Publications by authors named "Reza Akhavan-Sigari"

15 Publications

  • Page 1 of 1

Melatonin attenuated the behavioral despair induced by acute neurogenic stress through blockade of N-methyl D-aspartate receptors in mice.

Heliyon 2021 Jan 11;7(1):e05900. Epub 2021 Jan 11.

Department of Neurosurgery, University Medical Center Tuebingen, Germany.

It has been well documented that administration of melatonin could reveal antidepressant-like effect in rodents. However, the protective effect of melatonin on stress-induced depression/anxiety and its underlying mechanism is yet to be understood. In this regard, in the current study, acute foot-shock stress (FSS) was used to evaluate the antidepressant-like effect of melatonin on neurogenic stress-induced depression in mice. Behavioral evaluation was done by using the forced swimming test (FST) and Open-field test (OFT). Melatonin, MK-801, and ketamine (NMDA receptor antagonists), and NMDA (NMDA receptor agonist) were used to elucidate any association between melatonin and NMDA pathway in behavioral despair induced by acute-FSS. Applying acute-FSS to mice significantly induced depressant-like behavior in FST without any significant impact on locomotor activity in the OFT. We observed that melatonin (dose-dependently) significantly improved the depressant-like effect of FSS, but it did not impact the locomotion in animals. Acute injection of MK-801 at sub-effective doses (0.01 mg/kg) or ketamine (0.1 mg/kg) potentiated the antidepressant-like effect of a sub-effective dose of melatonin. However, the sub-effective dose of NMDA (30 mg/kg) abolished the protective effect of melatonin on the behavioral profile of stressed animals. Our results could reflect the antidepressant-like effect of melatonin on neurogenic stress-induced depressive behaviors in mice. Also, our results showed that NMDA receptors could be involved in the antidepressant-like effect of melatonin.
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http://dx.doi.org/10.1016/j.heliyon.2021.e05900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810776PMC
January 2021

Oncogenic miRNAs and target therapies in colorectal cancer.

Clin Chim Acta 2020 Sep 11;508:77-91. Epub 2020 May 11.

Department of Neurosurgery, University Medical Center Tuebingen, Eberhard-Karls University, Tuebingen, Germany.

OncomiRNAs involved in human colorectal cancer (CRC) are capable of suppressing the expression of their targets via cleavage or translational arrest. Therefore, an improved understanding the functions of these oncomiRNAs and the molecular pathways in CRC development that they are involved in will assist in the manipulation of miRNAs, providing a novel therapeutic approach against CRC. In this review, we provide a particular perspective of miRNAs implicated in the progression of CRC. We describe an interaction network of CRC-associated miRNAs and their targets involved in tumor growth, proliferation, migration/invasion, epithelial-to-mesenchymal transition (EMT) formation, metastasis, and anticancer resistance. Additionally, the therapeutic potentials of these miRNAs in CRC are fully discussed. Thus, key oncogenic miRNAs involved in progression and metastasis of CRC (e.g., miR-181a/b, miR-135a/b, miR-150 and miR-150-5p, miR-155, miR-181b, miR-200 a/c, miR-22, miR-106a, hsa-miR-103a, hsa-miR-1827, miR-135b, miR-150 and miR-150-5p, miR-181b, and let-7f-5p) are considered in this review. Furthermore, proangiogenic and antiapoptotic miRNAs, their molecular regulatory networks, biological functions, and target genes are also discussed. An in-depth understanding of the molecular mechanisms underlying the regulation of miRNAs will increase the knowledge of miRNA regulatory function in the progression of CRC and promote the development of novel therapeutic measures.
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http://dx.doi.org/10.1016/j.cca.2020.05.012DOI Listing
September 2020

Unilateral discectomy: outcomes, postoperative pain, complications.

Eur J Transl Myol 2019 Oct 29;29(4):8545. Epub 2019 Oct 29.

Department of Neurosurgery, University Medical Center Tuebingen, Eberhard-Karls University, Tuebingen, Germany.

In low back pain management surgery is currently commonly used with a new technique called minimally invasive discectomy, while open discectomy is still preferable in many cases. In this regard, the efficacy of tubular discectomy (TD) were compared with conventional standard lumbar disc procedure (conventional microdiscectomy). This study was performed as a clinical trial conducted on patients who were under TD and conventional microdiscectomy using unilateral retractor at Bou Ali, Mehrad, Laleh Hospitals during the years 2001 to 2017. The pain score was determined based on the use of Visual Analogue Scale (VAS). The Roland Morris Disability Questionnaires (RMQ) and mean Oswestry disability index (ODI) were also calculated. Our findings revealed that the two groups were similar in terms of demographic characteristics (age, sex, body mass index, etc.) (p> 0.05). The findings indicated the superiority of TD over the classic approach. The mean scores of ODI in conventional microdiscectomy and TD groups were reported as 12.53 ± 7.09 and 9.51 ± 7.83, respectively. ODI revealed that patients with TD surgery had less disability in lifting objects, sitting, standing, and traveling. In the conventional microdiscectomy group, 12 (20%) patients were affected by complications of surgery, but no complication was reported in any patient with TD (p = 0.000). The mean index of Roland Morris disability in the conventional microdiscectomy and TD groups were estimated to be 6.033 ± 2.98 and 3.73 ± 3.25 (p = 0.000). However, both groups did not differ in terms of visual scores for pain and relapse (p > 0.05). Our study demonstrates that disease relapse within 6 months after the surgery, the RMQ and the ODI values were significantly better in TD than the other group.
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http://dx.doi.org/10.4081/ejtm.2019.8545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6926437PMC
October 2019

The Importance of the Hedgehog Signaling Pathway in Tumorigenesis of Spinal and Cranial Chordoma.

J Clin Med 2019 Feb 15;8(2). Epub 2019 Feb 15.

Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, 37075 Göttingen, Germany.

Chordomas is rare malignant bone tumors thought to arise from remnants of embryonic notochord along the spine, frequently at the skull base and sacrum. Although chordoma is slow growing tumors, while are extremely recurrent, and aggressive, as well as the rate of prognosis remains poorly. Radical surgery and high-dose radiation are the most used treatments. Currently, there is no effective chemotherapeutic standard for chordomas. The Hedgehog (HH) pathway adjusts various processes included in expansion and differentiation of tissues and organs throughout the fetus's life, furthermore cell growth and differentiation in the adult organism, of the cell in an adult organism, in which acute anesthesia is involved in multiple cancers. To study the role of signaling the hedgehog in the base of the skull and sacrum chordomas, the expression of SHH and GLI-1 levels were detected immuno histochemically, Additionally, PTCH-1 and GLI-1 expressions were distinguished by in- Situ- hybridization. Based on the findings presented herein, it is likely that the HH signal cascade was revealed even in cranial, where consecoently spinal chordoma and their recurrences play an important role. Our staining exhibited a canonical, ligand- dependent and autocrine Hedgehog signaling in skull base and sacrum chordomas including relapse. Due to the high levels of SHH and GLI-1 expression in all investigated chordoma samples, the study suggests a possible autocrine ligand-dependent activation of the canonical HH signaling cascade. A paracrine or non-canonical pathway cannot be excluded. Our results suggest that Hedgehog-inhibitors, like SHH-, GLI- and SMO- inhibitors, might serve as a potential and effective target for the treatment of chordomas.
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http://dx.doi.org/10.3390/jcm8020248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6406847PMC
February 2019

Study of Radial Nerve Injury Caused By Gunshot Wounds and Explosive Injuries among Iraqi Soldiers.

Open Access Maced J Med Sci 2018 Sep 21;6(9):1622-1626. Epub 2018 Sep 21.

Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany.

Background: Gunshot wounds and blast injuries to the upper limbs produce complex wounds requiring management by multiple surgical specialities.

Aim: We sought to determine the pattern of peripheral nerve injuries among Iraqi soldiers in the war.

Methods: We performed a 3 year retrospective cohort analysis based on medical records of patients with sustaining gunshot wounds and blast injuries to the upper limbs. Ethical approval was obtained from the institutional review board. The patients included were male, serving military personnel of all age groups and ranks presenting with weakness or sensory loss of radial nerve. Three hundred eighteen patients aged 24 years or older with a high-energy, diaphyseal fracture of the humerus and complete motor and sensory radial nerve palsy were reviewed retrospectively. In these patients, the physical examination and electrodiagnostic study were carried out by experienced neurologists. Seddon's classification system was used to assess the severity of the injury. The data related to the types of fracture, the type of damage, the factors causing damage and the failure of treatment were entered into the IBM SPSS 23 software after extraction of files. Based on mid-range indicators and data distribution, traumatic injuries among Iraqi soldiers in the war against ISIL were then investigated.

Results: A group of 318 patients with mean age of 25.41 ± 6 years were enrolled in the study, of which 127 patients were included with an open fracture and 191 patients with closed lesions. All 127 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. 113 of 127 subjects had primary repair of the radial nerve and recovered well. 14 of 127 subjects were not recovered. 3 of them had iatrogenic radial nerve injury due to the internal fixation device. Furthermore, all 191 patients with closed injuries recovered well. The average time to initial signs of recovery was 8 weeks (range, 1-27 weeks). Axonotmesis and Neurotmesis were found in 283 (89%) subjects. The average time to full recovery was determined to be 6 months (range, 1-22 months). The blast was found to be the main cause of nerve injury in 236 (74.2%) cases, followed by gunshot damage (21.4%, 68 subjects), falling from height and motor vehicle accidents (4.4%, 14 subjects) and multiple injuries (17%, 54 cases).

Conclusions: Trauma caused by factors such as explosions and gunshot worsens the condition of the injuries and presents the treatment conditions with many challenges. However, the success rate in post-surgical recovery of humerus fracture and injured radial nerve can be remarkably higher in young people as compared to other age groups.
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http://dx.doi.org/10.3889/oamjms.2018.346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182541PMC
September 2018

Primary Intracranial Manifestation of a Carcinosarcoma.

Asian J Neurosurg 2018 Jul-Sep;13(3):923-927

Department of Neuropathology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany.

Carcinosarcomas are tumors comprising part adenocarcinoma and part sarcoma; the presence of carcinosarcoma in the head-and-neck region is very rare. These tumors are typically highly aggressive (G3) and arise most frequently from the salivary gland. Here, we present a case report on a brain metastasis as the primary manifestation of a carcinosarcoma. Magnetic resonance imaging showed a tumor of the pineal region with infiltration of the brainstem and the corpus. The staging following the histopathological diagnosis revealed the origin of the tumor in the left parotid gland. We present an overview of the significance of published treatment strategies in carcinosarcoma.
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http://dx.doi.org/10.4103/ajns.AJNS_19_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159043PMC
October 2018

Uninstrumented Posterior Lumbar Interbody Fusion-Evidence Based or Matter of Habit? Perspective Statement.

World Neurosurg 2018 07 15;115:506-508. Epub 2018 May 15.

Department of Neurological Surgery, Division of Spine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1016/j.wneu.2018.05.042DOI Listing
July 2018

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia.

J Neurol Surg A Cent Eur Neurosurg 2017 Mar 23;78(2):161-166. Epub 2016 Sep 23.

Department of Neurosurgery, Universitätsmedizin Göttingen, Göttingen, Germany.

In microvascular decompression of the trigeminal nerve for trigeminal neuralgia (TN), the site of conflict is occasionally difficult to identify. Endoscopy has been described to better evaluate the anatomical conflict in such situations. We hypothesized that indocyanine green (ICG) angiography could allow for better visualization of the compressing artery and its anatomical relation to the nerve. ICG angiography was performed in 17 TN patients undergoing microvascular decompression. We focused on whether ICG angiography is helpful in determining the site of conflict, particularly when not directly visible via the microscope, and whether fluorescence is strong enough to shine through the nerve obliterating the direct view of the compressing vessel. In four patients, the site of conflict was immediately apparent after opening the cerebellopontine cistern, and ICG angiography did not provide the neurosurgeon with additional information. In another two patients, imaging quality and fluorescence were too poor. Of the remaining 11 patients with a hidden site of nerve-vessel conflict, ICG angiography was found to be helpful in anticipating the site of compression and the course of the artery in 7 patients, particularly in regard to the so-called shining-through effect through fiber bundles of the thinned nerve. Of all the patients, 88% reported at least improvement or cessation of their symptoms, including all of the patients with a shine-through effect. ICG angiography could be a helpful adjunct in decompressing the trigeminal nerve and can guide the surgeon to the nerve-vessel conflict. Intensity of the fluorescence is powerful enough to shine through thinned and splayed trigeminal nerve fiber bundles.
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http://dx.doi.org/10.1055/s-0036-1586746DOI Listing
March 2017

Unskilled unawareness and the learning curve in robotic spine surgery.

Acta Neurochir (Wien) 2015 Oct 19;157(10):1819-23; discussion 1823. Epub 2015 Aug 19.

Department of Neurosurgery, University Medicine Göttingen, Göttingen, Germany.

Background: Robotic assistance for the placement of pedicle screws has been established as a safe technique. Nonetheless rare instances of screw misplacement have been reported.The aim of the present retrospective study is to assess whether experience and time affect the accuracy of screws placed with the help of the SpineAssist™ robot system.

Methods: Postoperative computed tomography (CT) scans of 258 patients requiring thoracolumbar pedicle screw instrumentation from 2008 to 2013 were reviewed. Overall, 13 surgeons performed the surgeries. A pedicle breach of >3 mm was graded as a misplacement. Surgeons were dichotomised into an early and experienced period in increments of five surgeries.

Results: In 258 surgeries, 1,265 pedicle screws were placed with the aid of the robot system. Overall, 1,217 screws (96.2 %) were graded as acceptable. When displayed by surgeon, the development of percent misplacement rates peaked between 5 and 25 surgeries in 12 of 13 surgeons. The overall misplacement rate in the first five surgeries was 2.4 % (6/245). The misplacement rate rose to 6.3 % between 11 and 15 surgeries (10/158; p = 0.20), and reached a significant peak between 16 and 20 surgeries with a rate of 7.1 % (8/112; p = 0.03). Afterwards, misplacement rates declined.

Conclusions: A major peak in screw inaccuracies occurred between cases 10 and 20, and a second, smaller one at about 40 surgeries. One potential explanation could be a transition from decreased supervision (unskilled but aware) to increased confidence of a surgeon (unskilled but unaware) who adopts this new technique prior to mastering it (skilled). We therefore advocate ensuring competent supervision for new surgeons at least during the first 25 procedures of robotic spine surgery to optimise the accuracy of robot-assisted pedicle screws.
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http://dx.doi.org/10.1007/s00701-015-2535-0DOI Listing
October 2015

Continuation of medically necessary platelet aggregation inhibitors - acetylsalicylic acid and clopidogrel - during surgery for spinal degenerative disorders: Results in 100 patients.

Surg Neurol Int 2014 28;5(Suppl 7):S376-9. Epub 2014 Aug 28.

Department of Neurosurgery, Mashhad University of Medical Sciences, Taleghani Hospital, Mashhad, Iran.

Background: Patients undergoing spinal surgery while under anticoagulation therapy are at risk of developing bleeding complications, even though lower incidences have been reported for joint arthroplasty surgery. There is a gap in the medical literature examining the incidence of postoperative spinal bleeding in patients who were under anticoagulation medication at the time of surgery.

Methods: We prospectively followed a consecutive cohort of 100 patients (58 male, 42 female) undergoing spinal surgery. The average patient age was 48.7 years and the minimum follow up time was 12 months. Diagnosis was lumbar spinal stenosis in 20, herniated lumbar discs in 63, degenerative cervical disc disease in 3, and cervical disc herniation in 14 cases. In our study, platelet aggregation inhibitors (clopidogrel and/or acetylsalicylic acid) were given for the treatment of cardiovascular and cerebrovascular thrombotic events, to reduce risk of stroke in patients who have had transient ischemia of the brain or acute coronary syndrome, and as secondary prevention of atherosclerotic events (fatal or nonfatal myocardial infarction (MI). A cessation of anticoagulants (acetylsalicylic acid or clopidogrel) in our patients in the peri- and postoperative period was contraindicated.

Results: Sixty-three patients were on both clopidogrel and acetylsalicylic acid and 37 on acetylsalicylic acid only. None of the patients suffered any postoperative bleeding complication. Three patients suffered postoperative wound dehiscence and one patient had an infection that required reoperation.

Conclusion: The question of whether preoperative platelet aggregation inhibitors must be stopped before elective spinal surgery has never been answered in the literature. In our prospective series, we have found no increase in the risk of postoperative spinal bleeding with the use of clopidogrel or acetylsalicylic acid. This finding suggests that spine surgery can be done without stopping anticoagulation. Lacking specific guidelines, each patient should be treated on an individual basis, and the potential benefits of anticoagulation should be compared with the potential risks (risk-benefit ratio).
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http://dx.doi.org/10.4103/2152-7806.139675DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173210PMC
October 2014

Connection between Cell Phone use, p53 Gene Expression in Different Zones of Glioblastoma Multiforme and Survival Prognoses.

Rare Tumors 2014 Jul 8;6(3):5350. Epub 2014 Aug 8.

Department of Neurosurgery, Islamic Azad University, Medical Branch , Mashhad, Iran.

The aim of this paper is to investigate p53 gene expression in the central and peripheral zones of glioblastoma multiforme using a real-time reverse transcription polymerase chain reaction (RT-PCR) technique in patients who use cell phones ≥3 hours a day and determine its relationship to clinicopathological findings and overall survival. Sixty-three patients (38 males and 25 females), diagnosed with glioblastoma multiforme (GBM), underwent tumor resection between 2008 and 2011. Patient ages ranged from 25 to 88 years, with a mean age of 55. The levels of expression of p53 in the central and peripheral zone of the GBM were quantified by RT-PCR. Data on p53 gene expression from the central and peripheral zone, the related malignancy and the clinicopatholagical findings (age, gender, tumor location and size), as well as overall survival, were analyzed. Forty-one out of 63 patients (65%) with the highest level of cell phone use (≥3 hours/day) had higher mutant type p53 expression in the peripheral zone of the glioblastoma; the difference was statistically significant (P=0.034). Results from the present study on the use of mobile phones for ≥3 hours a day show a consistent pattern of increased risk for the mutant type of p53 gene expression in the peripheral zone of the glioblastoma, and that this increase was significantly correlated with shorter overall survival time. The risk was not higher for ipsilateral exposure. We found that the mutant type of p53 gene expression in the peripheral zone of the glioblastoma was increased in 65% of patients using cell phones ≥3 hours a day.
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http://dx.doi.org/10.4081/rt.2014.5350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178273PMC
July 2014

Connection between expression of inducible nitric oxide synthase (iNOS) in skull base chordoma and lower urinary tract symptoms.

Int Urol Nephrol 2014 Nov 12;46(11):2109-16. Epub 2014 Aug 12.

Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany,

Objective: To provide first insights into the potential role of iNOS expressed by skull base chordoma, which causes brainstem compression in and around Barrington's nucleus, and its effect on the micturition center.

Methods: Urodynamic testing of 22 symptomatic patients was performed. All women and men with skull base chordoma treated in two hospitals in Germany between 1986 and 2007 were studied. Lower urinary tract symptoms (LUTS) were documented in patients with acute brainstem compression due to local chordoma growth positive for iNOS expression. Brain magnetic resonance (MRI) images of the lesions of the symptomatic patients were performed.

Results: Of 74 treated patients, 22 (7 women, 15 men) with a median age of 37 years were evaluated with voiding diaries and computer urodynamic investigation. Urodynamic testing of 22 symptomatic patients with positive iNOS expression of skull base chordoma revealed detrusor overactivity in 55 %, low-compliance bladder in 14 %, detrusor sphincter dyssynergia in 45 % and uninhibited sphincter relaxation in 27 %. There was a significant correlation between strong iNOS expression (score 3-6) in skull base chordoma and severe urinary symptoms (p = 0.003, Spearman ρ = 0.526).

Conclusions: The expression of iNOS in skull base chordoma compressing the dorsolateral pons, in and around Barrington's nucleus, may influence the pontine micturition center (PMC) and be responsible for lower urinary tract symptoms. Nitric oxide may possibly act as a neurotransmitter. We assume that the high infiltration of chordoma with monocyte/macrophages enhances the release of nitric oxide, as monocyte/macrophages are the main source of iNOS.
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http://dx.doi.org/10.1007/s11255-014-0806-yDOI Listing
November 2014

Prognostic significance of immunohistochemical expression of VEGFR2 and iNOS in spinal chordoma.

Eur Spine J 2014 Nov 15;23(11):2416-22. Epub 2014 Jun 15.

Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany,

Purpose: To clarify whether vascular endothelial growth factor receptor 2 (VEGFR2) and inducible nitric oxide synthase (iNOS) are involved in the angiogenesis and recurrence of spinal chordoma tissues and influence the overall survival.

Methods: All patients affected by a spinal chordoma surgically treated between 1986 and 2007 were reviewed. We examined the expression of VEGFR2 and iNOS with immunohistochemistry using a tissue microarray containing 120 chordoma samples. Local recurrence and overall survival (OS) were analyzed.

Results: A series of 40 chordoma patients who underwent surgery for a total of 120 lesions (including 80 recurrent lesions) were identified (sacrum 77.5 %, lumbar spine 17.5 %, cervical/thoracic spine 5 %). Surgical margins were wide in 30 (75 %), marginal in 8 (20 %) and intralesional in 2 (5 %) patients. Median follow-up was 120 months. The 5- and 10-year OS of the entire series of patients was 78.6 and 30 %, respectively. There were five primary chordomas (12.5 %) with moderate and 35 (87.5 %) with strong expression of VEGFR-2. All recurrent spinal chordomas displayed strong expression of VEGFR-2. The expression of iNOS was predominately moderate to high in primary chordomas: There were 15 tumors (37.5 %) with moderate and 25 tumors (62.5 %) with strong expression. All recurrent chordomas displayed strong expression of iNOS.

Conclusion: The high expression of VEGFR-2 and iNOS affected the OS. The OS at 10 years was only 30 %.
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http://dx.doi.org/10.1007/s00586-014-3417-5DOI Listing
November 2014

Expression of PDGFR-α, EGFR and c-MET in spinal chordoma: a series of 52 patients.

Anticancer Res 2014 Feb;34(2):623-30

University Medical Center Göttingen, Georg-August-University Göttingen, Germany. Robert-Koch-Strasse 40, 37075 Göttingen, Germany.

Aim: To investigate the expression of platelet-derived growth factor (PDGF) receptor-A (PDGFRα), epidermal growth factor receptor (EGFR) and c-Met in spinal chordoma. To the authors' knowledge, little is known regarding the prognostic significance of receptor tyrosine kinase in spinal chordoma.

Materials And Methods: Using immunohistochemical techniques, the authors investigated PDGFR-α, EGFR and c-MET expression in 52 primary and 104 recurrent lesions, and compared these data with clinicopathological parameters.

Results: PDGFR-α, EGFR and c-MET were found to be expressed in 75.0%, 83% and 77% of primary, and in 97.0% of recurrent lesions in all investigated receptor tyrosine kinases. Higher PDGFR-α and c-MET expression was found to be correlated with younger patient age. Lesions with a higher expression of PDGFR-α demonstrated significantly higher EGFR scores in both primary and recurrent lesions compared to those with lower PDGFR-α expression. In recurrent lesions, higher c-MET expression was found to be associated with significantly better prognosis than those with lower c-MET expression (p=0.033). Lesions with a higher level of PDGFR-α expression were found to have significantly poorer prognosis than those with lower PDGFR-α expression (p=0.024). Those patients with lower EGFR expression were found to have significantly better prognosis than those with higher EGFR expression (p=0.005).

Conclusion: In the current study, c-MET expression in patients with spinal chordoma was found to be correlated with a younger patient age and a favorable prognosis. Patients with a higher level of PDGFR-α and EGFR expression were found to have a significantly poorer prognosis than those with lower PDGFR-α and EGFR expression.
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February 2014

Stevens Johnson syndrome--an adverse drug reaction occurred after uncomplicated removal of an intracerebral cavernous hemangioma.

J Neurol Surg A Cent Eur Neurosurg 2013 Dec 14;74 Suppl 1:e58-61. Epub 2013 Jan 14.

Department of Neurosurgery, Imam Reza University, Razavi Hospital, Mashhad, Iran.

Background: Toxic epidermal necrolysis (TEN) is a rare, severe adverse drug reaction. Stevens-Johnson syndrome (SJS) represents the milder end of the spectrum. The exact pathogenesis of TEN and SJS is still unknown. Many drugs, including prednisolone, cyclosporin, and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of phenytoin as a prophylactic anticonvulsant after brain surgery, particularly for brain tumors, is a common practice, regardless of whether the patient has a previous history of convulsions. This treatment policy assumes that the benefits exceed the risks.

Case: In this paper, we describe a young patient who underwent a total removal of an intracerebral cavernous hemangioma following development of SJS after taking phenytoin postoperatively.

Conclusion: We suggest that the practice of routine use of phenytoin following brain surgery should be re-evaluated because the treatment may be neither essential nor without side effects.
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http://dx.doi.org/10.1055/s-0032-1330112DOI Listing
December 2013