Retrospective neuropathologic analysis of adult spinal tumors in a single neuroscience center 2018 - 2023.

Chapter 20 - Brain and spinal tumors

President's Opening Remarks - Reflections on the Bond of Trust Between the Physician and his Patient.- Ernst von Bergmann and the Beginning of Neurosurgery in Berlin.- Extradural Tumors of the Spine.- Intraoperative Spinal Cord Monitoring.- Spinal Cord Tumors.- Basic Anatomic Considerations Concerning the Surgical Approaches to the Spinal Column.- Spinal Tumors.- Neurological Problems in Conjunction with Spinal Tumors.- Differential Diagnostics of Spinal Tumors.- Diagnosis by Examination of Cerebrospinal Fluid in Spinal Tumor Cases.- Conventional Radiologic Diagnosis of Spinal Tumors.- Nuclear Medicine in the Diagnosis of Spinal Tumors.- Spinal Tumors: Magnetic Resonance Imaging.- Spinal Tumors: A Multi-Center Study of the Deutsche Gesellschaft fur Neurochirurgie.- The Use of Transthoracic and of Ventro-lateral Access in the Surgical Treatment of Extradural Spinal Tumors in the Thoracic and Lumbar Areas.- Unilateral Approaches to Spinal Tumors.- The Transsacral, Transcoccygeal Approach to Prevertebral Spinal Tumors.- Operative Treatment of Aneurysmal Bone Cysts of the Spine - Radical Excision and Spinal Stabilization.- Osteosynthesis in Patients with Malignant Tumors of the Cervical Vertebral Column: Indications, Techniques, and Results.- Osteosynthesis with AO Plates in the Cervical and Lumbar Regions of the Vertebral Column in Cases of Spinal Metastases.- Differential Diagnosis and Operative Treatment of Rare Intraforaminal Space-Occupying Lesions.- Acute Leriche Syndrome in the Differential Diagnosis of Acute Paraplegia.- Misdiagnoses in Spinal Tumors.- Tumors of the Craniocervical Region: Difficulties in Diagnosis Microsurgery and Laser Surgery.- Diagnosis and Treatment of Space-Occupying Lesions at the Craniocervical Junction.- Inclincation of the Odontoid Process in Children and Adults - an Anatomical and Functional Investigation.- Cytostatic Treatment of Spinal Tumors.- Malignant Lymphomas and Spinal Cord Compression.- Aspects of Neurosurgical Intervention for Spinal Manifestations of Malignant Lymphomas.- Clinical and Neuropathological Aspects of Rare Semimalignant Spinal Tumors: Case Reports of a Giant Cell Tumor (Osteoclastoma) and an Atypical Osteoblastoma.- Experimental Neurosurgery.- Microsurgical Anatomy of the Transoral Approach for Anterior Processes of the Upper Cervical Spine.- CT Absorption Analysis in Intracranial Tumor Diagnostics.- Impulse Cytophotometry and the Biological Behavior of Gliomas.- Swelling Behavior of C6 Glioma Cells During Shutdown of Energy Metabolism.- Treatment of Vasogenic Brain Edema by Inhibitors of the Kallikrein-Kinin System.- Neurotransmitter Contents in Low-Grade Gliomas and Glioblastomas.- The Influence of Acutely Increasing ICP upon Diuresis and Water-Electrolyte Balance and Its Modification by Neurohypophysectomy (An Experimental Study).- Noninvasive Measurement of Local Cerebral Blood Flow (nl-CBF) with Stable Xenon Enhanced Dynamic CT - Description of Method and Analysis of Flow Data.- Perioperative Chemiluminescence of Polymorphonuclear Leukocytes and Monocytes in Brain Tumor Patients.- Experimental Hypertensive Intracerebral Mass Hemorrhage in Cats.- Cerebrospinal Fluid and Serum Levels of the Arachidonic Acid Metabolites 6-keto-PGF1? and Thromboxane B2 in Patients with Subarachnoid Hemorrhage.- The Effect of the Cleavage Peptide C3aDesArg of the Third Complement Component on the Accumulation of Leukocytesin Cerebrospinal Fluid (CSF) and on the Permeability ofthe Blood-CSF Barrier.- Rostral Spread of Epidural 3H-Labeled Morphine.- Subdural Implantation of RG2 Glioma Spheroids in Rat Cerebellum: A New Experimental Brain Tumor Model.- Testing of Hydrocephalus Shunt Systems.- Vessel Repairs of the Carotid Artery of the Rat Using the Modified Nd:YAG Laser.- Neurosurgical Intensive Care.- Legal Problems of Intensive Care.- Computer-Aided Neuromonitoring: Conditions, Techniques, and Clinical Applications.- Present Status of Barbiturates in the Acute Stage of Cerebral Damage.- Cerebrovascular Reserve and Brain-Protective Measures in Cases of Interruption of Carotid Artery Flow.- Intensive-Medical Aspects in the Treatment of Increased Intracranial Pressure.- Possibilities and Limitations of High-Dose Barbiturate Therapy in the Management of Intracranial Hypertension.- Treatment of Intracranial Hypertension Without Barbiturates.- Significance of Acute Disturbances of Pupillary Function in Postoperative Intensive Care After Operations for Craniopharyngiomas.- Provisional Diagnostic Value of the Anaphylatoxin Radioimmunoassay (C3a-desArg-RIA) in the Neurosurgical Intensive Care Unit.- Investigations of Pituitary Function in Severe Head Injury by Radioimmunoassay.- Biological Rhythms of Electrophysiological and Endocrinological Parameters in Acute and Chronic Intracranial Lesions.- Neuromonitoring Supplemented by nrCBF.- Postoperative Observation at the Neurosurgical Intensive Care Unit After Surgery of the Posterior Fossa.- Monitoring of Brain Stem Auditory Evoked Potentials (BAEPs) in the Intensive Care Treatment of Craniocerebral Traumata.- Auditory Evoked Potentials During and After Complete Ischemiaof the Brain.- Criteria for the Diagnosis of Brain Death.- Limitations of Intensive Care Medicine - as Viewed by a Neurosurgeon.

Spinal cord tumors include tumors developing from its parenchyma, vessels, roots and membranes. The main theory of the formation of spinal cord tumors is the polyetiological dysontogenetic theory. According to this theory, hereditary factors, dysembriogenesis, trauma, carcinogenic effects, viral infection, intoxication, radiation, etc. play an important role in the development of tumors. Although scientists keep finding out more about genetic and environmental factors influencing the development of many types of tumors, spinal tumors are still a relatively unknown subject. Spinal tumors partially contain pathological genes, but in many cases, researchers don't know what causes these genetic changes. Tumors of the central nervous system (CNS) make up 12% of all tumors, tumors of the spinal cord – 3% of nervous system disorders, in the structure of malignant lesions of the CNS – 1,4-5%, occur mainly at the age of 20-60 years. In children, as well as in elderly and senile persons, these tumors are rare. Most often, they develop not from the brain matter, but from the surrounding tissue, and when they increase in size, they compress the spinal cord. Spinal tumors are usually divided into primary and secondary. The group of primary tumors include tumors, originating from the brain matter (intramedullar tumors), and those that grow from the membranes of the brain, roots, vessels (extramedullar tumors). Extramedullar tumors are much more common (in 80% of all spinal tumors) than intramedullar tumors. Extramedullar tumors can be both subdural and epidural. The majority of extramedullar tumors are subdural. Occasionally there are tumors, some of which are located inside the dural sac, and some – outside the dura mater, they are subdural-epidural tumors, as well as epidural-extrovertebral tumors. Among extramedullar tumors the most commonly diagnosed are meningiomas and neurinomas, among intramedullar the most common are ependymomas, less common are astrocytomas and oligodendroglioma. Glioblastomas of the spinal cord is extremely rare; the most common metastases from the posterior fossa are medulloblastomas. Intracerebral tumors of the spinal cord are characterized by greater biological benignity, than similar brain tumors. Extracerebral spinal cord tumors have no such differences in their biological properties. In general, spinal cord tumors are more common in elderly patients. Neurinomas and meningiomas predominate in adults, and ependymomas and dysgenetic tumors (teratoma, epidermoid cysts) – in children. Peculiarities of etiopathogenetic aspects, clinical course, influence on socio-economic factors encourage further improvement of diagnosis and more detailed study of this type of tumors. Materials and methods. The analysis of medical records of patients with spinal cord tumors, who were hospitalized in neurological departments of the Sumy Regional and 4th City Clinical Hospitals in 2015-2018 was carried out. 69 clinical cases were processed in order to investigate the prevalence of spinal cord tumors in the Sumy region, the characteristics of the disease in this group of patients, the leading symptoms, methods of diagnosis and treatment. The analysis of statistical data, obtained after processing of the research materials, was carried out using the licensed version of the IBM SPSS Statistics 17 software. Our study significantly established that, according to the histological structure, in 46 patients (28 women and 18 men) meningiomas were predominant and that in 31 patients they were located at the level of Th6-Th12. Mainly in 42 patients (33 women and 9 men, p<0.05) spinal cord neoplasms were localized at the level of Th6-Th12, with extramedular-intradural tumor location – 57 patients (38 women and 19 men). According to our study, pain syndrome significantly prevailed in 42 patients (35 with extramedular-intradural tumor localization). The study of the histological structure of tumors depending on their localization is an integral part of both diagnosis and treatment, and an important component of predicting the quality of life of the patient.

Introduction:The most recent local study on the incidence of histological subtypes of all brain and spinal tumours treated surgically was published in 2000. In view of the outdated data, we investigated the presenting characteristics, histological subtypes and outcomes of adult patients who underwent surgery for brain or spinal tumours at our institution.Methods:A single-centre retrospective review of 501 patients who underwent surgery for brain or spinal tumours from 2016 to 2020 was conducted. The inclusion criteria were (a) patients who had a brain or spinal tumour that was histologically verified and (b) patients who were aged 18 years and above at the time of surgery.Results:Four hundred and thirty-five patients (86.8%) had brain tumours and 66 patients (13.2%) had spinal tumours. Patients with brain tumours frequently presented with cranial nerve palsy, headache and weakness, while patients with spinal tumours frequently presented with weakness, numbness and back pain. Overall, the most common histological types of brain and spinal tumours were metastases, meningiomas and tumours of the sellar region. The most common complications after surgery were cerebrospinal fluid leak, diabetes insipidus and urinary tract infection. In addition, 15.2% of the brain tumours and 13.6% of the spinal tumours recurred, while 25.7% of patients with brain tumours and 18.2% of patients with spinal tumours died. High-grade gliomas and metastases had the poorest survival and highest recurrence rates.Conclusion:This study serves as a comprehensive update of the epidemiology of brain and spinal tumours and could help guide further studies on brain and spinal tumours.

We reviewed the literature concerning primary brain and spinal tumors with first manifestation or acceleration of symptoms during pregnancy or within the first postpartum week and encountered four new cases in our center. The incidence of brain tumors that become symptomatic during pregnancy appears to be decreased compared with that in age-matched women. The relative frequency of the different primary brain tumor types is not changed by pregnancy. The number of meningiomas gradually tends to increase during pregnancy, with gliomas and spinal vascular tumors accumulating in the first and third trimesters, respectively. Postpartum amelioration of symptoms has especially been described for meningiomas and spinal vascular tumors. We conclude that different types of tumors are influenced at different stages of pregnancy. Although progesterone receptors predominate compared with estrogen receptors, no definite causal relationship with progesterone has been established.

Patients of central nervous system (CNS) tumors have a potential to develop psychiatric disorder. These may present resulting from tumor mass, edema, or patient's failure to adapt to their illness and treatment. The presence of psychiatric disorders may cause disability, decreased daily functioning, reduced quality of life, and even death. In order to provide adequate treatment to patients with CNS tumors, it's important to evaluate the type of psychiatric disorder in patients with spinal and brain tumors. This study aimed to investigate the prevalence of psychiatric disorder dan related factors that exist in patients with brain and spinal tumors. In a study conducted at Cipto Mangunkusumo General Hospital from January to December 2023, factors associated with psychiatric disorders in patients with CNS tumors were investigated. The analysis included a total of 161 subjects from inpatient settings. In depth interview was utilized to assess psychiatric disorder. Data analyses were carried out using the Chi-square and Fisher's exact test to assess the relationship between locations of tumor, neurological deficits, and psychiatric disorders. There were 161 subjects with mean age of 48.86±13.13 years, mostly women (59.0%). Patients with spinal tumor have more psychiatric disorders compared to their counterpart with intracranial tumor (79.1% and 76.3% respectively), while the most common psychiatric disorder was adjustment disorder. There is no significant relationship between tumor location and psychiatric disorder. In both patients with intracranial and spinal tumors, the most common neurological deficit was cancer pain (88.2%). However, bivariate analysis showed that among the neurological deficits found in the CNS tumor patients, dysphagia (P=0.02) and incontinence (P=0.02) have significant relationship with depression, while pain (P=0.02) and cognitive dysfunction (P=0.01) have significant relationship with adjustment disorder. It also showed that pain (P<0.001), cognitive dysfunction (P=0.002), and seizure (P=0.03) have significant relationship with organic mental disorder. Dysphagia, incontinence, pain, cognitive disfunction, and seizure were identified as risk factors for psychiatric disorders in intracranial and spinal tumor patients. The finding underscores the importance of screening and comprehensive psychiatric evaluations in patients with CNS tumors, as psychiatric symptoms may significantly impact their quality of life and treatment outcomes.

Few studies exist on the demographics and trends of pediatric central nervous system (CNS) tumors in Iran. In this study, we retrospectively reviewed all caseswith confirmed CNS tumors admitted to Mofid Pediatric Hospital, Tehran, Iranduring the last 18 years. Data on gender, age of diagnosis, pathologic classification and tumor location were extracted from the available medical records. We used the last version of International Classification of Childhood Cancer. Overall, 258 (81.9%) brain tumors and 57 (18.1%) spinal tumors were identified. Our subjects comprised of 147 (46.7%) female and 168 (53.3%) male children. More male dominancy was observed in brain tumors with a male to female ratio of 1.2 compared with 1.03 of spinal tumors. Malignant CNS tumors were most common in 1-4 yr age group. The four most common brain tumors in our subjectswere astrocytomas, medulloblastoma, ependymoma and craniopharyngioma. Overall, 53.1% of the brain tumors were supratentorial. Gliomas, PNET and neuroblastma were the most frequent primary spinal tumors in our study. We observed an increasing trend for both brain and spinal tumors that was moreremarkable in the last 5 years. Our results are comparable with similar single center studies on CNS tumors during childhood. The observed disparities could be attributed to the single center nature of our study and geographical, environmental and racial variations in pediatric CNS tumors. The increasing trend of both brain and spinal tumors could warrant further investigations at provincial and national levels to investigate probable contributing environmental risk factors.

OBJECTIVE: To determine the frequency of different spinal cord tumor subtypes across age and gender groups. METHODOLOGY: A retrospective study was conducted at the Pathology Department of the Basic Medical Sciences Institute, JPMC Karachi, between October 2019 and September 2022. All spinal cord tumor specimens submitted for histological assessment were included in the research. The age, gender, and histological results of the samples were considered while reviewing them in detail. RESULTS: A total of 25 cases of spinal cord tumors were examined, according to this study. The most common histopathological spinal cord tumors are Meningioma, followed by Astrocytoma. Patients with spinal cord tumors ranged in age from 7 to 65 years old, with a mean age of 37. The findings of this study show that with a male-to-female ratio of 0.4:1, spinal cord tumors are more common in females than in males. CONCLUSION: Meningioma 13 (7.2%) and astrocytoma 3 (1.7%) were the most common types of spinal tumors observed. Patients with spinal tumors are more likely to be in their 30s, and they also tend to be more prevalent in women.

On the basis of the studies reported on steroid receptors in brain tumours, cytoplasmic and nuclear estrogen (ER) and progesterone (PR) receptors have been examined in forty primary spinal cord tumours: fifteen neurinomas, three neurofibromas, nine meningiomas, nine ependymomas, two astrocytomas, one oligodendroglioma and one hemangiopericytoma with the exchange method in the presence of sodium thiocyanate for ER and using the synthetic progestin R5020 for PR. Regardless the type of the tumour, ER have been detected with a higher incidence in male than in female patients (78% versus 59%). PR had the same incidence in male and in female patients. The neurinoma was the oncotype more constantly provided with steroid receptors: nuclear ER, in fact, has been found with an incidence of 75% in male and of 43% in female patients. This oncotype is usually provided in both sexes with PR. Ependymomas is spinal tumour with the highest incidence of cytosol ER both in male and in female patients. On the basis of the above results reported it can be assumed that hormonal factors might be involved in the occurrence as well as in the growth of spinal cord tumours. Therefore it can be hypothesized that hormonal treatment might favourably be used as an adjuvant therapy in some selected patients with receptor positive spinal tumours.

Spinal tumors constitute 10-32% of all primary central nervous system tumors. Accurate radiologic and histopathology diagnosis is crucial in the management and prognosis. The aim of the study was to describe the imaging patterns and to determine the agreement of imaging pattern of spinal tumors with intra-operative and histopathology findings. A retrospective cross-sectional study of 47 patients with spinal tumor done from May 2018 to October 2020. Medical records were reviewed for clinical data, history, physical examination, magnetic resonance imaging (MRI), intraoperative findings and histopathology reports. The agreement between imaging, intraoperative finding and histopathology diagnosis was analyzed. Intradural extramedullary tumors constituted 37 (78%) cases followed by six (12.8 %) extradural tumors and four (9.2%) intramedullary tumors. Schwannoma accounted for 13 (27.7%) cases followed by meningioma, 12 (25.5%) cases. Twenty-seven (57.4%) cases were thoracic level and cervical level were nine (19.1%) cases. Twelve (25.5%) cases did not have a definite intraoperative diagnosis. Imaging and intraoperative diagnosis was in agreement in 21 (44.6 %) cases and disagreed in 14 (29.7%) cases. For the imaging diagnosis and histopathology, 29 (61.7%) were in agreement and 18 (38.3 %) were in disagreement. In conclusion, the commonest site to be involved was the thoracic spine and schwannoma was the commonest tumor. The low agreement between imaging and histopathology could have been improved by optimizing the imaging reports and techniques.

Brain and spinal tumours: contemporary challenges in clinical practice

James Watson Kernohan (1896–1981): Frontiers in neuropathology

Harvey Cushing's refinement of Halsted's meticulous surgical techniques facilitated safe resection of intradural spinal tumors. Although Cushing focused his attention on brain tumors at the Peter Bent Brigham Hospital, his numerous contributions to the treatment of intradural spinal tumors include the description of these tumors' natural histories and their histological classifications. The application of his experienced intracranial techniques to the resection of spinal tumors improved outcomes. The authors review selected operative notes and sketches to demonstrate his technique in the excision of the spinal cord tumors.

Background By intraoperative analysis of fresh frozen sections, neuropathologists provide important information of different brain and spinal tumors to the neurosurgeon during surgery. This facilitates characterization of these tumors intraoperatively to optimize the surgical strategy and patient management. However, preparation and staining are time consuming using conventional techniques of intraoperative fresh frozen section. Stimulated Raman Histology (SRH) was introduced as novel technique providing high-resolution digital images of unprocessed tissue samples directly in the operating room comparable to conventional histopathological images. Additionally, SRH images are fast and easily accessible by neuropathologists. Recently, first data showed promising results on the accuracy and feasibility of SRH in comparison to conventional H&amp;E staining. Material and Methods In a time period of 4 months, patients with different brain or spinal tumors who underwent neurosurgical resection or open/stereotactic biopsy at the Dept. of Neurosurgery, Medical University Vienna were included in this study. Tumor tissue samples were collected intraoperatively whenever safely possible for analysis with SRH. Subsequently, unprocessed tissue samples were scanned by SRH, and intraoperative histopathological images were created directly in the operating room within a few minutes. All collected tissue samples were then sent for routine neuropathological workup. In an overall analysis, SRH images and H&amp;E staining of all patients were analyzed separately by two board certified neuropathologists. Information on age, localization and suspected diagnosis was provided in each case in order to simulate the situation of intraoperative fresh frozen section. In a next step the technical feasibility and diagnostic accuracy of SRH was calculated. Results In this study, tissue samples of 95 patients who underwent neurosurgical resection or open/stereotactic biopsy of different brain and spinal tumors were collected intraoperatively and analyzed by SRH. In total, 31 gliomas, 30 meningiomas, 19 metastases, 7 neurinomas and 8 rare tumors were analyzed. In the present study the use of SRH was technically feasible in all cases and could be easily integrated in the neurosurgical workflow to provide rapid digital histopathological images for the analyzing neuropathologists. According to our data, SRH provided high diagnostic accuracy (&amp;gt;95%) in the investigated different brain and spinal tumors. Conclusion Based on our preliminary data the technical use of SRH is feasible and showed a high rate of diagnostic accuracy in a large series of different brain and spinal tumors. By using this promising technique, we intend to modernize intraoperative histopathological assessment by providing rapid digital images of brain and spinal tumors to optimize the management of these patients.

Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors.Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5–Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery—with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors.Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy.Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.