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The imaging characteristics are rather different from those of other tumors In the CT scan one observes a well-demarcated heterogeneous hyperdense mass with fairly uniform contrast enhancement Calci cation and some degree of cystic change are common in supratentorial tumors but less so in infratentorial ones There are mixed signal characteristics on MRI, generally hypointense on T1 sequences and hyperintense on T2 An intraventricular location supports the diagnosis of ependymoma, but meningioma and a number of other tumors may be found in this location Treatment It is notable that the interval between the rst symptom and the diagnosis ranges from 4 weeks, in the most malignant types, to 7 to 8 years In a follow-up study of 101 cases in Norway, where ependymomas made up 12 percent of all primary intracranial tumors (and 32 percent of intraspinal tumors), the postoperative survival was poor Within a year, 47 percent of the patients had died, although 13 percent were alive after 10 years Doubtless the prognosis depends on the degree of anaplasia (M rk and L ken), the location of the tumor, and whether it is operable Surgical removal is supplemented by radiation therapy, particularly to address the high rate of seeding of the ventricles and spinal axis In the treatment of cerebral ependymoblastomas, antitumor drugs are often used in combination with radiation therapy Meningioma (See also page 577) This is a benign tumor, rst illustrated by Matthew Bailie in his Morbid Anatomy (1787) and rst recognized by Bright, in 1831, as originating from the dura mater or arachnoid It was analyzed from every point of view by Harvey Cushing and was the subject of one of his most important monographs Meningiomas represent about 15 percent of all primary intracranial tumors; they are more common in women than in men (2:1) and have their highest incidence in the sixth and seventh decades Some are familial There is evidence that persons who have undergone radiation therapy to the scalp or cranium are vulnerable to the development of meningiomas and that the tumors appear at an earlier age in such individuals (Rubinstein et al) There are a number of reports of a meningioma developing at the site of previous trauma, such as a fracture line, but the association is uncertain The most frequent genetic defects of meningiomas are truncating (inactivating) mutations in the neuro bromatosis 2 gene (merlin) on chromosome 22q These are present in the great majority of certain meningiomas (eg, broblastic and transitional types), but not others Merlin deletions probably also play a role in those instances in which there is a loss of the long arm of chromosome 22 In meningiomas of both the sporadic and neuro bromatosis (NF2)-associated types, other genetic defects are found, including deletions on chromosomes 1p, 6q, 9p, 10q, 14q, and 18q Meningiomas also elaborate a variety of soluble proteins, some of which (vascular endothelial growth factor) are angiogenic and relate to both the highly vascularized nature of these tumors and their prominent surrounding edema (see Lamszus for further details) Some meningiomas contain estrogen and progesterone receptors The implications of these ndings are not yet clear but may relate to the increased incidence of the tumor in women, its tendency to enlarge during pregnancy, and an association with breast cancer The precise origin of meningiomas is still not settled According to Rubinstein, they may arise from dural broblasts, but in our opinion, they are more clearly derived from arachnoidal (meningothelial) cells, in particular from those forming the arachnoid villi Since the clusters of arachnoidal cells penetrate the dura in largest number in the vicinity of venous sinuses, these are the.

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Sometimes you may want certain fields to be automatically filled This is usually the case where you have a unique ID for each record In the example table you have seen in this chapter, the SupID field is supposed to have unique values, but the way they are set up, somebody has to add a unique value It could be the administrator, but such an entry system limits the entry process to a single person working from a list Wouldn t it be better to have the unique ID value be entered no matter who enters the values for the other fields To quote Curly, soitenly! At this stage not too many entries have been made in the database table, so it should not be too difficult to make the necessary changes to set up an automatic unique value to be entered into the SupID field The following steps guide you through this process:

sites of predilection for the tumor Grossly, the tumor is rm, gray, and sharply circumscribed, taking the shape of the space in which it grows; thus, some tumors are at and plaque-like, others round and lobulated They may indent the brain and acquire a pia-arachnoid covering as part of their capsule, but they are clearly demarcated from the brain tissue (extra-axial) except in the unusual circumstance of a malignant invasive meningioma Rarely, they arise from arachnoidal cells within the choroid plexus, forming an intraventricular meningioma Microscopically, the cells are relatively uniform, with round or elongated nuclei, visible cytoplasmic membrane, and a characteristic tendency to encircle one another, forming whorls and psammoma bodies (laminated calci c concretions) A notable electron microscopic characteristic is the formation of very complex interdigitations between cells and the presence of desmosomes (Kepes) Cushing and Eisenhardt and, more recently, the World Health Organization (Lopes et al) have divided meningiomas into many subtypes depending on their mesenchymal variations, the character of the stroma, and their relative vascularity, but the value of such classi cations is debatable Currently neuropathologists recognize a meningothelial (syncytial) form as being the most common It is readily distinguished from other similar but non-meningothelial tumors such as hemangiopericytomas, broblastomas, and chondrosarcomas The usual sites of meningioma are the sylvian region, superior parasagittal surface of the frontal and parietal lobes, olfactory groove, lesser wing of the sphenoid bone, tuberculum sellae, superior surface of the cerebellum, cerebellopontine angle, and spinal canal Some meningiomas such as those of the olfactory groove, sphenoid wing, and tuberculum sellae express themselves by highly distinctive syndromes that are diagnostic in themselves; these are described further on in this chapter Rarely, they are mul-

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it from No to Yes Change the (Is Identity) parameter to Yes, the Identity Increment to 1, and the Identity Seed (the starting value) to 15100 Figure 12-11 shows the new settings