Complications of Chemotherapy in Patients with Brain and Spinal Cord Tumors

ABSTRACT Background: Localization and delineation of extent of lesions is critical for safe maximal resection of brain and spinal cord tumors. Frame-based and frameless stereotaxy and intraoperative MRI are costly and not freely available especially in economically constrained nations. Intraoperative ultrasound has been around for a while but has been relegated to the background. Lack of objective evidence for its usefulness and the perceived “user unfriendliness” of US are probably responsible for this. We recount our experience with this “forgotten” tool and propose an objective assessment score of its utility in an attempt to revive this practice. Materials and Methods: Seventy seven intraoperative ultrasound (IOUS) studies were carried out in patients with brain and spinal cord tumors. Seven parameters were identifi ed to measure the “utility” of the IOUS and a “utility score” was devised (minimum 0 and maximum 7). Individual parameter and overall scores were calculated for each case. Results: IOUS was found to be useful in many ways. The median overall score was 6 (mean score 5.65). There were no scores less than 4 with the majority demonstrating usefulness in 5 or more parameters (91%). The use of the IOUS signifi cantly infl uenced the performance of the surgery in these cases without signifi cantly prolonging surgery. Conclusions: The IOUS is a very useful tool in intraoperative localization and delineation of lesions and planning various stages of tumor resection. It is easy, convenient, reliable, widely available, and above all a cost-eff ective tool. It should be increasingly used by neurosurgeons in the developing world where costlier intraoperative localization and imaging is not available freely.

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Imprints, Smears, and Frozen Sections of Brain Tumors

Neurosurgery ◽

10.1227/00006123-199110000-00015 ◽

1991 ◽

Vol 29 (4) ◽

pp. 575-579 ◽

Cited By ~ 15

Author(s):

Marc G. Reyes ◽

Fayez M. Homsi ◽

Larry W. McDonald ◽

Roberta P. Glick

Keyword(s):

Spinal Cord ◽

Middle Fossa ◽

Frozen Sections ◽

Spinal Cord Tumors ◽

Paraffin Sections ◽

Intraoperative Diagnosis ◽

The Central Nervous System ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Brain And Spinal Cord

Abstract In this study, we compared the suitability and accuracy of imprints, smears, and frozen sections of suspected brain and spinal cord tumors of 150 patients. Eighty-six percent of the imprints, 91% of the smears, and 99% of the frozen sections were suitable for interpretation. Among the suitable preparations, 82% of the imprints, 92% of the smears, and 99% of the frozen sections agreed with our diagnosis on paraffin sections. Although frozen sections were clearly more accurate than imprints and smears, the latter two provided diagnoses in patients with acquired immunodeficiency syndrome where frozen sections were not done to avoid contaminating our cryostat and in a patient with an epidermoid cyst of the middle fossa that could not be adequately frozen sectioned. Our study shows that imprints and smears complement frozen sections in the intraoperative diagnosis of tumors of the central nervous system.

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