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OBJECTIVEChordomas are rare malignant tumors thought to arise from remnants of the notochord. They can be located anywhere along the axial skeleton but are most commonly found in the clival and sacrococcygeal regions, where the notochord regresses during fetal development. Chordomas are resistant to many current therapies, leaving surgery as the primary method of treatment. Cancer cell lines have been useful for developing new cancer treatments in a laboratory setting that can then be transferred to the clinic, but there are only 4 validated chordoma cell lines available. The objective of this work was to establish chordoma cell lines from surgical tissue in order to expand the library of lines available for laboratory research.METHODSChordoma tissue from the clivus was processed and sorted by flow cytometry to obtain an isolated population of chordoma cells. These cells were grown in culture and expanded until enough doublings to consider the line established. Identification of a chordoma cell line was made with known markers for chordoma, and the line was observed for ALDH (aldehyde dehydrogenase) subpopulations and tested in serum-free growth conditions as well as in vivo.RESULTSA fifth chordoma cell line, UM-Chor1, was successfully established. This is the first chordoma cell line originating from the clivus. Validation was confirmed by phenotype and positivity for the chordoma markers CD24 and brachyury. The authors also attempted to identify an ALDHhigh cell population in UM-Chor1, UCH1, and UCH2 but did not detect a distinct population. UM-Chor1 cells were able to form spheroids in serum-free culture, were successfully transduced with luciferase, and could be injected parasacrally and grown in NOD/SCID mice.CONCLUSIONSThe availability of this novel clival chordoma cell line for in vitro and in vivo research provides an opportunity for developments in treatment against the disease.

✓ A case report of monostotic fibrous dysplasia of the clivus in a postadolescent woman is described. Although fibrous dysplasia of craniofacial structures is well documented, involvement of the clivus has not been reported. Diagnosis by clinical, radiographic, and histopathological features is detailed. Implications for the role of surgery and management are discussed.

Object The extended transsphenoidal approach to the suprasellar region has the advantages of minimal invasiveness and brain manipulation in the surgical treatment of small to medium lesions. At the same time, however, it carries a higher risk of postoperative cerebrospinal fluid (CSF) leakage and related complications than those for the standard transsphenoidal approach. Effective reconstruction of large skull base defects is a major concern in such extended approaches and remains challenging. Methods Between January 2004 and April 2006, 21 patients affected by different suprasellar lesions underwent the extended endoscopic endonasal transtuberculum-transplanum approach. Three different techniques were used for the skull base reconstructions. In all cases, dehydrated human pericardium (Tutoplast) for dural reconstruction and a copolymer of l-lactic acid and glycolic acid (LactoSorb) as a bone substitute were used. Collagen sponges, fibrin glue, and an inflated Foley balloon catheter were also used to fill the sphenoid sinus cavity. Results Two cases of postoperative CSF leaks (9.5%) and one case of mycotic sinusitis (4.8%) occurred following the intradural (inlay) and intraextradural (inlay-overlay) graft positioning. No cases of postoperative CSF leakage occurred in cases in which the extradural-only reconstruction procedure was applied. No meningitis or other complications related to the closure were noticed. Conclusions The rate of postoperative CSF leakage after an extended approach to the suprasellar area is higher compared with that following standard pituitary surgery. Reconstruction after craniopharyngioma surgery exposes patients to an increased risk of postoperative CSF leaks. The extradural (overlay) technique was found to be the most effective in assuring a watertight closure.

✓ A new method for evaluating the patency of a ventriculoatrial shunt is described, and early experience with it is reported. Transesophageal echocardiography can demonstrate a cerebrospinal fluid leak in the right atrium through the atrial tip of a shunting device. This capability was an incidental discovery, and since then the accuracy of the technique in evaluating the patency of a ventriculoatrial shunt has been prospectively studied in 20 observations of 16 patients. The method proved to be accurate in 90% to 100% of cases. It is concluded that transesophageal echocardiography offers a rapid and accurate assessment of ventriculoatrial shunt function, is well tolerated, and is easy to perform.

✓ The author presents a long-term follow-up report of his experience with decompression of the posterior trigeminal root in 350 cases. He has found that the suboccipital approach results in fewer recurrences of pain than the temporal approach.

✓ A large subdural xanthogranuloma was removed from the posterior fossa of a 53-year-old woman with symptoms of Hand-Schüller-Christian disease. Two additional masses with similar density on computerized tomography were found in the hypothalamus and in the choroid plexus of the right lateral ventricle.

✓ Seventeen ventriculograms with the non-ionic water-soluble contrast medium, metrizamide, were performed in 15 patients, with negligible adverse effects. Visualization of the ventricular system was good in most of the patients. A combined technique, using both metrizamide and gas, increased the diagnostic value of the procedure in some cases.

✓ A series of 20 cases of arachnoid cysts in the posterior fossa is reported. Classification was made according to the location of the cysts. Accurate clinical localization was only possible with cysts in the cerebellopontine angle. Ventriculography and pneumoencephalography were the most helpful investigations for making the diagnosis. Treatment consisted of suboccipital craniectomy and complete removal. There were four operative deaths. The remaining 16 patients had essentially complete recoveries.

T HE first report of multiple intracranial meningiomas in 1889 by Anfimow and Blumenau I aroused interest which is still current in the problem of multiple brain tumors. Recently, Levin, et al.2 collected 92 such cases, the rate of multiplicity being approximately 2 .3%. The following case of a patient with two intracranial and one spinal cord meningiomas is unique in that the three large tumors occupied separate neuraxial compartments, the cranial vault, posterior fossa, and the spinal canal, and matured symptomatically almost simultaneously.

✓ The author reports the safe and satisfactory use of Conray ventriculography in 26 patients with increased intracranial pressure and discusses his technique for this procedure.

✓ A posterior fossa epidermoid cyst with high computerized tomographic attenuation is reported. The pathological and radiological features of this unusual case are presented.

✓ The straight sinus was examined in 43 human cadavers. In 13.95% of the cadavers the straight sinus was double, being either median in position, that is, one was superior and the other inferior (9.3%), or paramedian, that is, both lay side by side on either side of the midline at the junction of the falx cerebri with the tentorium cerebelli (4.65%).