scholarly journals Risk of Brain Herniation After Craniotomy With Preoperative Lumbar Spinal Drainage: A Single-Surgeon Experience of 365 Patients Among 3000 Major Cranial Cases

2020 ◽  
Author(s):  
Brandon C Lane ◽  
Robert Scranton ◽  
Aaron A Cohen-Gadol
Keyword(s):  
Clinical Symptoms ◽  
Mass Effect ◽  
Brain Herniation ◽  
Surgical Indications ◽  
Tumor Removal ◽  
Lumbar Drain ◽  
Surgeon Experience ◽  
Brain Relaxation ◽  
Lumbar Spinal ◽  
Revascularization Procedures

Abstract BACKGROUND Lumbar spinal drainage (LSD) can significantly facilitate brain relaxation and improve ease of surgical goals for a variety of neurosurgical indications. Although rapid drainage of large volumes of spinal fluid can theoretically produce shifts in brain compartments and herniation syndromes, the clinical significance of this phenomenon when LSD is used immediately before craniotomy is unclear. OBJECTIVE To report a large single-surgeon consecutive experience with symptomatic brain herniation after lumbar drainage before craniotomy. METHODS Included were 365 patients who underwent LSD with either lumbar drain or lumbar puncture for a variety of different neurosurgical pathologies between 2008 and 2018 immediately before craniotomy. We reviewed the surgical indications, craniotomy location, approach, type of LSD, presence of postoperative brain herniation on imaging, type of herniation, clinical symptoms, lesion pathology, and 30-d modified Rankin Scale score for each patient. RESULTS There was no patient who suffered from the development of new or worsening symptomatic or radiological brain herniation directly related to use of immediate preoperative LSD. This included 204 supratentorial and 161 infratentorial procedures. Surgical indications included 188 tumors, 5 aneurysms, 37 arteriovenous malformations, 2 revascularization procedures, 97 microvascular decompressions, 10 optic nerve decompressions requiring extradural clinoidectomy for tumor removal, and 26 “other” pathologies. CONCLUSION Brain herniation did not occur postoperatively with the use of immediate preoperative LSD in our series, regardless of craniotomy location, pathology, extent of mass effect, or approach. Our experience suggests that LSD is a potentially safe preoperative adjunct that can be used to facilitate surgical objectives.

Correlation of axial loaded magnetic resonance imaging with clinical symptoms in lumbar spinal canal stenosis patients

MedPharmRes ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 15-19
Author(s):  
Son Nguyen ◽  
Son Vi ◽  
Hoat Luu ◽  
Toan Do
Keyword(s):  
Spinal Canal ◽  
Clinical Symptoms ◽  
Axial Loading ◽  
Spinal Canal Stenosis ◽  
Leg Pain ◽  
Cross Sectional ◽  
Canal Stenosis ◽  
Conventional Mri ◽  
Frame System ◽  
Lumbar Spinal

There are cases when symptoms are available but no abnormal stenosis is found in MRI and vice versa. Axial-loaded MRI has been shown that it can demonstrate more accurately the real status of spinal canal stenosis than conventional MRI. This is the first time we applied a new system that we have recreated from the original loading frame system in order to fit with the demands of Vietnamese people. Sixty-two patients were selected from Phu Tho Hospital in Phu Tho Province, Vietnam, who fulfilled the inclusion criteria. The Anterior-posterior diameter (APD), Dura Cross-sectional Area (DSCA) in conventional MRI and axial loaded MRI, and changes in APD and DCSA were determined at the single most constricted intervertebral level. The APD and DCSA in axial loaded MRI had very good significant correlations with VAS for back pain (rs=0.83, 0.79), leg pain (rs=0.69, 0.57) and JOA score (rs=0.70, 0.65). APD and DCSA in axial loaded MRI significantly correlated with the severity of symptoms. Our axial loading MRI provides more valuable information than the conventional MRI for assessing patients with LSCS.

scholarly journals Surgeon Reliability for the Assessment of Lumbar Spinal Stenosis on MRI: The Impact of Surgeon Experience

10.14444/4034 ◽  
2017 ◽  
Vol 11 (5) ◽  
pp. 34 ◽  
Author(s):  
Satyajit V. Marawar ◽  
Ian A. Madom ◽  
Mark Palumbo ◽  
Richard A. Tallarico ◽  
Nathaniel R. Ordway ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Surgeon Experience ◽  
Lumbar Spinal ◽  
The Impact

scholarly journals Minimally Invasive Lumbar Spinal Decompression in Elderly Patients with Magnetic Resonance Imaging Morphological Analysis

2018 ◽  
Vol 12 (2) ◽  
pp. 285-293 ◽  
Author(s):  
Seungman Ha ◽  
Youngho Hong ◽  
Seungcheol Lee
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Clinical Symptoms ◽  
Morphological Features ◽  
Radiological Parameters ◽  
Significant Difference ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Case-control study.</p></sec><sec><title>Purpose</title><p>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with lumbar spinal stenosis (LSS) who were treated by minimally invasive surgery (MIS) unilateral laminectomy for bilateral decompression (ULBD) using a tubular retractor.</p></sec><sec><title>Overview of Literature</title><p>Numerous methods using imaging have been attempted to describe the severity of spinal stenosis. But the relationship between clinical symptoms and radiological features remains debatable.</p></sec><sec><title>Objective</title><p>In this study, we aimed to investigate clinical outcomes and morphological features in elderly patients with LSS who were treated by MIS-ULBD.</p></sec><sec><title>Methods</title><p>We methodically assessed 85 consecutive patients aged &gt;65 years who were treated for LSS. The patients were retrospectively analyzed in two age groups: 66–75 years (group 1) and &gt;75 years (group 2). Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria. Outcome parameters were compared between the groups at the 1-year follow-up. Core radiologic parameters for central and lateral stenosis were analyzed and clinical findings of the groups were compared.</p></sec><sec><title>Results</title><p>At the 1-year follow-up, patients in both groups 1 and 2 demonstrated significant improvement in their VAS and ODI scores. All clinical outcomes, except postoperative ODI, were not significantly difference between the groups. In addition, no significant difference was noted in the preoperative radiological parameters between the groups. There was no statistically significant correlation between radiological parameters and clinical symptoms or their outcomes. Moreover, no differences were noted in perioperative adverse events and in the need for repeat surgery at follow-ups between the groups.</p></sec><sec><title>Conclusions</title><p>MIS-ULBD by tubular approach is a safe and effective treatment option for elderly patients with LSS. Clinical outcomes in patients with LSS and aged &gt;75 years were comparable with those in patients with LSS and aged 66–75 years. Moreover, we did not find any correlation between radiological parameters and clinical outcomes in either of the two patient groups.</p></sec>

scholarly journals Orbital Schwannoma: Case Report and Review

2019 ◽  
Vol 38 (03) ◽  
pp. 199-202 ◽  
Author(s):  
Ricardo Lourenço Caramanti ◽  
Mário José Goes ◽  
Feres Chaddad ◽  
Lucas Crociati Meguins ◽  
Dionei Freitas de Moraes ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Previous History ◽  
Mass Effect ◽  
Complete Resection ◽  
High Signal ◽  
Resonance Imaging ◽  
History Of Disease ◽  
Orbital Pain ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

AbstractOrbital schwannomas are rare, presenting a rate of incidence between 1 and 5% of all orbital lesions. Their most common clinical symptoms are promoted by mass effect, such as orbital pain and proptosis. The best complementary exam is the magnetic resonance imaging (MRI), which shows low signal in T1, high signal in T2, and heterogeneous contrast enhancement. The treatment of choice is surgical, with adjuvant radiotherapy if complete resection is not possible. We report the case of a 24-year-old male patient with orbital pain and proptosis, without previous history of disease. The MRI showed a superior orbital lesion compatible with schwannoma, which was confirmed by biopsy after complete resection using a fronto-orbital approach.

Gliomatosis Cerebri: A Brain Tumour Which is too Difficult to Treat?

1998 ◽  
Vol 43 (3) ◽  
pp. 84-86 ◽  
Author(s):  
D. Choi ◽  
U. Schulz ◽  
K. Seex
Keyword(s):  
Brain Tumour ◽  
Clinical Symptoms ◽  
Ct Scanning ◽  
Mass Effect ◽  
World Health Organisation ◽  
Gliomatosis Cerebri ◽  
World Health ◽  
Low Grade ◽  
The Brain ◽  
Diffuse Brain

Gliomatosis cerebri is a rare form of primary diffuse brain tumour first described by Nevin in 1938.1 It was originally considered to be a post-mortem diagnosis before Troost et al reported a clinically diagnosed case in 1987.2 However antemortem diagnosis remains difficult due to vague clinical symptoms and often non-specific findings on CT scanning. Gliomatosis cerebri has been classified by the World Health Organisation as an infiltrative tumoural process, which involves at least two, and usually three, lobes of the brain.3 Magnetic resonance (MR) imaging shows a diffuse infiltrative process with possible mass effect but no necrosis. histology is usually of a low grade astrocytic neoplasm which seemingly infiltrates out of proportion to the degree of anaplasia. We report two patients who presented over the past year, whose clinical and radiological features prompted a preoperative diagnosis of gliomatosis cerebri, confirmed by biopsy.

scholarly journals 114 Association of Trunk Muscle Function with Gait Ability of Patients with Lumbar Spinal Canal Stenosis

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv28-iv33
Author(s):  
Takeshi Shintani ◽  
Shingo Otsuki ◽  
Masashi Hashimoto ◽  
Satoshi Tagashira ◽  
Kazuaki Kinoshita
Keyword(s):  
Muscle Function ◽  
Spinal Canal ◽  
Clinical Symptoms ◽  
Trunk Muscle ◽  
Spinal Canal Stenosis ◽  
Lumbar Spinal Canal Stenosis ◽  
Change Rate ◽  
Canal Stenosis ◽  
Lumbar Spinal Canal ◽  
Lumbar Spinal

Abstract Introduction Lumbar spinal canal stenosis (LSCS) is not always correlated with spinal stenosis and severity of clinical symptoms. Although, it is important for trunk muscle function to enhance the dynamic stability of the lumbar spine, however few studies have reported on this. We hypothesized that trunk muscle function and gait ability of LSCS patients are related. This study aimed to clarify the association between trunk muscle function, using Side Bridge test (SB), and gait ability of LSCS patients. Methods The subjects were 42 patients with LSCS: 17 supported the trunk by the foot (F-group), and 25 supported the trunk by the knee (K-group) in the SB test. The SB test was performed to determine the posture holding time. Gait ability was evaluated by measuring the time of 10-m walk test (10MWT) preoperatively and 2 weeks postoperatively. The 2 weeks postoperative 10MWT was divided by the preoperative 10MWT to calculate the 10MWT change rate. The contents of this study were the relation between SB test and preoperative 10MWT, SB test and 10MWT change rate in each group. Moreover, the median value of SB test was calculated for both groups; based on these values, the patients were categorized into high-value and low-value groups. Differences between the 10MWT and 10MWT change rates of both groups were examined using Mann-Whitney U-test. Results There was a significant correlation between SB test and 10MWT (F-group: r=-0.63, p=0.004; K-group: r=-0.59, p = 0.002), 10 MWT change rate (F-group: r=-0.59, p=0.01; K-group: r=-0.41, p=0.04). With respect to the 10MWT, the high-value group was significantly faster than the low-value group (F-group: p=0.02, K-group: p=0.03), and with respect to the 10MWT change rate, the high-value group was significantly better than the low-value group (F-group: p=0.02, K-group: p=0.01). Conclusion Trunk muscle function is associated with gait ability of LSCS patients.

Management of large vestibular schwannoma. Part II. Primary Gamma Knife surgery: radiological and clinical aspects

2011 ◽  
Vol 115 (5) ◽  
pp. 885-893 ◽  
Author(s):  
Rick van de Langenberg ◽  
Patrick E. J. Hanssens ◽  
Jeroen B. Verheul ◽  
Jacobus J. van Overbeeke ◽  
Patty J. Nelemans ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Clinical Symptoms ◽  
Growth Control ◽  
Mass Effect ◽  
Gamma Knife Surgery ◽  
Clinical Aspects ◽  
Volumetric Growth ◽  
Trigeminal Neuropathy ◽  
Clinical Control

Object In large vestibular schwannomas (VSs), microsurgery is the main treatment option. A wait-and-scan policy or radiosurgery are generally not recommended given concerns of further lesion growth or increased mass effect due to transient swelling. Note, however, that some patients do not present with symptomatic mass effect or may still have serviceable hearing. Moreover, others may be old, suffer from severe comorbidity, or refuse any surgery. In this study the authors report the results in patients with large, growing VSs primarily treated with Gamma Knife surgery (GKS), with special attention to volumetric growth, control rate, and symptoms. Methods The authors retrospectively analyzed 33 consecutive patients who underwent GKS for large, growing VSs, which were defined as > 6 cm3 and at least indenting the brainstem. Patients with neurofibromatosis Type 2 were excluded from analysis, as were patients who had undergone previous treatment. Volume measurements were performed on contrast-enhanced T1-weighted MR images at the time of GKS and during follow-up. Medical charts were analyzed for clinical symptoms. Results Radiological growth control was achieved in 88% of cases, clinical control (that is, no need for further treatment) in 79% of cases. The median follow-up was 30 months, and the mean VS volume was 8.8 cm3 (range 6.1–17.7 cm3). No major complications occurred, although ventriculoperitoneal shunts were placed in 2 patients. The preservation of serviceable hearing and facial and trigeminal nerve function was achieved in 58%, 91%, and 86% of patients, respectively, with any facial and trigeminal neuropathy being transient. In 92% of the patients presenting with trigeminal hypesthesia before GKS, the condition resolved during follow-up. No patient- or VS-related feature was correlated with growth. Conclusions Primary GKS for large VSs leads to acceptable radiological growth rates and clinical control rates, with the chance of hearing preservation. Although a higher incidence of clinical control failure and postradiosurgical morbidity is noted, as compared with that for smaller VSs, primary radiosurgery is suitable for a selected group of patients. The absence of symptomatology due to mass effect on the brainstem or cerebellum is essential, as are close clinical and radiological follow-ups, because there is little reserve for growth or swelling.

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