Burkhard S. Kasper

Non-obstetric surgery for intracranial meningioma is uncommon during pregnancy and poses significant risks to both the mother and the fetus. We present a case of a parturient that presented with acute mental status changes and we illustrate the decision making process that resulted in a best-possible outcome. A woman at 29-week gestation presented with acute language and speech deficits and deteriorating mental status after 2 weeks of headache. Imaging demonstrated a large intracranial mass. A multidisciplinary meeting was held to determine the best treatment plan. The decision was to proceed with caesarean delivery under epidural anesthesia to allow intraoperative monitoring of neurological function. Six hours after successful delivery, the patient had acute mental status changes and she was taken to the operating room immediately for resection of her tumor, which turned out to be a clear cell meningioma. Cerebral meningioma is usually a slow-growing tumor; however, during pregnancy, the mass may expand rapidly due to hormonal receptor expression. The presentation of this patient would have normally led to urgent resection of the mass. But the complicating factor was her 29-week pregnancy as standard intraoperative treatment during neurosurgery is known to adversely affect the fetus. A multidisciplinary meeting was critical for this patient's care, and is recommended by us when treating such patients.

The study by Fauser and colleagues on subtypes of focal cortical dysplasia (FCD) and their impact on post-surgical outcome in focal epilepsies (Fauser et al., 2004) focussed on reports of milder forms of FCD, i.e. focal cortical dysplasia type I (Type 1-FCD) and mild malformations of cortical development (mMCD) according to a recent classification system (Palmini et al., 2004). These entities were compared with cases with dysmorphic neurons and balloon cells on histopathology (Type 2-FCD).

Marked perivascular clustering (PC), i.e., groups and rows of small round cells along white matter vessels, is seen in temporal lobe epilepsy (TLE) specimens obtained by surgery. This study focuses on the constituting cell types and discusses clinical significance and pathogenesis of PC, which are so far unknown. Based on a series of 59 nonlesional TLE surgical specimens, we characterized PC by immunohistochemistry and correlated the amount of PC with clinical parameters. PC cells were variably positive for galactocerebroside, myelin basic protein and S-100 protein, while glial fibrillary acidic protein, vimentin, nestin and neuronal antigens were not expressed. There was no correlation between the amount of PC and any clinical feature, including age at surgery, age at epilepsy onset, duration of epilepsy, preoperative seizure frequency, childhood febrile convulsions, family history of epilepsy, and postsurgical outcome. Our findings suggest oligodendroglial differentiation of PC, while its primary (dysplastic) versus secondary (reactive) pathogenesis remains unresolved.