Subtemporal Transtentorial Approach in Mesencephalic and Perimesencephalic Lesions in Children—A Series of 20 Patients

2019 ◽  
Author(s):  
Pietro Spennato ◽  
Carmela Chiaramonte ◽  
Carmela Russo ◽  
Nicola Onorini ◽  
Giuseppe Mirone ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Neurological Deficits ◽  
Direct Access ◽  
Low Grade ◽  
Superior Cerebellar Peduncle ◽  
High Grade ◽  
Subtemporal Approach ◽  
Advantages And Disadvantages ◽  
Neoplastic Lesions ◽  
Surrounding Areas

Abstract BACKGROUND Midbrain and surrounding areas are among the most difficult regions to surgically approach in neurosurgery. The subtemporal approach is a well-known neurosurgical approach that is rarely described in children. OBJECTIVE To assess the feasibility, advantages, and disadvantages of subtemporal approach in children. METHODS A total of 20 pediatric patients with intra-axial tumors involving the lateral midbrain or superior cerebellar peduncle or with extra-axial tumors in the middle incisural space/Meckel cave underwent subtemporal transtentorial approaches with the aim to remove (16 cases) or biopsy (4 cases) their lesions. These cases were retrospectively reviewed and the surgical approach described. RESULTS Total resection was achieved in 11 patients. In the 4 patients who underwent biopsies, a diagnosis was obtained. A total of 5 patients presented non-neoplastic lesions (dermoid tumors or cavernomas). A total of 9 patients harbored low-grade tumors and 6 high-grade tumors. Patients with low-grade tumors and non-neoplastic lesions are all alive with no evidence of disease or stable residue. Four patients affected by high grade tumors died. No patient suffered permanent neurological deficits related to the surgical approach. Three patients presented temporary neurological deficits following the procedure: one case of strabismus, one case of aphasia and hemiparesis, secondary to delayed, transient thrombosis of the Labbé vein, and 1 case of trigeminal neuralgia. CONCLUSION The subtemporal approach represents a feasible approach for mesencephalic and perimesencephalic lesions in children. It provides an ample and direct access, with excellent outcomes and acceptable postoperative morbidity.

scholarly journals Comparative analysis of endoscopic and histopathological features of superficial elevated lesions resected by endoscopic mucosal resection in the distal and proximal colon

2016 ◽  
Vol 43 (3) ◽  
pp. 178-184
Author(s):  
ARTUR ADOLFO PARADA ◽  
CARMEN AUSTRALIA PAREDE MARCONDES RIBAS ◽  
FILADELFIO EUCLYDES VENCO ◽  
JOSÉ CELSO ARDENGH ◽  
MARIANA AMARAL REIS ◽  
...  
Keyword(s):  
Distal Colon ◽  
Proximal Colon ◽  
Low Grade ◽  
High Grade ◽  
Cross Sectional ◽  
Mucosal Resection ◽  
Mucosal Surfaces ◽  
Neoplastic Lesions ◽  
The Mean ◽  
Histopathologic Features

ABSTRACT Objective: to compare endoscopic and histopathologic features of superficial, elevated lesions with one or more centimeters in diameter, diagnosed by videocolonoscopy on the distal and proximal colon, and subjected to mucosal resection. Methods: we conducted a retrospective, cross-sectional, observational study involving 8,075 videocolonoscopies. From this total, we evaluated 166 mucosectomies in 145 patients with superficial, elevated lesions with a diameter equal to or greater than 1cm. Results: the lesion prevalence was lower in G1 than in G2 (34.9% vs. 65%). The mean age, gender distribution and size (1.9cm in G1 versus 2.0cm in G2, p=0.921) were similar. There was no difference of mucosal surfaces in relation to the location (p=0.575). Considering Intraepithelial neoplasias, both the low grade, high grade (including carcinomas) and hyperplasic ones showedd no difference (p=0.527), nor did the neoplastic lesions when divided into serrated and non-serrated (p=0.124). Excluding 13 hyperplastic lesions and two carcinomas, 124 (82.1%) were non-serrated and 27 (17.9%), serrated. Conclusion: were found no significant differences between endoscopic and histopathological aspects of superficial, elevated lesions of 1cm or more in diameter in distal colon compared with the proximal, when resected by mucosectomy. Although not significant, there was a tendency of association between the location of the lesion and the presence of serrated features.

scholarly journals HISTOPATHOLOGICAL SPECTRUM OF UROTHELIAL LESIONS: AN OBSERVATIONAL STUDY

2020 ◽  
pp. 1-4
Author(s):  
Nishat Ahmad ◽  
Saurabh Banerjee ◽  
A K. Srivastava
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Bladder Tumour ◽  
Histopathological Analysis ◽  
Low Grade ◽  
High Grade ◽  
Urothelial Carcinomas ◽  
Neoplastic Lesions ◽  
Papillary Urothelial Carcinoma ◽  
Muscle Invasion

BACKGROUND: Urinary bladder cancer is second most common cancer after prostate cancer in the genitourinary system. Urothelial Carcinoma is the commonest tumour type accounting for 90% of all primary tumours of the bladder Histopathological analysis of cystoscopic bladder biopsy and Transurethral resection of the bladder tumour (TURBT) material are the mainstay for cancer diagnosis. This study was aimed to determine the frequency of different types of neoplastic lesions of the urinary bladder and to determine the grade and stage of urothelial tumours. MATERIAL METHOD: The study was carried out in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS), Ranchi from January 2018 to June 2020 and included 30 cases of cystoscopic biopsies and TURBT specimens. RESULTS: Out of 30 cases of neoplastic lesions, majority were of high grade papillary urothelial carcinoma (n=14, 46.67%) followed by low grade papillary urothelial carcinoma (n=9, 30%), 3 cases (10%) were of PUNLMP, 2 cases (6.66%) of papilloma and 1 (3.33%) case each of moderately differentiated squamous cell carcinoma and extra nodal NHL. The most common age group was 41-50 years and 51-60 years with 9 (30%) cases each. Muscle invasion was seen only in high grade papillary urothelial carcinomas. CONCLUSION: High-grade urothelial carcinomas with lamina propria and muscle invasion are the most common neoplastic lesion of urinary bladder with significant morbidity and mortality. Muscle invasion and grading, as per TNM staging, are valuable prognostic factors.

Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis

2010 ◽  
Vol 13 (5) ◽  
pp. 589-593 ◽  
Author(s):  
Charles A. Sansur ◽  
Davis L. Reames ◽  
Justin S. Smith ◽  
D. Kojo Hamilton ◽  
Sigurd H. Berven ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Surgical Approach ◽  
Complication Rate ◽  
Univariate Analysis ◽  
Morbidity And Mortality ◽  
Low Grade ◽  
Complication Rates ◽  
High Grade ◽  
Previous Surgery ◽  
History Of

Object This is a retrospective review of 10,242 adults with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) from the morbidity and mortality (M&M) index of the Scoliosis Research Society (SRS). This database was reviewed to assess complication incidence, and to identify factors that were associated with increased complication rates. Methods The SRS M&M database was queried to identify cases of DS and IS treated between 2004 and 2007. Complications were identified and analyzed based on age, surgical approach, spondylolisthesis type/grade, and history of previous surgery. Age was stratified into 2 categories: > 65 years and ≤ 65 years. Surgical approach was stratified into the following categories: decompression without fusion, anterior, anterior/posterior, posterior without instrumentation, posterior with instrumentation, and interbody fusion. Spondylolisthesis grades were divided into low-grade (Meyerding I and II) versus high-grade (Meyerding III, IV, and V) groups. Both univariate and multivariate analyses were performed. Results In the 10,242 cases of DS and IS reported, there were 945 complications (9.2%) in 813 patients (7.9%). The most common complications were dural tears, wound infections, implant complications, and neurological complications (range 0.7%–2.1%). The mortality rate was 0.1%. Diagnosis of DS had a significantly higher complication rate (8.5%) when compared with IS (6.6%; p = 0.002). High-grade spondylolisthesis correlated strongly with a higher complication rate (22.9% vs 8.3%, p < 0.0001). Age > 65 years was associated with a significantly higher complication rate (p = 0.02). History of previous surgery and surgical approach were not significantly associated with higher complication rates. On multivariate analysis, only the grade of spondylolisthesis (low vs high) was in the final best-fit model of factors associated with the occurrence of complications (p < 0.0001). Conclusions The rate of total complications for treatment of DS and IS in this series was 9.2%. The total percentage of patients with complications was 7.9%. On univariate analysis, the complication rate was significantly higher in patients with high-grade spondylolisthesis, a diagnosis of DS, and in older patients. Surgical approach and history of previous surgery were not significantly correlated with increased complication rates. On multivariate analysis, only the grade of spondylolisthesis was significantly associated with the occurrence of complications.

scholarly journals Magnetic resonance–guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study

2020 ◽  
Vol 26 (1) ◽  
pp. 13-21
Author(s):  
Elsa V. Arocho-Quinones ◽  
Sean M. Lew ◽  
Michael H. Handler ◽  
Zulma Tovar-Spinoza ◽  
Matthew Smyth ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Brain Tumors ◽  
Adjuvant Treatment ◽  
Pediatric Brain Tumors ◽  
Tumor Location ◽  
Neurological Deficits ◽  
Low Grade ◽  
High Grade ◽  
Pediatric Brain

OBJECTIVEThis study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors.METHODSData from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed.RESULTSA total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3–72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created.CONCLUSIONSSLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.

Short-term Complications Associated With Surgery for High-Grade Spondylolisthesis in Adults and Pediatric Patients

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Dwight Saulle ◽  
Lawrence G. Lenke ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pediatric Patients ◽  
Case Reports ◽  
Case Series ◽  
Adult Patients ◽  
Neurological Deficits ◽  
Low Grade ◽  
Complication Rates ◽  
High Grade ◽  
Short Term

Abstract BACKGROUND: Although it is generally agreed upon that surgery for high-grade spondylolisthesis (HGS) is associated with more complications than low-grade spondylolisthesis, its description is primarily based on case reports and relatively small case series. OBJECTIVE: To assess short-term complication rates associated with the surgical treatment of HGS in pediatric and adult patients and to identify factors associated with increased complication rates. METHODS: All cases of HGS from the Scoliosis Research Society Morbidity and Mortality database for the year 2007 were reviewed. Patients were classified as pediatric (⩽18 years) or adult (&gt;18 years). Complications were tabulated, and the rates were compared between the patient groups and based on clinical and surgical factors. RESULTS: 165 cases of HGS were reported (88 pediatric, 77 adult). There were 49 complications (29.7%) in 41 patients (24.8%), with no difference in the proportions of pediatric vs adult patients with a complication (P = .86). Occurrence of new neurological deficit after surgery was the most common complication, seen in 19 (11.5%) patients. Performance of an osteotomy was associated with a higher incidence of new neurological deficits in both adult and pediatric groups (P = .02 and P = .012, respectively). Although most of the new neurological deficits improved over follow-up, 10% had no improvement. CONCLUSION: This study provides short-term complication rates associated with surgical treatment for HGS in adult and pediatric patients and may prove valuable for patient counseling, surgical planning, and in efforts to improve the safety of patient care.

scholarly journals Profiles of histopathological lesions of urinary bladder: A five years study

2016 ◽  
Vol 6 (12) ◽  
pp. 1001-1004
Author(s):  
EP Shrestha ◽  
K Karmacharya
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Lamina Propria ◽  
Bladder Neoplasms ◽  
Low Grade ◽  
High Grade ◽  
Army Hospital ◽  
Neoplastic Lesions ◽  
Muscle Invasion

Background: Neoplastic and non-neoplastic urinary bladder lesions are the main reasons for morbidity and mortality throughout the world. Amongst these, urothelial carcinoma is a common primary tumor of urinary bladder (90%). The objective of this study is to determine the profile of various urothelial lesions received in Army Hospital within 5 years of period.Materials and methods: Five years retrospective study of cystoscopic biopsies and radical cystectomy specimens were carried out in Department of Pathology, Army hospital.Results: Out of 53 cystoscopic biopsies and radical cystectomy specimens, 42 were neoplastic and 11 were non neoplastic lesions. Thirty six urothelial carcinomas were observed out of which 20 were high grade urothelial carcinoma and 16 were low grade. Out of 20 high grade urothelial carcinoma, 17 had muscle invasion and 3 had invasion upto lamina propria. Of 16 low grade urothelial carcinoma, 12 were noninvasive, 2 had invasion upto lamina propria and 2 had muscle invasion. Papilloma was the commonest benign lesions found (7.1%) followed by papillary urothelial neoplasms of low malignant potential (PUNLMP) (2.4%) and hemangioma (2.4%).Conclusion: This article have highlighted upon the importance of histopathological study in evaluating urinary bladder lesions. Also, it has helped in determining that neoplastic lesions were more common than non-neoplastic lesions as seen in our study. A great majority of neoplastic lesions were of urothelial origin. Cystoscopic studies and biopsies help in early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow up.

Surgical morbidity of transsylvian versus transcortical approaches to insular gliomas

2020 ◽  
Vol 132 (6) ◽  
pp. 1731-1738 ◽  
Author(s):  
Colin J. Przybylowski ◽  
Jacob F. Baranoski ◽  
Veronica M. So ◽  
Jeffrey Wilson ◽  
Nader Sanai
Keyword(s):  
Extent Of Resection ◽  
Volumetric Analysis ◽  
Study Data ◽  
Neurological Deficits ◽  
Low Grade ◽  
High Grade ◽  
Surgical Morbidity ◽  
Transsylvian Approach ◽  
Posterior Quadrant ◽  
Transcortical Approach

OBJECTIVEThe choice of transsylvian versus transcortical corridors for resection of insular gliomas remains controversial. Functional pathway compromise from transcortical transgression and vascular injury during transsylvian dissection are the primary concerns. In this study, data from a single-center experience with both approaches were compared to determine whether one approach was associated with a higher rate of morbidity than the other.METHODSThe authors identified 100 consecutive patients who underwent resection of pure insular gliomas at the Barrow Neurological Institute. Volumetric analysis was performed using FLAIR and contrast-enhanced T1-weighted MRI for low- and high-grade gliomas, respectively, for extent of resection (EOR) and diffusion-weighted sequences were used to detect for postoperative ischemia. Step-wise logistic regression analysis was performed to identify predictors of neurological morbidity.RESULTSData from 100 patients with low-grade or high-grade insular gliomas were analyzed. Fifty-two patients (52%) underwent a transsylvian approach, and 48 patients (48%) underwent a transcortical approach. The mean (± SD) EOR was 91.6% ± 12.4% in the transsylvian group and 88.6% ± 14.2% in the transcortical group (p = 0.26). Clinical outcome metrics for the 2 groups were similar. Overall, 13 patients (25%) in the transsylvian group and 10 patients (21%) in the transcortical group had evidence of ischemia on postoperative MR images. For both approaches, high-grade histology was associated with permanent morbidity (p = 0.01). For patients with gliomas located within the superior-posterior quadrant of the insula, development of postoperative ischemia was associated with only the transsylvian approach (46% vs 0%, p = 0.02).CONCLUSIONSAreas of restricted diffusion are common on postoperative MRI following resection of insular gliomas, but only a minority of these patients develop permanent neurological deficits. Insular glioma patients with high-grade histology may be at particular risk for developing symptomatic postoperative ischemia. Both the transcortical and transsylvian corridors are associated with reasonable morbidity profiles, although gliomas situated within the superior-posterior quadrant of the insula are more safely accessed with a transcortical approach.

scholarly journals Stereotactic Transcerebellar Approach to Pontine Lesions through the Middle Cerebellar Peduncle

1999 ◽  
Vol 5 (1) ◽  
pp. 19-25 ◽  
Author(s):  
F. Parker ◽  
M.F. Levesque ◽  
J. Bittoun ◽  
D. Doyon ◽  
M. Tadie
Keyword(s):  
Clinical Outcome ◽  
Mr Studies ◽  
Neurological Deficits ◽  
High Yield ◽  
Low Grade ◽  
High Grade ◽  
Inappropriate Therapy ◽  
Middle Cerebellar Peduncle ◽  
Cerebellar Peduncle ◽  
Pontomedullary Junction

A stereotactic approach to the pons through the middle cerebellar peduncle based on MR studies was used to biopsy 18 patients. The stereotactic coordinates and angles were defined with reference to three orthogonal planes (mid-sagittal, IVth ventricular floor and pontomedullary junction). The pathological diagnoses were in keeping with clinical outcome and comprised five high-grade astrocytomas, three low-grade astrocytomas, two glioblastomas multiforme, two oligodendrogliomas, two primitive neuroectodermic tumours, two lymphomas, one medulloblastoma, and one tuberculosis. This approach provides a high yield of positive histological diagnoses with little morbidity (transient neurological deficits in two cases) and thereby avoids inappropriate therapy.

Klinische Wertigkeit der Positronen-Emissions-Tomographie (PET) bei onkologischen Fragestellungen: Ergebnisse einer interdisziplinären Konsensuskonferenz

1996 ◽  
Vol 35 (02) ◽  
pp. 42-52 ◽  
Author(s):  
R. Bares ◽  
U. Bull ◽  
A. Guhlmann ◽  
E. Moser ◽  
M. F. Wannenmacher ◽  
...  
Keyword(s):  
Low Grade ◽  
High Grade ◽  
Klinische Anwendung ◽  
Wissenschaftliche Studien

Zusammenfassung Ziel: Es ist das Ziel der vorliegenden Arbeit, an Hand bisher publizierter Studienergebnisse eine Beurteilung des klinischen Stellenwertes von PET in der Onkologie zu erarbeiten. Methoden: Im Rahmen einer interdisziplinären Konferenz mit namhaften Experten wurde eine Wertung des gegenwärtigen Stands von PET in der Onkologie an Hand der in der Literatur dokumentierten Studienergebnisse erarbeitet. Angestrebt wurde eine differenzierte Bewertung von PET für die klinische Anwendung in fünf Klassen (1a, 1b, 2a, 2b, 3) von »angemessen« (1a), »akzeptabel« (1b), »hilfreich« (2a), »noch keine Bewertung möglich« (2b), »ohne Nutzen« (3). Ergebnisse: Für den klinischen Einsatz in der Onkologie ist 2-F18-Fluorodeoxyglukose (FDG) das Radiopharmakon der Wahl. PET ist klinisch in der Patientenversorgung zur Rezidivdiagnostik von high-grade Gliomen (FDG), low-grade Gliomen (C-11 Methionin oder F-18 Tyrosin), für die Dignitätsdiagnostik des peripheren Lungenrundherdes bei Risikopatienten sowie für die Diagnostik des Pankreaskarzioms indiziert (Indikation 1a). PET kann in der Patientenversorgung bei folgenden Indikationen (1b) eingesetzt werden: »low-grade« Gliome, Suche nach unbekanntem Primärtumor bei Kopf-Hals-Tumoren, Rezidivdiagnostik des nicht kleinzelligen Bronchialkarzinoms sowie des Rektumkarzinoms, Lymphknotenstaging beim nicht kleinzelligen Bronchial-Karzinom, Pan-kreas-Karzinom, muskelinvasiven Blasen-Karzinom und Hoden-Karzinom. Staging bei M. Hodgkin (Stad. I/II versus III), frühe Therapiekontrolle bei Resttumor und Rezidivdiagnostik bei M. Hodgkin und hochmalignen Non-Hodgkin-Lymphomen, Lymphknoten-Staging und Fern-metastasensuche beim malignen Melanom (Breslow >1,5 mm), Lymphknoten- und Fernmetastasen-Nachweis beim Schilddrüsen-Karzinommit erhöhtem hTg und nicht radiojodspeichernden Metastasen. Zahlreiche weitere Indikationen zeichnen sich bereits jetzt ab, sind jedoch noch weniger gut durch wissenschaftliche Studien belegt. Für die meisten Indikationen außerhalb wissenschaftlicher Studien ist eine individuelle Kosten-Nutzen-Betrachtung durch den verantwortlichen Arzt geboten. Schlußfolgerungen: Die metabolische Bildgebung von PET besitzt für eine Vielzahl onkologischer Fragestellungen prinzipielle Vorteile gegenüber der anatomisch-morphologisch orientierten Schnittbilddiagnostik. Für die klinische Indikationsstellung ist allerdings eine differenzierte Betrachtung der spezifischen Leistungsfähigkeit von PET geboten.

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