.

Chordomas of the skull base are one of the rarest intracranial malignancies that arise from ectopic remnants of embryonal notochod. The proximity of many chordomas to neurovascular structures makes gross total resection difficult, and the tendency for recurrence leads to the routine use of adjuvant postoperative radiation. Several surgical approaches are used ranging from extensive craniotomies to minimally invasive endonasal endoscopic approaches.

Stereotactic radiosurgery for benign meningiomas.

Meningiomas are the second most common primary tumor of the brain. Surgical resection is the preferred treatment for easily accessible tumors that can be safely removed. However, many tumors arise deep within the skull base making complete surgical resection difficult or impossible.

Management of recurrent intracranial hemangiopericytoma.

Intracranial hemangiopericytoma (HPC) is an aggressive meningothelial neoplasm. A particularly challenging aspect of management of patients with HPC is optimizing treatment for recurrence, progression, and extracranial metastasis. Here we describe a modern cohort of patients with recurrent HPC to better understand treatment strategies that may improve outcome.

Intracranial hemangiopericytoma: clinical experience and treatment considerations in a modern series of 40 adult patients.

Introduction: Intracranial hemangiopericytoma (HPC) is a malignant meningothelial tumor. Because of its rarity, few guidelines exist for optimal management.

Methods: University of California at San Francisco patients managed for intracranial HPC were compiled into a single database based on a retrospective review of patient records.

A critical evaluation of cystic features in primary glioblastoma as a prognostic factor for survival.

Object: The presence of cystic features in glioblastoma (GBM) has been described as a favorable prognostic factor. The aim of this study was to determine the survival outcome in patients undergoing surgery for newly diagnosed primary GBM with a large cystic component as compared with a large cohort of patients with noncystic GBM, while controlling for well-characterized prognostic factors.

Methods: A retrospective review of 354 consecutive patients treated with resection of primary GBM was performed using medical records and imaging information obtained at the University of California, San Francisco from 2005 to 2009.

A comprehensive analysis of intracranial chordoma and survival: a systematic review.

Objective: Despite the published information on cranial chordoma, most of the data regarding survival in these patients has come from a single institution. Here, we perform a systematic review of the literature to evaluate across multiple institutions the overall survival after treatment for intracranial chordoma.

Materials And Methods: We systematically analysed every study published in English and found a total of over 2000 patients being treated for intracranial chordoma.

Cranial chondrosarcoma and recurrence.

The literature regarding recurrences in patients with cranial chondrosarcoma is limited to small series performed at single institutions, raising the question if these data precisely reflect the true recurrence of this tumor for guiding the clinician in the management of these patients. An extensive systematic review of the English literature was performed. The patients were stratified according to treatment modality, treatment history, histological subtype, and histological grade, and the recurrence rates were analyzed.

Implications of cystic features in vestibular schwannomas of patients undergoing microsurgical resection.

Background: Cystic vestibular schwannomas (VSs) are described as being more aggressive than solid tumors.

Objective: We examined 468 VS patients to evaluate whether the presence of cystic components in VSs may be an important feature for predicting postoperative outcome.

Methods: We selected all VS patients from a prospectively collected database (1984-2009) who underwent microsurgical resection for VS.

The next step: innovative molecular targeted therapies for treatment of intracranial chordoma patients.

Background: Chordomas are rare, locally aggressive malignancies that often exhibit an insidious natural history and are difficult to eradicate. Surgery and radiotherapy are the treatment mainstays of chordoma, but the chance of local recurrence remains high. Patients who relapse or cannot undergo a complete en bloc resection generally have a poor prognosis.

Surgical resection and adjuvant radiotherapy for a large pineal hemangiopericytoma.

Hemangiopericytoma of the pineal region is exceedingly rare. We describe a patient with a large pineal region hemangiopericytoma who underwent a third ventriculostomy followed by a gross total resection by a unilateral interhemispheric approach with adjuvant radiotherapy. The patient remains recurrence free 4 years after treatment.

Pediatric intracranial aneurysms.

Intracranial pediatric aneurysms arising in children are rare. The treatment of these lesions requires both an understanding of their unique features as well as surgical, interventional, and pediatric critical care expertise offered through a multidisciplinary setting. The patient population, clinical presentation, complications, and trends in treatments are discussed in this article.

Adjuvant radiation therapy and chondroid chordoma subtype are associated with a lower tumor recurrence rate of cranial chordoma.

Cranial chordomas are rare tumors that have been difficult to study given their low prevalence. Individual case series with decades of data collection provide some insight into the pathobiology of this tumor and its responses to treatment. This meta-analysis is an attempt to aggregate the sum experiences and present a comprehensive review of their findings.

Monitoring immune responses after glioma vaccine immunotherapy.

Immunotherapy provides the ideal candidate of therapeutic attack against malignant gliomas because it allows for targeting of cancer cells without the potential for nonspecific toxicity. This is important when glial tumor cells spread far through normal brain tissue. Current vaccine therapies are in clinical trials and are showing beneficial responses.

A systematic review of intracranial chondrosarcoma and survival.

Most data regarding survival in patients with chondrosarcoma are limited to case studies and small series performed at single institutions. A systematic review was performed to study the relationship between potential prognostic factors and survival. The survival rates were analyzed according to modality of treatment, treatment history, histological subtype, and histological grade.