[Occlusion of the superior sagittal sinus caused by meningioma, intracranial volume-pressure relations and brain edema]

Fifty-one cases of parasagittal meningiomas were analysed. In 37 cases the tumour was situated in the middle and posterior part of the falx. In 17 cases occlusion of the superior sagittal sinus was diagnosed and confirmed by angiography. No correlation was found between the extent of brain oedema and sinus occlusion and tumour size. However, extensive oedema was present in tumours of high malignancy. Occlusion of the sagittal sinus caused no increase of intracranial pressure or venous stasis. This suggests that sinus occlusion caused by meningioma is completely compensated and has no effect on the preoperative and postoperative course.

Circulating glycoconjugates in CSF of meningioma patients

This study investigated whether tumor-associated gangliosides or glycoproteins may be markers for meningiomas in CSF. The concentrations of a number of gangliosides and sulphatide were determined with specific monoclonal antibodies and cholera toxin B-subunit in a thin-layer chromatography overlay technique. As compared to a reference group of 10 individuals (mean age 50 +/- 14 years), the CSF samples from 7 meningioma patients (mean age 55 +/- 12 years) were found to contain significantly increased concentrations of ganglioside GD3 [II3(NeuAc)2-LacCer], one of the major gangliosides in meningioma tissue specimens. Sulphatide was significantly increased in 6 of 7 patients. Tumor-associated glycoproteins detected by the lectin Ricinus communis 1 in meningioma tissue specimens, but not in normal human brain tissue, were also found in the CSF of the meningioma patients. An early diagnosis of meningiomas might be achieved by the combined assay in CSF of ganglioside GD3 and glycoproteins with Ricinus communis lectin.

Cerebrospinal fluid carcinoembryonic antigen and alphafetoprotein in patients with central nervous system neoplasia

A solid phase immunoassay was used to evaluate the levels of serum and cerebrospinal fluid of alphafetoprotein and carcinoembryonic antigen in 33 individuals treated for backache and headache with no evidence of organic neurological disease, 19 patients with primary CNS tumor (benign or malignant) and 22 with CNS metastasis from a solid tumor. AFP serum and CSF levels were found in trace amounts or slightly elevated not exceeding normal limits in all groups. Patients with CNS metastasis were found to have statistically significant higher CEA levels (both in serum and CSF) than the control group, and the patients with primary brain tumors. Patients with leptomeningeal dissemination had statistically significantly higher CEA CSF levels than did patients with primary tumors, and patients with parenchymal metastasis.

Characteristics of cisternal cerebrospinal fluid associated with primary brain tumors in the dog: a retrospective study

Results of cisternal CSF analyses of 77 dogs with primary brain tumors (1970 to 1984) were examined retrospectively. The types of primary brain tumors were astrocytomas, choroid plexus papillomas, ependymomas, meningiomas, and oligodendrogliomas. Fifty-three dogs had complete CSF analyses performed (total WBC count, total protein content, and pressure). Of these 53 CSF, 39.6% had a pattern of change consistent with current descriptions of CSF associated with brain neoplasia. Results of the remaining 60.4% of the 53 CSF were normal (9.4%) or had an atypical pattern of abnormality (50.9%). The CSF associated with meningiomas was unique in having CSF with a WBC count greater than 50 cells/microliter and a WBC differential count greater than 50% polymorphonuclear (PMN) cells. Within the meningioma group, a predominance of PMN cells in the CSF correlated with necrosis or PMN cell infiltration of the tumors. Additional correlations between specific CSF characteristics and histologic features of the tumors could not be made. Statistical analysis of the 77 CSF revealed that the mean CSF total WBC count of the oligodendroglioma group was significantly less than the mean WBC count of the choroid plexus papilloma group and the meningioma group. The mean CSF total protein contents of the astrocytoma group and the meningioma group were significantly less than the mean protein of the choroid plexus papilloma group. The mean CSF pressure of the tumor groups was not significantly different. For all 77 tumors, the most common abnormality was an increased total protein content (69.4%); the least common abnormality was an increased total WBC count (41.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

MR imaging of intradural extramedullary tumors of the cervical spine

Magnetic resonance imaging was performed in eight patients with extramedullary cervical tumors; two were studied with a 0.15 T resistive system and six with a 0.5 superconductive unit. All tumors were verified surgically: Five meningiomas and three schwannomas were found. Magnetic resonance demonstrated the location and size of the tumors as well as their relationship with and mass effect on the adjacent spinal cord. Meningiomas showed a tendency to have relaxation times close to those of the normal parenchyma; in multiple echo sequences their signal tends to decay in a way similar to that of the spinal cord. The different signal from the surrounding cerebrospinal fluid sometimes provides a visual cleavage to define the extramedullary location of the neoplasm. Schwannomas and neurofibromas have a less constant behavior; their T2 relaxation time may be slightly longer than that of the spinal cord and the tumor may display a more intense signal in the T2 weighted images. Usually, however, the signal intensity of the extramedullary tumors is lower than that of the intramedullary.

Decreased cerebrospinal fluid glutamine levels in patients with benign brain tumors

CSF glutamine concentrations were studied in 12 patients with benign brain tumors (meningioma, craniopharyngioma, or osteofibroma), 12 patients with malignant brain tumors (astrocytoma, medulloblastoma, pinealoblastoma, or chondrosarcoma), 9 patients with noncerebral tumors, and a reference group of 24 patients. The mean +/- SD levels in the benign tumor group (424 +/- 124 microM) were significantly lower (p less than 0.0004) than those in the reference group (642 +/- 195 microM). There was no significant difference between the CSF glutamine concentrations in the malignant cerebral tumor group (643 +/- 210 microM) or noncerebral tumor group (599 +/- 127 microM) and those in the reference group. In patients with benign brain tumors there was indication of an inverse linear relationship between the logarithm of CSF glutamine concentration and tumor diameter.

Concentrations of Ag, Al, Au, Bi, Cd, Cu, Pb, Sb, and Se in cerebrospinal fluid of patients with cerebral neoplasms

We measured the concentrations of nine trace elements in cerebrospinal fluid of 11 patients with malignant brain tumors, 11 with benign brain tumors, and 10 control patients, using flameless atomic absorption spectrophotometry. The mean and standard deviation for these concentrations (microgram/L) in the control group were 5.1 +/- 2.9 (silver), 326.6 +/- 171.2 (aluminum), 38.5 +/- 32.2 (gold), 36.6 +/- 23.7 (bismuth), 1.5 +/- 1.3 (cadmium), 39.8 +/- 24.7 (copper), 15.7 +/- 11.5 (lead), 20.9 +/- 3.8 (antimony), and 19.1 +/- 13.3 (selenium). Concentrations of silver and lead were markedly increased in patients with malignant cerebral neoplasms. The malignant-tumor/control patient concentration ratios were 2.31 for silver and 2.11 for lead. We observed no significant differences between the results for the benign tumor patients and the control group.

[Phasic nature of intracranial hypertension in patients with parasagittal meningiomas]

Complex quantitative determination of the relationship of the cerebrospinal system viscoelastic properties and the CSF dynamics in the brain contributed to identification of the phase character of intracranial hypertension in patients with parasagittal meningiomas and to the disclosure of compensatory mechanisms which come into action during the development of intracranial hypertension. Pathophysiological analysis of the functional condition of these compensatory mechanisms may be of essential importance in deciding on the optimum terms for the surgical treatment of patients with parasagittal meningiomas and for prognosticating the results of neurosurgical operations.

Pathogenesis of raised cerebrospinal fluid pressure

Raised cerebrospinal fluid pressure may be caused by (a) subarachnoid CSF circulation blocks (b) obstruction of CSF absorption in the arachnoid villi (c) disorders of the venous return from the superior sagittal sinus to the heart. The common factor in these mechanisms is obstructed CSF drainage. Some clinical conditions illustrating these principles are reviewed.

The cytopathology of cerebrospinal fluid. II. Metastatic cancer, meningeal carcinomatosis and primary central nervous system neoplasms

The evaluation of cerebrospinal fluid (CSF) requires adaption of basic cytopathologic principles to the specific neoplasms that involve the central nervous system (CNS). In this review, general criteria for detecting malignant cells in CSF are presented. The incidence and cytologic characteristics of specific metastatic tumors that involve CSF are reviewed, and the incidence, pathogenesis and natural history of meningeal carcinomatosis are discussed. The role of cytopathology in the detection and management of primary CNS tumors is presented. Emphasis is placed on the cytologic characteristics of individual types of primary brain tumors and the application of fine needle aspiration biopsy to intracranial lesions.

[Meningitis carcinomatosa (author's transl)]

On the basis of a case report the clinical picture of meningitis carcinomatosa is discussed. The cerebrospinal fluid is the most important criterion for the diagnosis. All other examinations (EEG, brain-scan, X-ray) yield only imperfect information. The clinical picture of meningitis carcinomatosa is similar above all to meningitis tuberculosa. If cerebrospinal fluid shows inflammatory signs and there is a breakdown of cerebral nerves (blindness, deafness) meningitis carcinomatosa always should be considered, even if thorough examination does not succeed in proving a primary tumour.

Concentration of homovanillic acid and 5-hydroxyindoleacetic acid in the ventricular cerebrospinal fluid of patients with obstructive hydrocephalus

In 12 patients with different posterior fossa tumours the concentrations of homovanillic acid (HVA) and of 5-hydroxyindoleacetic acid (5-HIAA) were measured in cerebrospinal fluid from the lateral ventricles. All patients had obstructive hydrocephalus. Patients with a clear increase of 5-HIAA/HVA ratio in the ventricular CSF have died subsequently. This feature may have a diagnostic value, and indicates the prevalence of serotoninergic neurones in patients with obstructive hydrocephalus with fatal course after surgery.

[Diagnostic value of the CSF uric acid level (author's transl)]

Uric acid is the end-product of purine metabolism, and purines are the nitrogenous bases derived from the breakdown of nucleic acids. The CSF uric acid level is thought to be the index of the turnover of the nucleic acid and the degree of the cellular destruction in the brain. CSF uric acid levels were investigated in normal controls (30 cases) and in patients with brain tumor (20 cases), microcephalus (8 cases) and craniostenosis (4 cases). The mean values and standard deviations of CSF uric acid levels in normal controls were as follows; Newborn--9 yrs 0.34 +/- 0.09 mg/dl; 10 yrs--19 yrs 0.50 +/- 0.18 mg/dl; 20 yrs--29 yrs 0.46 +/- 0.05 mg/dl; 30 yrs--39 yrs 0.35 +/- 0.10 mg/dl; 40 yrs--49 yrs 0.35 +/- 0.23 mg/dl. Thereafter 0.72 +/- 0.21 mg/dl. The increased CSF uric acid levels after the age of 50 is thought to be due to the cellular destruction in the brain. CSF uric acid levels increased in patients with highly malignant brain tumor such as grade 3 or 4 astrocytoma and sarcomatous meningioma, but were normal in patients with grade 2 astrocytoma and meningiomas of meingothelial or fibroblastic type. CSF uric acid levels decreased in patients with microcephalus, but were almost normal in patients with craniostenosis. There is a significant correlation between CSF uric acid levels and the degree of brain atrophy in infants.

The course of intracranial pressure and volume-pressure relationships following extirpation of meningiomas and astrocytomas

Thirty-five patients with meningiomas were compared with 37 patients with astrocytomas with respect to the postoperative course of their ICP and elastance. In the case of the meningioma patients, the ICP increased on average over a longer period and achieved higher values than in the astrocytoma patients. In the first group, the elastance attained values that were three times as high as in the second group. There was no fixed relationship between pressure and elastance in the two groups of patients.

[Surface properties of cerebrospinal fluid cells following intrathecal methotrexate treatment]

Authors first in the literature described the surface profile of lymphocytes, plasma cells, phagocytes and malignant lymphoblasts of the liquor after intrathecal Methorexat therapy (i.thec.MTX). After prolonged treatment with MTX the mentioned cells were examined by SEM. The surface of the plasma cells and storage cells was found to be normal. Various stages of the phagocytosis could be observed. On the other hand the majority of lymphoblasts of leukaemic origin after the first administration of i.thec.MTX revealed damaged cell surfaces.

[Endocrinological evaluation of sellar and suprasellar tumor cases (the ninth report)--on the PRL levels in the CSF (author's transl)]

Prolactin (PRL) levels in the cerebrospinal fluid (CSF) and plasma of 25 patients with sellar and suprasellar tumors, i.e. 5 of PRL secreting adenoma, 5 of GH secreting adenoma, 7 of so-called non-functioning pituitary adenoma, 5 of tuberculum sellae meningioma and 3 of craniopharyngioma, were studied in relation to the size of suprasellar extension measured by our own method on pneumoencephalograms. Plasma and CSF samples were obtained simultaneously at the time of lumbar puncture for pneumoencephalography. 1) Five patients of PRL secreting adenoma, whose plasma PRL levels ranged from 530 to 4,000 ng/ml, showed high PRL levels over 50 ng/ml in the CSF. On the contrary, 20 patients of the other tumors, whose plasma PRL levels were lower than 30 ng/ml, showed low PRL levels in th4 CSF, being below the sensitivity limit in the majority. 2) In 3 out of 5 PRL secreting adenomas, the PRL level in the CSF was higher than the plasma level and they showed a fairly large extrasellar extension. However in the remaining 2 the PRL level in the CSF was lower than a tenth of that in the plasma, and these revealed relatively small suprasellar extension. From these facts the presence of PRL at a high level in the CSF seems to be specific in the PRL secreting adenomas, and there seems to be a relationship between the CSF-plasma ratio of PRL level and the extrasellar extension in these cases.

Malignant brain tumours associated with adenylate kinase in cerebrospinal fluid

Adenylate-kinase activity was measured in cerebrospinal fluid (C.S.F.) from 35 healthy control subjects and 11 patients with brain tumours, of which 9 were malignant and 2 benign. No adenylate kinase could be detected in C.S.F. from the controls or from the patients with benign brain tumours. The enzyme was consistently found in C.S.F. from patients with malignant brain tumours.

Cerebrospinal fluid cytology in patients with brain tumors; a simple method using the cell culture technique

A simplified cytologic method using the cell culture technique was employed in 71 cases with brain tumor. Neoplasitc cells were demonstrated in 17 cases (24%), that is in 11 out of 30 cases of glioma, four out of ten cases of metastatic brain tumor, and two out of 17 cases of meningioma. None of 14 other miscellaneous tumors proved positive. Identification of glioma cells could be easily made because they usually showed characteristic morphology and good proliferation in vitro. However, for other types of tumor, conventional methods were considered to be superior to the culture method because their exfoliated cells usually underwent rapid degeneration without showing characteristic morphology during the culture. Some of the illustrative cases were presented.

The relationship of polyamines in cerebrospinal fluid to the presence of central nervous system tumors

Cerebrospinal fluid (CSF) polyamine concentrations were assayed in patients with and without central nervous system tumors, using a high-pressure liquid chromatographic technique. Definite elevations were found in the CFS polyamine concentrations of patients with untreated malignant central nervous system tumors when compared with those concentrations observed in the CSF of patients without neoplasia. Patients undergoing successful tumor therapy for malignant central nervous system tumors showed CSF polyamine concentrations that closely approximated the concentrations found in the CSF of patients without tumor.

Primary leptomeningeal sarcomatosis. Clinicopathological report of six cases

6 autopsy cases of primary leptomeningeal sarcomatosis are presented as a distinct nosological entity with a variable clinical picture and morphology in 5 males and 1 female. The clinical course from onset of symptoms till death ran for only a few weeks in most cases. 2 infants showed brain tumor symptoms and signs. 2 patients of advanced age presented a polyradiculoneuritic syndrome and 2 young adults had spinal cord compression symptoms and a mixed clinical form. In almost all cases, clinical symptoms and signs were for most of the course confined to one part of the neuraxis. The CSF was distinctly abnormal in all cases, showing elevated protein, depressed glucose and pleocytosis of variable extent. CSF sediment was investigated in 3 cases in all of which malignant tumor cells were found so a diagnosis of malignant meningeal tumor was made during life. Electron microscopy of CSF cells in 1 case confirmed the primitive character of the tumor cells. Complete autopsies revealed absence of any neoplasm outside of the CNS. Gross meningeal involvement was visible in all cases. Histologically, 3 tumor types were distinguished: polymorphic cell sarcoma, an undifferentiated form, and fibrosarcomatosis. Clinical data are analyzed in order to distinguish the condition from other neoplasms or infectious, especially tuberculous meningeal infiltrations. CSF cytology studies are considered the most useful step in clinical diagnosis. Neuropathological features are reviewed with stress on differentiation from malignant lymphomas of the CNS, diffusely spreading medulloblastoma, meningeal melanoblastosis and gliomatosis. The origin of meningeal sarcomatosis cells is briefly discussed. The use of the term "meningeal meningiomatosis" for this condition is deprecated.