Clinical Neuroscience

[Reoperation of recurrent supratentorial lobar gliomas (astrocytoma, glioblastoma)]

ÁFRA Dénes1, SIPOS László1

MARCH 20, 1997

Clinical Neuroscience - 1997;50(03-04)

[Hundred-nine patients with recurrent supratentorial gliomas were reoperated during the last 15 years at the National Institute of Neurosurgery, Budapest. The patients were grouped according to the WHO classification based on the first histology. Fifty patients with low grade (A 2), 30 with anaplastic astrocytoma (A 3) and 29 with glioblastoma multiforme (GM) were reoperated on. Nine patients with low grade astrocytoma were irradiated following the first operation. They survived 5 to 14 months (median value 7 months). Those 22 patients who were irradiated after the reoperation survived longer despite the malignant tranformation of their tumour. The median survival time was 24 months. Twenty-four patients with anaplastic astrocytoma received radiotherapy after the first operation in a total dose from 50 to 60 Gy. Six patients did not give their consent. The median survival after the second operation was 5.5 months. Four patients also received chemotherapy and 1 of them is still alive 4 years after the reoperation. Out of the 29 patients operated on with glioblastoma 20 were irradiated. The median survival after the reoperation was 3 months, and only a few patients lived longer than 6 months. Chemotherapy itself did not influence the survival time significantly in either group. The survival time was influenced significantly by the first histology. Radiotherapy after the reoperation prolonged the survival time significantly, especially in the group of patients with primary low grade astrocytoma. Reoperation of patients with malignant astrocytoma who were irradiated immediately after the first operation extended the survival time slightly.]


  1. Országos Idegsebészeti Tudományos Intézet, Budapest



Further articles in this publication

Clinical Neuroscience

[Comparative human immunohistochemical investigations of peptidergic innervation of embryonal and adult cerebral blood vessels]

BÜKI András, DÓCZI Tamás, HORVÁTH Zoltán, FÜRTÖS András

[Peptidergic fibres innervating human embryonic and adult cerebral blood vessels were screened for calcitonine gene-related peptide, neuropeptide-Y and substance-P immunopositive fibres, the mediaadventitia border displayed a network-like fibre arrange ment. There was no significant difference either in the distribution of the individual peptidergic fibres or in the age-dependent appearance of peptidergic networks. On the basis of these results it seems to be unlikely that the different clinical course of juvenile and adult subarachnoid haemorrhages could be the result of an age specific difference of peptidergic fibre distribution influencing the neurogenic mecha nisms of cerebral autoregulation.]

Clinical Neuroscience

[Statistical evaluation and pathological significance of the incidence of corpus amylaceum]


[Objective: Semiquantitative evaluation of the corpus amylaceum (polyglucosan body) was carried out by a method reported before on a 1407 autopsy - partly biopsy - material. Design: The present report contains the data of the occurrence of corpus amylaceum in different disease groups demonstrated in tables expressed in numbers and percentage evaluated by homogenity examination. Setting: The manifold neuropathological examination enabled the reaching of some implications of clinical significance too. Material and method: The material involved a great number of cases not reported before. The cases were classified according to their ages and different diseases as well as a new grading system of quantitative evaluation of the frequency of corpus amylaceum in various localizations. Main outcome measures: The most important aspects were the examination of the predilection sites, the elucidation of the development of corpus amylaceum and occurrence in different conditions and diseases. Results: The method and examination permitted drawing conclusions as follows: 1. The chronic, recurring vascular-barriere disturbances appeared significant in the formation of corpus amylaceum. - 2. There was not an expressive difference between the ischemic and hemorrhagic vascular diseases considering the number of corpus amylaceum nor did more corpus amylaceum occur in Alzheimer's disease than in aged. - 3. Greater amount of corpus amylaceum may be found in some spinal cord lesions. – 4. The formation of corpus amylaceum was not observed in the regions of astrocytic gliosis (e.g. postraumatic) or in astrocytomas. This finding needs further study. - 5. The linear correlation between age and the increased quantity of corpus amylaceum may also be proved statistically. Conclusions: It deserves particular attention that more mechanisms may play a role in the formation of corpus amylaceum such as the insufficiency of astrocytes in the utilization of glucose which may be associated with accumulation of some carbohydrate polymers and glycogen. The increased volume of cerebrospinal fluid in the predilection sites is also an important factor. The spinal cord proved to be a prominent predilection site, where the great amount of corpus amylaceum occurred in some diseases which may be explained by the increased quantity of stress proteins. The final conclusion is that the corpus amylaceum has a pathog nostic significance, but it has a tendency for higher occurrence in some conditions.]

Clinical Neuroscience

[Progressive myoclonus epilepsy - A review and case histories]


[Progressive myoclonus epilepsy (PME) syndrome is a heterogeneous entity underlain by rare genetic diseases. The most frequent origins of progressive myoclonus epilepsy are: Unverricht-Lundborg disease, Lafora's disease, ceroid lipofuscinosis, MERRF (myoclonus epilepsy with ragged red fibers) and sialidosis. Action myoclonic jerks, epileptic seizures, mental deterioration, neurological impairments are the four main symptoms of PME syndrome. Nowadays in more and more cases a causal diagnosis is possible in the PME syndrome. In this paper clinical data and findings of our 10 outpatients suffering from PME were analysed retrospectively. Electrophysiological, neuroimaging and histological examinations were performed. On the basis of the findings of the 10 patients 6 suffered from Unverricht-Lundborg disease, 1 from Lafora disease and 1 from MERRF In 2 patients we were not able to find specific diagnosis. Among our patients gypsy nationality occurs in a relatively large proportion and we know of more gypsy PME cases under care of other centres. It may raise the question whether Hungarian gypsies suffer from PME more frequently. This paper - to our knowledge – is the first study dealing with a group of PME cases in Hungary.]

Clinical Neuroscience

[Moyamoya disease with partial epilepsy and cerebral infarct in early childhood]

NEMES András, LAZÁNYI Zoltán, NAGY István

[An 8-month-old infant with initial partial epileptic seizure is described in whose case moyamoya disease and a form of infarct were established. In connection with the case the possible reasons for the pathological picture, clinical characteristics and diagnosis are detailed. Attention is called to the fact that stroke can be considered as a possible etiological factor while clarifying the etiology of a partial epileptic seizure in infancy.]

Clinical Neuroscience

[Recent data for the pathobiochemistry of tension-type headache]

TAJTI János, SZOK Délia, VÉCSEI László

[The most prevalent of the independent headache disorders (30%) is tension-type headache (other types: migraine 4-10%, cluster 0.04-2.4%). These patients represent 50-90% of the patients in the "Headache Outpatient Clinics". This justifies a review of the latest biochemical data aimed at elucidating the pathomechanism of the disease. According to the criteria of the International Headache Society (IHS), two main forms of tension-type headache are distinguished. Tension-type episodic headache: fewer than 15 attacks per month, but at least 10 attacks lasting from 30 minutes to 7 days. Typically, they are pressing, tight, but not throbbing. Mild to moderate pain, bilateral, around the temples or forehead, pan-like, not increasing with normal physical activity, not accompanied by photophobia or phonophobia. Chronic tension-type headache: more than 15 attacks of headache per month, lasting all day and with features similar to the episodic form, for at least 6 months. In this summary, we first present the main experimental findings and then the conclusions that can be drawn from them. ]

All articles in the issue

Related contents

Clinical Neuroscience

Long-term follow-up results of concomitant chemoradiotherapy followed by adjuvant temozolomide therapy for glioblastoma multiforme patients. The importance of MRI information in survival: Single-center experience

LUKÁCS Gábor, TÓTH Zoltán, SIPOS Dávid, CSIMA Melinda, HADJIEV Janaki, BAJZIK Gábor, CSELIK Zsolt, SEMJÉN Dávid, REPA Imre, KOVÁCS Árpád

Introduction - Glioblastoma multiforme (GBM) is the most common malignant primary anomaly of central nervous system. The GBM infiltrates the nearly sturctures from the initial tumor and its metastatic attribution is well known. The aim of our single-centered retrospective study was to introduce the importance of postoperative medical imaging confirmation of total tumor resection for patient with GBM combined concomitant and adjuvant chemoradiotherapy on a 10 year long patient follow up. Methods - From January 2006 to April 2015 we registered 59 patients with newly diagnosed GBM at the University of Kaposvár Health Center Institute of Diagnostic Imaging and Radiation Oncology. The histological diagnosis was confirmed by a proficient neuropathologist (World Health Organisation WHO; grade IV astrocytoma). According to histological status if the ECOG performance status of patients allowed it the mutidisciplinary oncoteam recommended adjuvant chemoradiotherapy all features strictly by Stupp protocol. (60 Gy dose on the gross tumor volume and 2-3 cm margin for the clinical target volume with parallel 75 mg/m2 TMZ. Four weeks after monotherapial phase patients had to recieve 6 cycles of TMZ first cycle with 150 mg/m2 up to 200 mg/m2). The irradiation was carried out by a conformal three dimensional planning system. Results - 59 patients with the median age of 63 (range 17-84) year. Our sample counted 34 male patients and 25 woman patients. 14 patients underwent gross total tumor resection while, 39 patients underwent partial resection and the rest from our sample 6 patients passed through biopsy. Statistical analysis showed a lengthier survival among males than females, with a median survival of 13 months for males and females, the OS of 26.209 for males, meanwhile 15.625 for females. However, the difference is not considerable (log-rank p=0.203). Our study found that the estimated survival of patients at least 50 years old is significantly shorter at a median survival of 12 months (log rank p=0.027) than that of patients below 50 years of age at a median survival of 23 months. The longest estimated median survival was calculated with patients of ECOG '0' condition (16 months). However, no significant difference was found in the estimated survival of patients of different ECOG conditions (log-rank p=0.146). Based on the extent of surgery, complete resection resulted in the longest average survival of 36.4 months, followed by 21.5 months among patients with biopsy, and 15.8 months among patients with partial resection. Different surgical procedures, however, did not result in significant differences in survival (log-rank p=0.059). The overal survival of patients who had complete resection confirmed by MRI compared with the overal survival of patients with residual tumor confirmed by MRI as well we can estimate that there is significant difference between these two groups (p=0,004). Conclusion - Despite complex and intense treatment, recurrence is inevitable and causes relatively rapid death. In our analysis complete resection, as defined from the neurosurgeon’s report and postoperative MRI, resulted in an independently significant improvement in OS. Our results are the evidences that the treatment of patients with glioblastoma multiforme in Hungary is at least on the same level as any other developed European countries.

Clinical Neuroscience

[Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases]

BANCZEROWSKI Péter, SIMÓ Magdolna, SIPOS László, SLOWIK Felícia, BENOIST György, VERES Róbert

[Primary glioblastoma multiforme located intramedullary in the spinal cord is a very rare entity. The authors report eight cases and discuss the clinical features, the possibility of diagnosis, combinated treatment and pathomorphological signs focusing on the relevant literature and their experience.]

Clinical Neuroscience

[Interpretation of the resoults of DNA image analysis in astrocytomas - biology and prognosis]

SZŰCS István, LEEL-ŐSSY Lóránt, KINDLER Miklós

[Ploidy and proliferative activity of 72 astrocytomas (except glioblastomas) were examined with nuclear DNA content by computed image analysis. The majority of samples originated from paraffin embedded material but they were partly obtained from surgical biopsy by printing or smear technique. The 72 astrocytomas were classified according to Kernohan's grading system. Different areas of tumours were evaluated according to their ploidy (euploid, diploid, aneuploid and heterogenous ranges), proliferative parameters and DNA indices. The transitional zone sometimes revealed higher proliferative index with euploidy. The DNA distribution showed greater population even in the case of moderate malignancy. Uniform – single population - DNA distribution characterized the benign type in 79% with DNA index within the diploid range. The remaining 21% had aneuploidy with another population (heterogenous). The higher the malignancy the greater the population may be found with the higher percentage of S phase cells. The mitotic forms displayed higher DNA index as well as G 2 phase even in the transitional zone of the tumour. The heterogeneity with higher percentage of S- phase correlated well with the histological type of the tumour. The follow-up study of some astrocytomas sometimes did not show a good correlation with the DNA values. However a good correlation was found between the number of cells with higher S and G 2 phases and the type of histogram in the majority of cases studied. The different parts of the tumours also varied in these respects, which should be taken into consideration during needle biopsies.]

Clinical Neuroscience

Multimodality teratment of anaplastic supratentorial gliomas with high-dose dibromodulcitol and dibromodulcitol plus BNCU (a pilot study)

ÁFRA Dénes, MAYER Árpád, SÍPOS László

A pilot study with a high dose DBD, and DBD plus BCNU therapy for the treatment of malignant gliomas has been performed. Radiotherapy combined with DBD in a dose of 700 mg/sqm/week was administred to 27 patients after extensive removal of supratentorial anaplastic astrocytomas and glioblastomas. Subsequently, DBD in a dose of 1400 mg/sqm was given monthly to a group of nine patients and another thirteen patients received DBD plus BCNU on two consecutive days in a dose of 1000 mg/sqm and 150 mg/sqm, every 6-8 weeks. Both kinds of chemotherapy have been well tolerated, no patient died because of toxic side effect. Following the first dose of DBD and BCNU such a severe myelotoxicity occurred in one case that treatment was discontinued but the patient recovered completely. The high-dose DBD treatment proved to be markedly effective against glioblastomas, while the combination of DBD and BCNU showed more pronounced activity against anaplastic astrocytomas. As the results were promising, accordingly further extensive studies seem to be worthwhile.

Clinical Neuroscience

[Characterization of human gliomas by the OITI C3-11 monoclonal antibody]

SIPOS László, TOSHIHIKO Wakabayashi, SZEIFERT György, FAZEKAS Ilona, ÁFRA Dénes

[OITI C3-11 monoclonal antibodies were produced against GFAP positive human glioblastoma tumour cells. The specificity of these antibodies was tested on different type of brain tumours and on normal adult brain both on tissue cultures and paraffin-embedded sections. Such OITI C3-11 monoclonal antibodies reacted with 16 of 18 malignant and 1 of 6 benign gliomas but did not react with meningioma, pituitary, adenoma, metastatic brain tumours and normal adult brain tissue.]