Faculty Bibliography

OBJECTIVE:To explore the histological, electrophysiological, radiological, and behavioral effects of radiosurgery using a new model of proton beam radiosurgery (PBR) of the rodent hippocampus. METHODS:Forty-one rats underwent PBR of the right hippocampus with nominal doses of 5 to 130 cobalt Gray equivalents (CGE). Three control animals were untreated. Three months after PBR, 41 animals were evaluated with the Morris water maze, 23 with T2-weighted magnetic resonance imaging, and 22 with intrahippocampal microelectrode recordings. Animals that were studied physiologically were killed, and their brains were examined with Nissl staining and immunocytochemical staining for glutamic acid decarboxylase, heat shock protein 72 (HSP-72), parvalbumin, calmodulin, calretinin, calbindin, and somatostatin. RESULTS:Ninety and 130 CGE resulted in decreased performance in the Morris water maze, increased signal on T2-weighted magnetic resonance imaging, diminished granule cell field potentials, and tissue necrosis, which was restricted to the irradiated side. These doses also resulted in ipsilateral up-regulation of calbindin and HSP-72. Parvalbumin was down-regulated at 130 CGE. The 30 and 60 CGE animals displayed a marked increase in HSP-72 staining on the irradiated side but no demonstrable cell loss. No asymmetries were noted in somatostatin, calretinin, and glutamic acid decarboxylase staining. Normal physiology was found in rats receiving up to 60 CGE. CONCLUSION/CONCLUSIONS:This study expands our understanding of the effects of radiosurgery on the mammalian brain. Three months after PBR, the irradiated rat hippocampus demonstrates necrosis at 90 CGE, but not at 60 CGE, with associated abnormalities in magnetic resonance imaging, physiology, and memory testing. HSP-72 was up-regulated at nonnecrotic doses.

The intracellular signaling pathways associated with neuronal injury after perforant pathway stimulation of the rodent hippocampus have not been examined. To determine whether activation of the p42/p44 (Erk1/2) MAP kinase (MAPK) phosphorylation cascade is linked to neuronal injury after perforant pathway stimulation (PPS), we stained for phosphorylated Erk1/2 (P-Erk1/2) and for DNA fragmentation, a marker of cell death after PPS. Eighteen Sprague-Dawley rats underwent PPS for 6 (n=6), 12 (n=6), or 24 (n=6) h and were sacrificed either immediately (n=9) or 48 h (n=9) after stimulation. Sham-operated non-stimulated control animals (n=2) and control animals receiving low frequency stimulation only (n=4) were also examined. Brain sections were stained for DNA fragmentation and P-Erk1/2. DNA fragmentation was evident only in granule cells and CA3 pyramidal cells of the stimulated side 48 h after 24 h of PPS. PPS resulted in robust phosphorylation of Erk1/2 that displayed a stereotyped timecourse, appearing first in hilar neurons on the ipsilateral side and later in hilar neurons, granule cells, hippocampal pyramidal and non-neuronal cell populations on both the stimulated and contralateral sides. Both Erk1/2 phosphorylation and DNA fragmentation show definite and reproducible staining patterns after PPS that vary based on duration of stimulation. Populations displaying Erk1/2 activation appeared to differ from those showing DNA fragmentation and neuronal injury.

BACKGROUND:We report the case of an extramedullary pathologically proven hemangioblastoma of the conus medullaris. As spinal dural arteriovenous fistulas most commonly present with a conus medullaris syndrome, our presentation of the MRI, myelographic, and angiographic findings of this unique lesion may be useful in differentiating these two entities. CLINICAL MATERIAL/METHODS:We report the case of a 57 year old woman with a two year history of progressive low back and right lower extremity pain and weakness. Spinal MRI and myelography demonstrated serpiginous vasculature on the dorsum of the spinal cord consistent with either a vascular tumor or malformation. Selective spinal angiography was thus undertaken by the neuroendovascular team which revealed a tumor nodule consistent with vascular tumor. T12-L1 laminectomy was performed and a 6 mm vascularized tumor was found in the intradural extramedullary compartment adjacent to the conus medullaris. The tumor was completely removed and pathological analysis was consistent with hemangioblastoma. CONCLUSION/CONCLUSIONS:This report documents a unique location for extramedullary spinal hemangioblastomas. Although both MRI and myelography are helpful in studying these lesions, angiography remains the gold standard in differentiating between vascular tumor and malformation. We suggest that the angiography be performed by a neurointerventional team to facilitate embolization, should this be warranted.

OBJECTIVE AND IMPORTANCE/OBJECTIVE:To our knowledge, this is the first reported case of the use of stereotactic radiotherapy for an eosinophilic granuloma (EG) of the clivus. We report follow-up information on two previously reported cases and suggest a management plan for this rare lesion. CLINICAL PRESENTATION/METHODS:We report the case of a 4.5-year-old boy who presented with a complete abducens palsy on the right with an associated head turn. A computed tomographic scan of his head revealed a lytic lesion on that side, and magnetic resonance imaging showed the mass to be of low intensity on T1-weighted images and of high intensity on T2-weighted images with heterogeneous enhancement. INTERVENTION/METHODS:A transnasal stereotactic biopsy was performed, revealing an EG. The patient was treated with stereotactic radiotherapy, and he became symptom-free with radiographic resolution of his lesion. Reviewing the literature, we found 13 series with 87 cases of EG in the petrous portion of the temporal bone. EG in the cranial base occurring outside of the temporal bone or in the temporal bone and extending intracranially is, however, quite rare, with only nine other cases reported, two of them clival. CONCLUSION/CONCLUSIONS:These findings suggest a classification schema in which cranial base EG lesions be grouped with either the more common extracranial petrous temporal bone lesions or the very rare intracranial lesions. Although there are few cases in the literature, treatment results indicate that clival EG, and perhaps all intracranial cranial base EGs, be treated by a biopsy alone, followed by surgery or stereotactic radiotherapy if there is an incomplete resolution of the symptoms or if there is a recurrence.

Studies of patients with temporal lobe epilepsy and of experimental models of this disorder suggest that the hippocampal dentate gyrus may be a common site of seizure onset and propagation. However, the nature of the dentate "network defect" that could give rise to spontaneous, intermittent, and synchronous population discharges is poorly understood. We have hypothesized that large expanses of the dentate granule cell layer have an underlying tendency to discharge synchronously in response to afferent excitation, but do not do so normally because vulnerable dentate hilar neurons establish lateral inhibition in the granule cell layer and thereby prevent focal discharges from spreading to surrounding segments. To address this hypothesis, we (1) identified functionally independent segments of the granule cell layer; (2) determined whether discharges in one segment evoke lateral inhibition in surrounding segments; and, (3) determined if disinhibition induces normally independent segments of the granule cell layer to discharge synchronously. Simultaneous extracellular recordings were made from two locations along the longitudinal or transverse axes of the granule cell layer using saline- and bicuculline-filled electrodes that were glued together. Leakage of 10 mM bicuculline from the electrode tip produced no detectable spontaneous activity. However, single perforant path stimuli evoked multiple population spikes at the bicuculline electrode and simultaneous normal responses at the nearby saline electrode. The multiple spikes evoked at the bicuculline electrode did not propagate to, and were not detected by, the adjacent saline electrode, indicating functional separation between neighboring subgroups of granule cells. Paired-pulse stimulation revealed that multiple discharges were not only restricted to one segment of the granule cell layer, but strongly inhibited surrounding segments. This lateral inhibition in surrounding segments often lasted longer than 150 msec. Finally, we evaluated granule cell activity at two normally independent sites within the granule cell layer both before and after disinhibition was induced by high frequency stimulus trains or bicuculline injection. Following a 10 sec, 20 Hz perforant path stimulus train, 2 Hz stimulation evoked virtually identical synchronized epileptiform discharges from normally separated sites. Similarly, intrahippocampal or intravenous bicuculline injection produced spontaneous synchronous epileptiform discharges throughout the granule cell layer. These results indicate that lateral or "surround" inhibition is an operant physiological mechanism in the normal dentate gyrus and suggest that afferent stimuli to a disinhibited dentate network evoke highly synchronized discharges from large expanses of the granule cell layer that are normally kept functionally separated by GABA-mediated inhibition.