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1. Müller HL, Handwerker G, Gebhardt U, Faldum A, Emser A, Kolb R, Sörensen N: Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness. Cancer Causes Control; 2006 May;17(4):583-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Melatonin treatment in obese patients with childhood craniopharyngioma and increased daytime sleepiness.
  • Because hypothalamic lesions may explain daytime sleepiness in craniopharyngioma patients, salivary melatonin and cortisol concentrations were examined in severely obese (BMI>or=4SD) and non severely obese (BMI<4SD) craniopharyngioma patients (n=79), patients with hypothalamic pilocytic astrocytoma (n=19), and control subjects (n=30).
  • Using a general linear model procedure analyzing the influence of BMI and tumor diagnosis on diurnal salivary melatonin we found that morning salivary melatonin levels were related to BMI (F test: p-value=0.004) and tumor diagnosis (F-test: p-value=0.032).
  • As decreased nocturnal melatonin levels were associated with increased daytime sleepiness, BMI and hypothalamic tumor diagnosis, we initiated an experimental melatonin substitution in 10 adult obese patients (5f/5m) with childhood craniopharyngioma.
  • [MeSH-major] Craniopharyngioma / metabolism. Melatonin / secretion. Melatonin / therapeutic use. Obesity / metabolism. Pituitary Neoplasms / metabolism. Sleep Stages
  • [MeSH-minor] Adolescent. Adult. Astrocytoma / complications. Astrocytoma / metabolism. Child. Child, Preschool. Circadian Rhythm. Disorders of Excessive Somnolence / complications. Disorders of Excessive Somnolence / drug therapy. Female. Humans. Hydrocortisone / blood. Hypothalamic Neoplasms / metabolism. Male. Saliva / chemistry


2. Shingu T, Akiyama Y, Daisu M, Maruyama N, Matsumoto Y, Miyazaki T, Nagai H, Yamamoto Y, Yamasaki T, Yoshida M, Maruyama R, Moritake K: Symptomatic hemorrhage associated with recurrent pilocytic astrocytoma with granulation tissue--case report. Neurol Med Chir (Tokyo); 2007 May;47(5):222-8
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  • [Title] Symptomatic hemorrhage associated with recurrent pilocytic astrocytoma with granulation tissue--case report.
  • A 51-year-old woman had been followed up for 10 years for recurrence of pilocytic astrocytoma 5 years after the initial treatment consisting of subtotal resection, chemotherapy, and radiation therapy.
  • Computed tomography and T(2)*-weighted magnetic resonance imaging revealed hemorrhage in the tumor located in the right basal ganglia, thalamus, and hypothalamus.
  • Histological examination confirmed recurrent pilocytic astrocytoma with organizing hematoma and granulation tissue.
  • Although neither symptomatic hemorrhage nor late benign recurrence is common, careful long-term follow up is necessary for patients with pilocytic astrocytoma.
  • [MeSH-major] Astrocytoma / pathology. Brain Neoplasms / pathology. Cerebral Hemorrhage / etiology. Neoplasm Recurrence, Local / pathology
  • [MeSH-minor] Adult. Female. Granulation Tissue / pathology. Humans

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  • (PMID = 17527050.001).
  • [ISSN] 0470-8105
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
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3. Witwer BP, Moftakhar R, Hasan KM, Deshmukh P, Haughton V, Field A, Arfanakis K, Noyes J, Moritz CH, Meyerand ME, Rowley HA, Alexander AL, Badie B: Diffusion-tensor imaging of white matter tracts in patients with cerebral neoplasm. J Neurosurg; 2002 Sep;97(3):568-75
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Recently, diffusion-tensor (DT) imaging techniques have been used to map white matter tracts in the normal brain.
  • The aim of this study was to demonstrate the role of DT imaging in preoperative mapping of white matter tracts in relation to cerebral neoplasms.
  • METHODS: Nine patients with brain malignancies (one pilocytic astrocytoma, five oligodendrogliomas, one low-grade oligoastrocytoma, one Grade 4 astrocytoma, and one metastatic adenocarcinoma) underwent DT imaging examinations prior to tumor excision.
  • Depending on the tumor type and location, evidence of white matter tract edema (two patients), infiltration (two patients), displacement (five patients), and disruption (two patients) could be assessed with the aid of DT imaging in each case.
  • The authors' experience with DT imaging indicates that anatomically intact fibers may be present in abnormal-appearing areas of the brain.
  • [MeSH-minor] Adenocarcinoma / secondary. Adult. Aged. Astrocytoma / pathology. Brain Mapping / methods. Female. Glioblastoma / pathology. Humans. Male. Middle Aged

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  • (PMID = 12296640.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Grant] United States / NIMH NIH HHS / MH / R01 MH62015
  • [Publication-type] Case Reports; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
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4. Akimoto J, Namatame H, Haraoka J, Kudo M: Epithelioid glioblastoma: a case report. Brain Tumor Pathol; 2005;22(1):21-7
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  • Her brain computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a well-circumscribed, heterogeneously enhanced tumor in the right thalamus.
  • Histological examination revealed a moderate number of tumor cells with fine bipolar processes in a mucoid matrix, which suggested pilocytic astrocytoma.
  • Immunohistochemically, the tumor cells were positive for glial fibrillary acidic protein (GFAP) and vimentin in the area resembling pilocytic astrocytoma, but in the epithelioid area they were negative for GFAP and vimentin as well as for breast cancer markers, including AE1/AE3.
  • The proliferating potential, represented by the MIB-1 labeling index, was high (82.5%) in the area of epithelioid appearance, compared to only 3% in the area of pilocytic astrocytoma-like appearance.
  • [MeSH-minor] Adult. Antineoplastic Agents, Hormonal / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Breast Neoplasms / drug therapy. Breast Neoplasms / pathology. Breast Neoplasms / surgery. Carcinoma, Ductal, Breast / drug therapy. Carcinoma, Ductal, Breast / pathology. Carcinoma, Ductal, Breast / surgery. Chemotherapy, Adjuvant. Combined Modality Therapy. Female. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Neurosurgical Procedures. Radiotherapy, Adjuvant. Tomography, X-Ray Computed

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  • (PMID = 18095100.001).
  • [ISSN] 1861-387X
  • [Journal-full-title] Brain tumor pathology
  • [ISO-abbreviation] Brain Tumor Pathol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Hormonal
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5. Lesser GJ: Chemotherapy of low-grade gliomas. Semin Radiat Oncol; 2001 Apr;11(2):138-44
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  • [Title] Chemotherapy of low-grade gliomas.
  • Histologic subtypes of low-grade gliomas include pilocytic astrocytomas (World Health Organization [WHO] grade I), diffuse infiltrating astrocytomas, oligodendrogliomas, and mixed oligo-astrocytomas (WHO grade II).
  • Although extended survival is typical with these tumors, most patients eventually succumb to recurrent or progressive disease despite receiving either adjuvant radiation therapy or radiation at the time of recurrence.
  • Not surprisingly, chemotherapy for low-grade gliomas has primarily been evaluated in the salvage setting of postradiotherapy progression in both adults and children.
  • Unfortunately, the published body of literature describing chemotherapy for these tumors is small and subject to a number of confounding methodologic limitations.
  • Nonetheless, some guidelines for the use of chemotherapy in these patients can be inferred from the published experience.
  • The data reviewed clearly identifies a potential benefit for PCV chemotherapy (procarbazine, CCNU, and vincristine) in at least a subset of patients with low-grade oligodendroglial tumors.
  • Nitrosoureas and platinum agents appear to have modest efficacy in recurrent oligodendroglial tumors and in some patients with newly diagnosed or progressive low-grade astrocytomas; however, surgery and radiation remain the primary treatment modalities for this group of malignancies.
  • Until new data becomes available, chemotherapy still should be used only as a salvage option in previously irradiated patients with recurrent or progressive low-grade gliomas.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Astrocytoma / drug therapy. Oligodendroglioma / drug therapy. Salvage Therapy
  • [MeSH-minor] Adolescent. Adult. Brain Neoplasms / drug therapy. Brain Neoplasms / radiotherapy. Brain Neoplasms / surgery. Child. Child, Preschool. Humans. Lomustine / administration & dosage. Middle Aged. Neoplasm Staging. Procarbazine / administration & dosage. Vincristine / administration & dosage

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  • [Copyright] Copyright 2001 by W.B. Saunders Company
  • (PMID = 11285551.001).
  • [ISSN] 1053-4296
  • [Journal-full-title] Seminars in radiation oncology
  • [ISO-abbreviation] Semin Radiat Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 35S93Y190K / Procarbazine; 5J49Q6B70F / Vincristine; 7BRF0Z81KG / Lomustine; PCV protocol
  • [Number-of-references] 32
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6. Franz DN, Leonard J, Tudor C, Chuck G, Care M, Sethuraman G, Dinopoulos A, Thomas G, Crone KR: Rapamycin causes regression of astrocytomas in tuberous sclerosis complex. Ann Neurol; 2006 Mar;59(3):490-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • We sought to see whether therapy with oral rapamycin could affect growth or induce regression in astrocytomas associated with TSC.
  • METHODS: Five subjects with clinically definite TSC and either subependymal giant cell astrocytomas (n = 4) or a pilocytic astrocytoma (n = 1) were treated with oral rapamycin at standard immunosuppressive doses (serum levels 5-15 ng/ml) from 2.5 to 20 months.
  • Magnetic resonance imaging scans were performed before and at regular intervals following initiation of therapy.
  • Interruption of therapy resulted in regrowth of subependymal giant cell astrocytomas in one patient.
  • Resumption of therapy resulted in further regression.
  • Treatment was well tolerated.
  • INTERPRETATION: Oral rapamycin therapy can induce regression of astrocytomas associated with TSC and may offer an alternative to operative therapy of these lesions.
  • [MeSH-major] Astrocytoma / drug therapy. Astrocytoma / etiology. Brain Neoplasms / drug therapy. Immunosuppressive Agents. Regression (Psychology). Sirolimus / therapeutic use. Tuberous Sclerosis / complications
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Dose-Response Relationship, Drug. Female. Humans. Magnetic Resonance Imaging / methods. Male. Models, Biological


7. Aarsen FK, Van Dongen HR, Paquier PF, Van Mourik M, Catsman-Berrevoets CE: Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology; 2004 Apr 27;62(8):1311-6
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  • [Title] Long-term sequelae in children after cerebellar astrocytoma surgery.
  • OBJECTIVE: To study long-term effects on neurologic, neuropsychological, and behavioral functioning in children treated for cerebellar pilocytic astrocytoma (CPA) without additional radio- and chemotherapy.
  • CONCLUSION: Despite the current opinion of a good quality of life after CPA treatment, careful long-term neurocognitive follow-up is needed in order to inform parents and teachers about the behavioral and cognitive sequelae and to contribute to timely social and educational intervention.
  • [MeSH-major] Astrocytoma / surgery. Cerebellar Neoplasms / surgery. Nervous System Diseases / diagnosis. Nervous System Diseases / etiology. Neurosurgical Procedures / adverse effects
  • [MeSH-minor] Adolescent. Adult. Apraxias / diagnosis. Apraxias / etiology. Child. Dysarthria / diagnosis. Dysarthria / etiology. Female. Follow-Up Studies. Humans. Language Disorders / diagnosis. Language Disorders / etiology. Male. Memory Disorders / diagnosis. Memory Disorders / etiology. Mental Disorders / diagnosis. Mental Disorders / etiology. Neurologic Examination. Neuropsychological Tests. Perceptual Disorders / diagnosis. Perceptual Disorders / etiology. Time

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  • (PMID = 15111667.001).
  • [ISSN] 1526-632X
  • [Journal-full-title] Neurology
  • [ISO-abbreviation] Neurology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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8. Stieber VW: Low-grade gliomas. Curr Treat Options Oncol; 2001 Dec;2(6):495-506
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  • The most common variants are pilocytic and low-grade astrocytomas, oligodendrogliomas, and mixed oligo-astrocytomas located in the cerebral hemispheres.
  • Prognostic factors that predict progression-free and overall survival include young age, pilocytic histology, good Karnofsky performance status, gross total resection, lack of enhancement on imaging, and small preoperative tumor volumes.
  • Dexamethasone is given at an initial dosage of 4 mg given four times daily.
  • It may be considered for any pilocytic astrocytoma from which a biopsy has been performed.
  • Based on prospective randomized phase III trials, 50.4 Gy to 54 Gy of conventionally fractionated radiotherapy appears to be a safe and effective regimen with minimal neurotoxicity; 45 Gy may be adequate for biopsied pilocytic astrocytomas.
  • Currently, RTOG trial 98-02 is investigating the efficacy of postradiation PCV chemotherapy (procarbazine, CCNU, and vincristine) in the treatment of newly diagnosed unfavorable low-grade gliomas.
  • Other areas of investigation include Temozolomide chemotherapy and the association of 1p and 19q chromosomal deletions with prolonged survival in oligodendrogliomas and sensitivity to PCV chemotherapy.
  • Radiosurgery and/or experimental chemotherapy may provide some measure of local control in the recurrent disease setting.
  • [MeSH-minor] Adolescent. Adult. Anti-Inflammatory Agents / therapeutic use. Anticonvulsants / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Edema / drug therapy. Brain Edema / etiology. Chemotherapy, Adjuvant. Combined Modality Therapy. Cranial Irradiation. Craniotomy. Dexamethasone / therapeutic use. Epidemiologic Methods. Forecasting. Humans. Prognosis. Radiosurgery. Radiotherapy Dosage. Radiotherapy, Adjuvant / adverse effects. Seizures / drug therapy. Seizures / etiology. Survival Analysis. Survival Rate. Treatment Outcome

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  • (PMID = 12057095.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Anti-Inflammatory Agents; 0 / Anticonvulsants; 7S5I7G3JQL / Dexamethasone
  • [Number-of-references] 57
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9. Cohen KJ, Broniscer A, Glod J: Pediatric glial tumors. Curr Treat Options Oncol; 2001 Dec;2(6):529-36
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Glial neoplasms in children comprise many heterogeneous tumors that include pilocytic and fibrillary astrocytomas, ependymomas, and the diffuse intrinsic pontine gliomas.
  • In addition, although most adult gliomas are supratentorial in location, in pediatrics infratentorial tumors (posterior fossa and brain stem) predominate.
  • We discuss three specific tumors: diffuse intrinsic pontine gliomas; pilocytic astrocytomas; and ependymomas.
  • Maximal surgical resection is the mainstay of therapy for both pilocytic astrocytomas and ependymomas.
  • Failure to achieve an optimal resection often results in progression and the need for further therapy for patients with pilocytic astrocytomas, and is ultimately fatal in most children with subtotally resected ependymomas.
  • Surgical resection has no role in the treatment of pontine gliomas.
  • Focal radiation therapy is included routinely in the treatment of ependymomas, and it has been shown to improve event-free survival.
  • This therapy also is used in the treatment of pontine gliomas because radiation treatment appears to slow inevitable tumor progression.
  • Radiation therapy in pilocytic astrocytomas is generally reserved for patients who progress after an initial surgical resection or for those patients with midline tumors; these patients are poor candidates for aggressive surgical resection.
  • The role of chemotherapy in these tumors is in evolution.
  • Chemotherapy for pilocytic astrocytomas, particularly in young children (for whom radiation therapy is avoided), appears to be effective in the treatment of a subset of patients.
  • Up-front chemotherapy is generally reserved for the youngest children who present with ependymoma.
  • In the recurrence setting, chemotherapy has shown some activity, although this approach is never curative.
  • Despite the application of various chemotherapeutics and other biologic agents, none of these therapies has improved the prognosis for patients with the uniformly lethal pontine glioma.
  • [MeSH-major] Brain Neoplasms / therapy. Glioma / therapy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Astrocytoma / mortality. Astrocytoma / therapy. Cerebrospinal Fluid Shunts. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Cranial Irradiation. Craniotomy. Disease Progression. Ependymoma / mortality. Ependymoma / therapy. Epidemiologic Methods. Humans. Hydrocephalus / etiology. Hydrocephalus / surgery. Infant. Infratentorial Neoplasms / mortality. Infratentorial Neoplasms / therapy. Palliative Care. Pons. Prognosis. Radiotherapy, Adjuvant. Treatment Outcome

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  • (PMID = 12057098.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 30
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10. Koeller KK, Rushing EJ: From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation. Radiographics; 2004 Nov-Dec;24(6):1693-708
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] From the archives of the AFIP: pilocytic astrocytoma: radiologic-pathologic correlation.
  • Pilocytic astrocytoma is the most common pediatric central nervous system glial neoplasm and the most common pediatric cerebellar tumor.
  • Surgical resection is the treatment of choice for all tumors, except for those involving the optic pathway and hypothalamic region, which may be treated with radiation therapy and chemotherapy.
  • Accurate interpretation of imaging studies plays an essential role in directing treatment of these tumors, particularly when they arise in the optic pathway of patients with neurofibromatosis type 1.
  • [MeSH-major] Astrocytoma / pathology. Astrocytoma / radiography. Tomography, X-Ray Computed
  • [MeSH-minor] Adult. Child. Humans

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  • (PMID = 15537977.001).
  • [ISSN] 1527-1323
  • [Journal-full-title] Radiographics : a review publication of the Radiological Society of North America, Inc
  • [ISO-abbreviation] Radiographics
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 98
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11. Hadjipanayis CG, Kondziolka D, Gardner P, Niranjan A, Dagam S, Flickinger JC, Lunsford LD: Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary. J Neurosurg; 2002 Jul;97(1):56-64
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  • [Title] Stereotactic radiosurgery for pilocytic astrocytomas when multimodal therapy is necessary.
  • OBJECT: The goal of this study was to examine the role of stereotactic radiosurgery in the treatment of patients with recurrent or unresectable pilocytic astrocytomas.
  • METHODS: During a 13-year interval, 37 patients (median age 14 years) required multimodal treatment of recurrent or unresectable pilocytic astrocytomas.
  • Multimodal treatment included fractionated radiation therapy in 10 patients, stereotactic intracavitary irradiation of tumor in four, chemotherapy in two, cyst drainage in six, ventriculoperitoneal shunt placement in three, and additional cytoreductive surgery in four.
  • The median radiosurgical dose to the tumor margin was 15 Gy (range 9.6-22.5 Gy).
  • No procedure-related death was encountered.
  • CONCLUSIONS: Stereotactic radiosurgery is a valuable adjunctive strategy in the management of recurrent or unresectable pilocytic astrocytomas.
  • Despite the favorable histological characteristics and prognosis usually associated with this neoplasm, an adverse location, recurrence, or progression of this disease requires alternative therapeutic approaches such as radiosurgery.
  • [MeSH-major] Astrocytoma / surgery. Astrocytoma / therapy. Brain Stem Neoplasms / surgery. Brain Stem Neoplasms / therapy. Radiosurgery
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / administration & dosage. Antineoplastic Agents, Phytogenic / administration & dosage. Biopsy. Child. Child, Preschool. Cisplatin / administration & dosage. Combined Modality Therapy. Cysts / surgery. Female. Follow-Up Studies. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Prognosis. Radiotherapy / adverse effects. Retrospective Studies. Treatment Outcome. Vincristine / administration & dosage

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  • (PMID = 12134933.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Phytogenic; 5J49Q6B70F / Vincristine; Q20Q21Q62J / Cisplatin
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12. Kraus JA, Wenghoefer M, Schmidt MC, von Deimling A, Berweiler U, Roggendorf W, Diete S, Dietzmann K, Müller B, Heuser K, Reifenberger G, Schlegel U: Long-term survival of glioblastoma multiforme: importance of histopathological reevaluation. J Neurol; 2000 Jun;247(6):455-60
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  • We compared two age- and gender-matched patient groups with different postoperative time to tumor progression (TTP), defined as "short-term" for TTP of less than 6 months (n = 54), and "long-term" for TTP of more than 12 months (n = 52).
  • In addition, three were reclassified as anaplastic astrocytoma (WHO grade III), and one was identified as anaplastic pilocytic astrocytoma (WHO grade III).
  • The correct histopathological recognition of these tumors has not only prognostic but also therapeutic implications, since oligodendroglial tumors are more likely to respond favorably to chemotherapy.
  • [MeSH-minor] Adult. Aged. Diagnostic Errors. Female. Humans. Male. Middle Aged. Observer Variation. Retrospective Studies. Survival Rate. Time Factors

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  • (PMID = 10929275.001).
  • [ISSN] 0340-5354
  • [Journal-full-title] Journal of neurology
  • [ISO-abbreviation] J. Neurol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] GERMANY
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13. Lesniak MS, Klem JM, Weingart J, Carson BS Sr: Surgical outcome following resection of contrast-enhanced pediatric brainstem gliomas. Pediatr Neurosurg; 2003 Dec;39(6):314-22
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  • Fifty-seven patients (64.0%) underwent surgical resection while 32 (36%) were treated with radiation and/or chemotherapy.
  • The pathology was consistent with juvenile pilocytic astrocytoma in 30 patients (52.6%) and glioblastoma multiforme in 12 patients (21.1%).
  • Consequently, we recommend surgical resection and pathological diagnosis of all enhancing brainstem tumors with adjuvant therapy reserved for recurrent or unresectable cases.
  • [MeSH-minor] Adolescent. Adult. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Contrast Media / administration & dosage. Female. Humans. Infant. Male. Prognosis. Radiotherapy, Adjuvant. Retrospective Studies. Sensitivity and Specificity. Survival Analysis. Treatment Outcome

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  • [Copyright] Copyright 2003 S. Karger AG, Basel
  • [CommentIn] Pediatr Neurosurg. 2004 Mar-Apr;40(2):99; author reply 100 [15292646.001]
  • (PMID = 14734866.001).
  • [ISSN] 1016-2291
  • [Journal-full-title] Pediatric neurosurgery
  • [ISO-abbreviation] Pediatr Neurosurg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Contrast Media
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14. Salgado JV, Costa-Silva M, Malloy-Diniz LF, Siqueira JM, Teixeira AL: Prefrontal cognitive dysfunction following brainstem lesion. Clin Neurol Neurosurg; 2007 May;109(4):379-82
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  • A 29-year-old man developed several cognitive and behavioral symptoms after neurosurgery for resection of a pilocytic astrocytoma in the pontine-mesencephalic area.
  • Interestingly, the cognitive symptoms improved after treatment with methylphenidate, which is a drug that modules catecholaminergic neurotransmission, thereby supporting this hypothesis.
  • [MeSH-major] Astrocytoma / surgery. Brain Stem Neoplasms / surgery. Cognition Disorders / physiopathology. Postoperative Complications / physiopathology. Prefrontal Cortex / physiopathology
  • [MeSH-minor] Adolescent. Adult. Attention / drug effects. Attention / physiology. Central Nervous System Stimulants / therapeutic use. Educational Status. Follow-Up Studies. Humans. Impulsive Behavior / diagnosis. Impulsive Behavior / drug therapy. Impulsive Behavior / physiopathology. Inhibition (Psychology). Interpersonal Relations. Learning Disorders / diagnosis. Learning Disorders / drug therapy. Learning Disorders / physiopathology. Male. Methylphenidate / therapeutic use. Neuropsychological Tests. Problem Solving / drug effects. Problem Solving / physiology

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  • (PMID = 17275997.001).
  • [ISSN] 0303-8467
  • [Journal-full-title] Clinical neurology and neurosurgery
  • [ISO-abbreviation] Clin Neurol Neurosurg
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Central Nervous System Stimulants; 207ZZ9QZ49 / Methylphenidate
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15. Endo H, Kumabe T, Jokura H, Shirane R, Ariga H, Takai Y, Yoshimoto T: Leptomeningeal dissemination of cerebellar malignant astrocytomas. J Neurooncol; 2003 Jun;63(2):191-9
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  • Primary malignant astrocytomas of the cerebellum are extremely rare, and the dissemination patterns and effectiveness of postoperative radiation therapy are unclear.
  • Five consecutive cases of histologically proven cerebellar malignant astrocytoma, two anaplastic astrocytomas, one anaplastic pilocytic astrocytoma, and two glioblastomas, were treated between 1997 and 2001.
  • Four patients underwent surgical removal, local irradiation, and chemotherapy, and one patient with anaplastic pilocytic astrocytoma received subtotal removal followed by gamma knife radiosurgery for the residual tumor.
  • All patients developed leptomeningeal dissemination.
  • The time interval between the diagnosis of the primary cerebellar tumor and the diagnosis of leptomeningeal dissemination was 5-29 months (mean 14.6 +/- 10.4 months).
  • Intensive treatment including chemotherapy and radiotherapy may be required in cerebellar malignant astrocytomas, considering the high incidence of symptomatic leptomeningeal dissemination.
  • [MeSH-major] Astrocytoma / secondary. Cerebellar Neoplasms / pathology. Meningeal Neoplasms / secondary
  • [MeSH-minor] Adult. Aged. Cerebral Ventricles / pathology. Child. Female. Humans. Magnetic Resonance Imaging. Middle Aged. Survival Rate. Treatment Outcome

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  • (PMID = 12825824.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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16. Vinchon M, Dhellemmes P: [Third ventricle tumors in children]. Neurochirurgie; 2000 Jun;46(3):323-34
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  • [Transliterated title] Particularités pédiatriques des tumeurs du troisième ventricule.
  • Tumors of the third ventricle in children raise specific problems, owing to their clinical presentation, pathology, treatment, and outcome.
  • Some histological types are specific of the pediatric group, such as the pilocytic astrocytoma or hypothalamic hamartoma, and others types which are exceptional in adults are relatively common in children, such as choroid plexus tumors.
  • Chemotherapy has reduced the indication of irradiation, and, in some cases, can be performed preoperatively to reduce tumor volume and intraoperative blood loss.
  • The therapeutic approach to these patients is thus pluridisciplinar, and should be tailored for each case, with a follow-up protracted well into the adult age.

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  • (PMID = 10854989.001).
  • [ISSN] 0028-3770
  • [Journal-full-title] Neuro-Chirurgie
  • [ISO-abbreviation] Neurochirurgie
  • [Language] fre
  • [Publication-type] English Abstract; Journal Article; Review
  • [Publication-country] FRANCE
  • [Number-of-references] 60
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17. Salmaggi A, Fariselli L, Milanesi I, Lamperti E, Silvani A, Bizzi A, Maccagnano E, Trevisan E, Laguzzi E, Rudà R, Boiardi A, Soffietti R, Associazione Italiana di Neuro-oncologia: Natural history and management of brainstem gliomas in adults. A retrospective Italian study. J Neurol; 2008 Feb;255(2):171-7
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  • In this retrospective study, we report clinical features at onset, imaging characteristics and subsequent course in a group of 34 adult patients with either histologically proven or clinico-radiologically diagnosed brainstem gliomas followed at two centers in Northern Italy.
  • In 21 of the patients histology was obtained and in 20 it was informative (2 pilocytic astrocytoma, 9 low-grade astrocytoma, 8 anaplastic astrocytoma and 1 glioblastoma).
  • In 8 of the patients, an initial watch and wait policy was adopted, while 24 were treated shortly after diagnosis with either radiotherapy alone [4] or radiotherapy and chemotherapy [20] (mostly temozolomide).
  • Only minor radiological responses were observed after treatments; in a significant proportion of patients (9 out of 15) clinical improvement during therapy occurred in the context of radiologically (MRI) stable disease.
  • Median overall survival time was of 59 months.
  • Investigation of putative prognostically relevant parameters showed that a short time between disease onset and diagnosis was related to a shorter survival.
  • Compared with literature data, our study confirms the clinical and radiological heterogeneity of adult brainstem gliomas and underscores the need for multicenter trials in order to assess the efficacy of treatments in these tumors.
  • [MeSH-major] Brain Stem Neoplasms / pathology. Brain Stem Neoplasms / therapy. Glioma / pathology. Glioma / therapy
  • [MeSH-minor] Adolescent. Adult. Aged. Antineoplastic Agents / adverse effects. Antineoplastic Agents / therapeutic use. Brain / pathology. Disease Progression. Female. Fluorodeoxyglucose F18. Humans. Image Processing, Computer-Assisted. Italy. Magnetic Resonance Imaging. Male. Middle Aged. Positron-Emission Tomography. Prognosis. Radiopharmaceuticals. Retrospective Studies. Spinal Cord / pathology. Survival Analysis. Treatment Outcome

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  • (PMID = 18293027.001).
  • [ISSN] 0340-5354
  • [Journal-full-title] Journal of neurology
  • [ISO-abbreviation] J. Neurol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Radiopharmaceuticals; 0Z5B2CJX4D / Fluorodeoxyglucose F18
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18. Badhe PB, Chauhan PP, Mehta NK: Brainstem gliomas--a clinicopathological study of 45 cases with p53 immunohistochemistry. Indian J Cancer; 2004 Oct-Dec;41(4):170-4
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  • Diffuse astrocytomas were seen in 40 cases (5% were Grade I, 47.5%Grade II, 32.5% Grade III and 15% Grade IV) and pilocytic astrocytomas in 5 cases.
  • Grade II astrocytomas were treated with excision and radiotherapy, while grade III and IV tumors were treated with radiotherapy and chemotherapy (CCNU).
  • It was found in 50 % of glioblastoma multiforme, 28.57% of grade III astrocytoma and 12.5% of grade II astrocytoma, while grade 1 astrocytomas failed to express p53 protein. p53 positivity was more in high grade lesions, decreasing significantly in lower grade lesions.
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Female. Humans. Immunohistochemistry. India / epidemiology. Infant. Infant, Newborn. Male. Middle Aged. Retrospective Studies. Survival Rate

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  • (PMID = 15659871.001).
  • [ISSN] 0019-509X
  • [Journal-full-title] Indian journal of cancer
  • [ISO-abbreviation] Indian J Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] India
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Tumor Suppressor Protein p53
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19. Hadjipanayis CG, Kondziolka D, Flickinger JC, Lunsford LD: The role of stereotactic radiosurgery for low-grade astrocytomas. Neurosurg Focus; 2003 May 15;14(5):e15
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  • METHODS: During a 13-year interval, 49 patients underwent stereotactic radiosurgery as part of multimodal treatment of their recurrent or unresectable low-grade astrocytomas.
  • Thirty-seven of these patients (median age 14 years) harbored pilocytic astrocytomas and 12 patients harbored World Health Organization (WHO) Grade II fibrillary astrocytomas (median age 25 years).
  • Multimodal treatment included fractionated radiotherapy in 14 patients, stereotactic intracavitary irradiation in five, chemotherapy in two, cyst drainage in eight, ventriculoperitoneal shunt placement in five, and additional cytoreductive surgery in five.
  • The median radiosurgical dose to the tumor margin was 15 Gy (range 9.6-22.5 Gy).
  • No procedure-related death was encountered.
  • CONCLUSIONS: Stereotactic radiosurgery is a potential alternative or adjunctive intervention in the management of selected patients with pilocytic or WHO Grade II fibrillary astrocytomas, usually performed for small-volume tumors in an attempt to avoid larger-field fractionated radiotherapy.
  • [MeSH-major] Astrocytoma / surgery. Brain Neoplasms / surgery. Radiosurgery / methods
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Female. Humans. Male. Middle Aged. Retrospective Studies

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  • (PMID = 15669811.001).
  • [ISSN] 1092-0684
  • [Journal-full-title] Neurosurgical focus
  • [ISO-abbreviation] Neurosurg Focus
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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20. Beppu T, Inoue T, Shibata Y, Kurose A, Arai H, Ogasawara K, Ogawa A, Nakamura S, Kabasawa H: Measurement of fractional anisotropy using diffusion tensor MRI in supratentorial astrocytic tumors. J Neurooncol; 2003 Jun;63(2):109-16
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  • In vivo, water diffusion displays directionality due to presence of complex microstructural barriers in tissue.
  • After biopsy, FA values were compared to assess the cellularity and vascularity of tumor tissue.
  • Although mean FA values trended to differ among histological types, all mean tumor FA values were lower than those of normal brain regions.
  • However, our results suggest that the FA values of glioblastoma, anaplastic astrocytoma, diffuse astrocytoma and pilocytic astrocytoma are largely affected by cellularity and/or vascularity, whereas that of gliomatosis cerebri are largely affected by the preservation of nerve fibers.
  • [MeSH-major] Astrocytoma / diagnosis. Brain Neoplasms / diagnosis. Diffusion Magnetic Resonance Imaging
  • [MeSH-minor] Adult. Aged. Anisotropy. Body Water / metabolism. Brain / metabolism. Diagnosis, Differential. Female. Humans. Male. Middle Aged

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  • (PMID = 12825815.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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21. Bommakanti K, Panigrahi M, Yarlagadda R, Sundaram C, Uppin MS, Purohit AK: Optic chiasmatic-hypothalamic gliomas: is tissue diagnosis essential? Neurol India; 2010 Nov-Dec;58(6):833-40
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Optic chiasmatic-hypothalamic gliomas: is tissue diagnosis essential?
  • The advocated treatment is mainly primary radiotherapy without a histological diagnosis.
  • PATIENTS AND METHODS: The magnetic resonance imaging (MRI) characteristics of 24 patients with either histologically proven optic chiasmatic "pilocytic astrocytoma" or radiologically suspected optic chiasmatic-hypothalamic gliomas were analyzed.
  • RESULTS: The three radiological groups were: Group-1 solid tumors with or without microcysts in 9 patients (histology: 8 pilocystic astrocytomas and 1 tuberculoma); Group-2 mixed tumors with solid and cystic components in 9 patients (histology: 7 pilocytic astrocytomas and 2 craniopharyngiomas); Group-3 ring enhancing lesions in 6 patients (all the 6 patients initially received antituberculous treatment, in 3 patients the lesion resolved and in the remaining 3 patients the lesion was subjected to biopsy as it did not resolve, the biopsy was suggestive of pilocytic astrocytoma).
  • Biopsy and tissue diagnosis should always be sought before instituting radiotherapy or chemotherapy for optic chiasmatic-hypothalamic gliomas.
  • [MeSH-minor] Adolescent. Biopsy / methods. Child. Child, Preschool. Contrast Media. Female. Humans. Magnetic Resonance Imaging / methods. Male. Young Adult

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  • [CommentIn] Neurol India. 2011 Jan-Feb;59(1):144 [21339694.001]
  • (PMID = 21150045.001).
  • [ISSN] 0028-3886
  • [Journal-full-title] Neurology India
  • [ISO-abbreviation] Neurol India
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] India
  • [Chemical-registry-number] 0 / Contrast Media
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22. Hukin J, Siffert J, Velasquez L, Zagzag D, Allen J: Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors. Neuro Oncol; 2002 10;4(4):253-60
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  • Satisfactorily followed data were obtained on 427 of the 588 patients with localized LGN at diagnosis between 1986 and 1998, 177 (42%) of whom developed progressive or recurrent disease.
  • The histologies were pilocytic astrocytoma (4), ganglioglioma (4), fibrillary astrocytoma (3), mixed glioma (1), and glioneurofibroma (1).
  • Management included chemotherapy (2) or radiotherapy (3) or both (7); 1 patient received only radical resections of symptomatic lesions.
  • We strongly urge that for optimum treatment planning all patients with recurrent LGN be staged with an enhanced spine and brain MRI before adjuvant therapy is initiated.
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Disease Progression. Female. Humans. Infant. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local / epidemiology. Neoplasm Recurrence, Local / therapy. Survival Analysis. Treatment Outcome

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  • (PMID = 12356355.001).
  • [ISSN] 1522-8517
  • [Journal-full-title] Neuro-oncology
  • [ISO-abbreviation] Neuro-oncology
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC1920666
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23. Nishio S, Morioka T, Fujii K, Inamura T, Fukui M: Spinal cord gliomas: management and outcome with reference to adjuvant therapy. J Clin Neurosci; 2000 Jan;7(1):20-3
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Spinal cord gliomas: management and outcome with reference to adjuvant therapy.
  • The authors review their experience with 19 consecutive cases with either astrocytic tumour (glioblastoma multiforme one, anaplastic astrocytoma one, astrocytoma 4, pilocytic astrocytoma 4) or ependymoma (10 tumours in 9 patients) of the spinal cord who were treated during the period from 1982 to 1996.
  • While a total removal of the tumour was achieved in 8 out of 10 ependymomas, the initial treatment for astrocytic tumours was a partial resection in 5, and biopsy in the remaining 5.
  • As adjuvant treatment, 8 patients received radiation therapy and 2 received chemotherapy.
  • Two patients with an astrocytic tumour received chemotherapy only, while the remaining 9 received neither radiation therapy nor chemotherapy initially.
  • After these treatments, 6 out of the 8 patients with low grade astrocytoma have remained alive for 1.3-12.6 years, while 2 patients with high grade astrocytic tumours died within 15 months following surgery.
  • The postoperative results and the rationale for surgery is discussed, and an approach for utilising adjuvant therapy for high grade tumours is also suggested.
  • [MeSH-major] Astrocytoma / surgery. Ependymoma / surgery. Spinal Cord Neoplasms / surgery
  • [MeSH-minor] Adolescent. Adult. Aged. Chemotherapy, Adjuvant. Child, Preschool. Female. Glioblastoma / drug therapy. Glioblastoma / radiotherapy. Glioblastoma / surgery. Humans. Infant. Male. Middle Aged. Postoperative Care. Radiotherapy, Adjuvant. Retrospective Studies

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  • (PMID = 10847645.001).
  • [ISSN] 0967-5868
  • [Journal-full-title] Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
  • [ISO-abbreviation] J Clin Neurosci
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] SCOTLAND
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24. Cao Z, Lv J, Wei X, Quan W: Appliance of preoperative diffusion tensor imaging and fiber tractography in patients with brainstem lesions. Neurol India; 2010 Nov-Dec;58(6):886-90
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • OBJECTIVE: To summarize the experience of surgical treatment of brainstem lesions with the assistance of DTI and fiber tractography.
  • Total resection was achieved in two patients with brainstem cavernomas and two patients with pilocytic astrocytoma.
  • The neurological functional status was better than preoperative period in eight patients, one patient with medulla oblongata astrocytoma deteriorated.
  • At the time of the last follow-up, the average postoperative score had improved by 0.56 to 1.66 points.
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Female. Humans. Imaging, Three-Dimensional. Male. Neurosurgery / methods. Preoperative Care. Retrospective Studies. Young Adult

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  • (PMID = 21150055.001).
  • [ISSN] 0028-3886
  • [Journal-full-title] Neurology India
  • [ISO-abbreviation] Neurol India
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] India
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25. Colosimo C, Cerase A, Maira G: Regression after biopsy of a pilocytic opticochiasmatic astrocytoma in a young adult without neurofibromatosis. Neuroradiology; 2000 May;42(5):352-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Regression after biopsy of a pilocytic opticochiasmatic astrocytoma in a young adult without neurofibromatosis.
  • Serial MRI over 60 months demonstrated regression after biopsy of a pilocytic opticochiasmatic astrocytoma in a 20-year-old woman with no signs of neurofibromatosis, together with improvement in vision.
  • The patient did not receive radio- or chemotherapy.
  • Aggressive treatment should be limited to cases with clear clinical and radiological progression.
  • [MeSH-major] Astrocytoma / pathology. Optic Chiasm / pathology. Optic Nerve Neoplasms / pathology
  • [MeSH-minor] Adult. Biopsy. Female. Humans. Magnetic Resonance Imaging. Remission, Spontaneous

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  • (PMID = 10872155.001).
  • [ISSN] 0028-3940
  • [Journal-full-title] Neuroradiology
  • [ISO-abbreviation] Neuroradiology
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] GERMANY
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26. Hargrave D: Paediatric high and low grade glioma: the impact of tumour biology on current and future therapy. Br J Neurosurg; 2009 Aug;23(4):351-63
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Paediatric high and low grade glioma: the impact of tumour biology on current and future therapy.
  • Gliomas are the most common type of paediatric brain tumour and range from benign low grade gliomas which can be resected/observed to aggressive brainstem gliomas with dismal survival rates.
  • Current therapies rely on neurosurgery, radiotherapy, chemotherapy or combination of these conventional modalities and although histopathology helps to direct therapy, molecular pathology has so far not played a major role in the management of paediatric glioma.
  • However, increasing knowledge of glioma biology is starting to impact on drug development towards targeted therapies.
  • Pilocytic astrocytoma, the most common childhood low grade brain tumour, has recently been shown to harbour an activated BRAF/MAPK/ERK pathway in the majority of cases; this represents an attractive target for new agents.
  • The molecular biology of adult malignant glioma is now well described and targeted therapies against VEGFR are already playing a role in the management of glioblastoma.
  • However, selection for specific targeted therapy is unlikely to be based on, or restricted by, age but will require individual case by case testing for target presence in order to direct and maximise the efficacy of molecular therapy.
  • Brainstem glioma remains a tumour with a dismal prognosis but relatively little is known about the underlying biology and progress will require a concerted effort to collect tissue by biopsy and autopsy to allow appropriate analysis to identify and validate targets.
  • A new era of molecular based therapies offers the promise of major benefits in the management of paediatric glioma but translating this promise into reality will require further understanding of the biology driving these tumours.
  • [MeSH-minor] Adolescent. Adult. Astrocytoma / genetics. Astrocytoma / pathology. Astrocytoma / therapy. Child. Child, Preschool. Combined Modality Therapy. Drug Delivery Systems. Genetic Predisposition to Disease. Genome-Wide Association Study. Hamartoma Syndrome, Multiple / genetics. Humans. Infant. Neoplasm Staging. Neurofibromatosis 1 / genetics. Prognosis. Tuberous Sclerosis / genetics


27. Bohner G, Masuhr F, Distl R, Katchanov J, Klingebiel R, Zschenderlein R, von Deimling A, van Landeghem FK: Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature. Acta Neuropathol; 2005 Sep;110(3):306-11
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature.
  • Spinal leptomeningeal biopsy revealed a pilocytic astrocytoma WHO grade I.
  • Despite chemotherapy with vincristin and carboplatin, the patient died 2 months after admission.
  • Sequence analysis of tumor protein 53 gene (TP53) revealed a missense mutation in exon 5, and expression of phosphatase and tensin homolog (mutated in multiple advanced cancers 1) (PTEN) protein was not detected, which may have contributed to astrocytoma development.
  • To our knowledge, this is the first definitive case of pilocytic astrocytoma presenting as PDLG.
  • [MeSH-major] Astrocytoma / pathology. Meningeal Neoplasms / pathology. Meninges / pathology. Neoplasms, Neuroepithelial / pathology. Neoplasms, Unknown Primary / pathology. Subarachnoid Space / pathology
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Biomarkers, Tumor / genetics. Brain / pathology. Brain / physiopathology. Diagnosis, Differential. Fatal Outcome. Humans. Magnetic Resonance Imaging. Male. Mutation / genetics. Spinal Cord / pathology. Spinal Cord / physiopathology. Spinal Cord Compression / etiology. Spinal Cord Compression / pathology. Spinal Cord Compression / physiopathology. Tumor Suppressor Protein p53 / genetics






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