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Epilepsy is the leading symptom in low grade gliomas. In order to evaluate the effect of interstitial radiosurgery on seizure incidence the authors retrospectively analysed the outcome of 80 patients with temporal grade-II astrocytomas and a history of epilepsy. Patients were treated by 125-iodine temporary implants using 60 Gy as reference dose. The dose rate was 9.6 +/- 1.6 cGy/h. Median follow-up was 4.1 years. In 20 patients benzodiazepine receptor imaging was performed using single photon emission computed tomography and iomazenil. Treatment with carbamazepine alone led to a significant reduction in seizure incidence with 28% of patients being seizure-free (p < 0.05). Interstitial radiosurgery led to a further reduction of seizures rendering 40% of patients seizure-free after 3 months. After 6 months only 21% of patients still had seizures that were refractory to medical treatment (p < 0.01). SPECT imaging revealed that all tumours had a significant reduction of benzodiazepine receptors which also applied to the surrounding brain. After interstitial radiosurgery of tumours, receptor density increased in brain adjacent to the tumour (0.68 to 0.94 ratio ipsi to contralateral brain, p < 0.01) coincident with significant tumour shrinkage. Thus, in epileptogenic temporal low grade gliomas, interstitial radiosurgery not only reduced the tumour burden but also effectively treated the concomitant epilepsy, resulting in 79% of patients being seizure-free after combined treatment by radiosurgery and anticonvulsive medication. These results compare favourably to the outcome after resection in lesional epilepsy raising the issue of radiosurgery as a less invasive alternative to open epilepsy surgery.

Stereotactic radiosurgery is an elegant alternative to microsurgery in both skull base meningiomas and solitary brain metastasis. Though efficacy for both entities has been established prognostic variables pertaining to individual tumour biology have not yet been identified. Therefore the authors measured regional glucose utilisation, thallium-uptake and blood flow in 20 patients (10 meningiomas, 10 metastasis) before and after LINAC radiosurgery. Measurements were performed using SPECT and stable xenon-CT. The mean tumour dose given was 16.3 and 19.5 Gy in meningiomas and metastasis respectively. Metastatic tumours were hypermetabolic in comparison to contralateral normal brain and responders to radiosurgery showed a lower tumour/brain ratio than non-responders (1.43 vs 0.91 respectively, p < 0.01). Meningiomas did not exhibit hypermetabolism and therapeutic outcome was not related to glucose utilisation. Thallium-uptake, however, was closely related to therapeutic response in meningiomas (1.37 vs 2.2 in responders vs non-responders, p < 0.01). This relationship could not be established in metastatic lesions. Blood flow was widely distributed in both meningiomas and metastasis (26-72.8 and 30.2-70.8 ml/100 g/min). rCBF did not correlate with therapeutic outcome. Using FDG-SPECT and thallium-201-SPECT the authors were able to distinguish between tumours likely to respond to stereotactic radiosurgery and those not prone to respond. Furthermore the methodology can be used to monitor therapeutic response in treated tumours before morphologic changes occur.

Radiographic imaging of the intratemporal portion of the fallopian canal is important in cases of traumatic facial nerve palsy to visualize the site of involvement. Even if high-resolution computed tomography is used, several images in various planes are necessary to obtain satisfactory diagnostic information. By using a classic axial scan and a wide window (bone algorithm), a 2D reconstruction can be performed "off-line" to visualize the mastoid portion of the fallopian canal. A reconstruction plane 45 degrees to the median-sagittal plane and through the lateral genu of the facial nerve provides the best imaging of the mastoid portion down to the stylomastoid foramen. In cases of temporal bone fractures with facial paralysis, an excellent demonstration of fracture line without further radiation exposure can be obtained in cases considered for surgical decompression.

This investigation of the optic canal is based on measurements of 60 macerated adult European skulls from the Alexander-Ecker Collection at the Anatomy Department of the University of Freiburg. An indian skull is also described, in which the cranial end of the left optic canal is closed by a bony plate. Computer tomographical and anatomical measurements were compared in order to assess the correlation of the two methods of investigation and the accuracy of the CT representation of osseous structures. The coronal projection of the optic canal proved to be optimal for CT examination--the sections meet the optic canal at an angle of 85.5 degrees. The measurements of transverse diameters correlate poorly, whereas vertical diameters and distances correlate well. The extent to which anatomical variations can be assessed by CT was also investigated. All anatomical variants could be observed in coronal sections, except the bony lamina in the Indian skull, which could not be seen until a contrast medium was used. The so-called "keyhole anomaly" appeared in 3.3% in our material, the "figure-of-eight" variant in 2.5%, and a carotid clinoid canal in 13.3%.