Stereotactic radiosurgery versus surgical resection for the management of intracranial meningiomas in elderly patients

Abstract Background The effect of time delay from diagnosis to surgery on the prognosis of elderly patients with liver cancer is not well known. We investigated the effect of surgical timing on the prognosis of elderly hepatocellular carcinoma patients undergoing surgical resection and constructed a Nomogram model to predict the overall survival of patients. Methods A retrospective analysis was performed on elderly patients with primary liver cancer after hepatectomy from 2012 to 2018. The effect of surgical timing on the prognosis of elderly patients with liver cancer was analyzed using the cut-off times of 18 days, 30 days, and 60 days. Cox was used to analyze the independent influencing factors of overall survival in patients, and a prognostic model was constructed. Results A total of 232 elderly hepatocellular carcinoma patients who underwent hepatectomy were enrolled in this study. The cut-off times of 18, 30, and 60 days were used. The duration of surgery had no significant effect on overall survival. Body Mass Index, Child-Pugh classification, Tumor size Max, and Length of stay were independent influencing factors for overall survival in the elderly Liver cancer patients after surgery. These factors combined with Liver cirrhosis and Venous tumor emboli were incorporated into a Nomogram. The nomogram was validated using the clinical data of the study patients, and exhibited better prediction for 1-year, 3-year, and 5-year overall survival. Conclusions We demonstrated that the operative time has no significant effect on delayed operation in the elderly patients with hepatocellular carcinoma, and a moderate delay may benefit some patients. The constructed Nomogram model is a good predictor of overall survival in elderly patients with hepatectomy.

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What is the reasonable option for elderly patients with incidental pancreatic cystic neoplasms? Follow-up observation versus surgical resection

Geriatrics and Gerontology International ◽

10.1111/ggi.12705 ◽

2016 ◽

Vol 17 (2) ◽

pp. 256-261

Author(s):

Hyo Jung Kim ◽

Jae Seon Kim ◽

Jae Min Lee ◽

Moon Kyung Joo ◽

Beom Jae Lee ◽

...

Keyword(s):

Elderly Patients ◽

Surgical Resection ◽

Cystic Neoplasms ◽

Pancreatic Cystic Neoplasms

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161: Surgical Resection(S) Plus Stereotactic Radiosurgery (SRS) Versus SRS Alone for Large Brain Metastases: A Comparative Study

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)08877-0 ◽

2021 ◽

Vol 163 ◽

pp. S68

Author(s):

Barbara-Ann Millar ◽

Normand Laperriere ◽

Tatiana Conrad ◽

Aristotelis Kalyvas ◽

Gelareh Zadeh ◽

...

Keyword(s):

Brain Metastases ◽

Comparative Study ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Large Brain

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The Cost Effectiveness of Stereotactic Radiosurgery versus Surgical Resection in the Treatment of Solitary Metastatic Brain Tumors

Neurosurgery ◽

10.1227/00006123-199509000-00012 ◽

1995 ◽

Vol 37 (3) ◽

pp. 445-455 ◽

Cited By ~ 137

Author(s):

Michael J. Rutigliano ◽

L. Dade Lunsford ◽

Douglas Kondziolka ◽

Michael J. Strauss ◽

Vikram Khanna ◽

...

Keyword(s):

Cost Effectiveness ◽

Brain Tumors ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Metastatic Brain Tumors ◽

The Cost

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Short-term therapeutic effects of low-dose cytarabine plus surgical resection on elderly patients with trigeminal nerve tumor and safety observation

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.311.6440 ◽

2014 ◽

Vol 31 (1) ◽

Author(s):

Xiang-Sheng Li ◽

Wei-Long Yang ◽

Fa-Zheng Shen ◽

Guo-Jun Gao ◽

Ji-Wei Ma ◽

...

Keyword(s):

Elderly Patients ◽

Surgical Resection ◽

Trigeminal Nerve ◽

Low Dose ◽

Therapeutic Effects ◽

Short Term ◽

Nerve Tumor ◽

Low Dose Cytarabine

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Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery

Neurosurgery ◽

10.1093/neuros/nyy436 ◽

2018 ◽

Vol 85 (5) ◽

pp. 632-641 ◽

Cited By ~ 6

Author(s):

Robert H Press ◽

Chao Zhang ◽

Mudit Chowdhary ◽

Roshan S Prabhu ◽

Matthew J Ferris ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Cumulative Incidence ◽

Postoperative Radiotherapy ◽

Multivariable Analysis ◽

Treatment Strategies ◽

Competing Risk ◽

Leptomeningeal Dissemination ◽

Increased Risk

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

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Two out of three of octogenarians benefitted from delayed resection of spinal meningiomas

Surgical Neurology International ◽

10.25259/sni_943_2021 ◽

2021 ◽

Vol 12 ◽

pp. 593

Author(s):

Ville Vasankari ◽

Roel Hubert Louis Haeren ◽

Mika Niemela ◽

Miikka Korja

Keyword(s):

Elderly Patients ◽

Surgical Resection ◽

Case Description ◽

Delayed Surgery ◽

Thoracic Spinal ◽

Spinal Meningiomas

Background: Can elderly patients with thoracic meningioma and severe paraparesis benefit from delayed surgery? Case Description: Two out of three octogenarians with severe preoperative paraparesis (all wheelchair-bound) were able to walk again following delayed (60–120 days from onset of deficit) surgical resection of thoracic spinal meningiomas. Conclusion: Two out of three octogenarians with thoracic meningiomas causing severe paraparesis benefitted from the delayed (i.e. from 60 to 289 days) surgical resection of their tumors.

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Surgical Management Of Posterior Fossa Arteriovenous Malformations

Operative Neurosurgery ◽

10.1227/01.neu.0000204641.38419.2d ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-189-ONS-201 ◽

Cited By ~ 6

Author(s):

John Sinclair ◽

Michael E. Kelly ◽

Gary K. Steinberg

Keyword(s):

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Posterior Fossa ◽

Arteriovenous Malformations ◽

Cranial Nerves ◽

Venous Drainage ◽

Cerebellar Nuclei ◽

Preoperative Embolization ◽

Frameless Stereotaxy ◽

Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

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