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Complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma (TSM) treatment. The authors retrospectively reviewed 51 patients treated surgically for TSM between 2003 and 2010, with special attention to surgical technique, visual outcomes, and prognostic factors for treatment outcome. All patients were operated via the lateral subfrontal approach. The cohort mean age and Karnofsky performance status (KPS) on admission was 57.1 ± 13.6 and 84.3 ± 11.7, respectively. The most common presenting sign was visual impairment. The mean tumor size was 29.4 ± 10.7 mm. In 45 of the patients (88.2%), gross total resection was achieved. Improvement and/or preservation of visual acuity and visual field were achieved in 95.9% and 85.3%, respectively. Visual functions on admission were found to be the strongest predictors for postoperative improvement in visual outcome, followed by better KPS on admission, smaller tumor size, and young age. Postoperative neurological complications included cerebrospinal fluid (CSF) leak, meningitis, and postoperative seizures. TSM can be safely operated on through the lateral subfrontal approach. A high percentage of complete tumor resection and excellent visual outcomes are achieved using this technique. Surgical treatment in the early stage of the disease may result in a better visual outcome.

Short tandem repeat (STR) analysis is a polymerase chain reaction (PCR)-based technology that is based on typing highly polymorphic repeats of 2-6 base pairs of DNA. Typically these repeats are inherited in codominant mode, so that the number of repeats in each allele is independently determined. Such analysis enables the identification of loss of heterozygosity (LOH) or a shift in a genetic region, and reveals whether two cell populations are genetically "similar" or different.2 Emerging first as a DNA identity tool in the forensic setting, several clinical diagnostic uses for STR typing have already been established: for example, follow-up of engraftment after bone marrow transplantation; identification of uniparental disomy pattern of inheritance; and assessment of maternal cell contamination in prenatal specimens. 13 The authors report a case in which STR typing was used to resolve a diagnostic dilemma involving two discrepant specimens from a patient with a brain tumor. case report History and ExaminationA 47-year-old, right-handed man presented to the emergency center with a 2-day history of progressive right leg weakness. His medical history was significant for heavy smoking of 40 pack-years. His physical examination findings were remarkable for right lower-extremity weakness and mild upper-limb dysmetria. However, findings on chest radiographs were unremarkable, and brain MRI studies obtained with contrast revealed two separate ring-enhancing lesions localized to the left frontal lobe (Fig. 1). The radiological differential diagnosis included multiple brain metastases, multicentric glioblastoma, lymphoma, or, less likely, brain abscesses. A stereotactic biopsy sample taken from the left frontal anterior lesion was most compatible with metastatic small cell carcinoma with neuroendocrine features ( Fig. 2A and B). At that time the working diagnosis, based on the history of heavy smoking, multiple brain lesions on MRI studies, and the pathology report was that of metastatic small cell lung carcinoma. Ten days after his initial presentation, the patient presented to the emergency center complaining of worsening right leg weakness, headaches, and blurred vision, and was admitted for urgent radiation treatment. Radiation Treatment and Subsequent OperationA chest CT scan performed at the time of admission abbreviatioNs LOH = loss of heterozygosity; PCR = polymerase chain reaction; STR = short tandem repeat. The differential diagnosis of a brain lesion with two discordant pathology reports includes the presence of collision tumor, metaplastic changes, and labeling errors that occurred during the processing of the specimen. The authors present a case in which the first brain biopsy from a 47-year-old patient with a history of heavy smoking was compatible with metastatic small cell carcinoma, and the second biopsy taken during decompression craniotomy 3 weeks later was compatible with WHO Grade IV glioblastoma. Using short tandem repeat (STR) analysis of the two specimens and nontumorderived patient DNA, the autho...

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