scholarly journals Evaluation of surgical outcome of giant intracranial meningiomas

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Ramy Teama ◽  
Mohamed Adawy ◽  
Mohamed Emara
Keyword(s):  
Surgical Outcome ◽  
Intraoperative Complications ◽  
Intracranial Meningioma ◽  
Surgical Removal ◽  
Study Group ◽  
Main Body ◽  
Total Removal ◽  
Large Size ◽  
Intracranial Meningiomas

Abstract Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

Prolactin-Secreting Adenomas: Surgical Results and Long-Term Follow-up

Neurosurgery ◽  
1989 ◽  
Vol 24 (5) ◽  
pp. 736-743 ◽  
Author(s):  
Giulio Maira ◽  
Carmelo Anile ◽  
Laura De Marinis ◽  
Antonino Barbarino
Keyword(s):  
Empty Sella ◽  
Surgical Removal ◽  
Total Removal ◽  
Efficacious Treatment ◽  
Transsphenoidal Microsurgery ◽  
Long Term Follow Up ◽  
Grade Ii ◽  
Adenomatous Tissue

ABSTRACT Transsphenoidal surgery is an efficacious treatment for patients with prolactin (PRL)-secreting adenomas, even if disrupted pituitary-hypothalamic relationships may persist and/or a recurrence of the PRL-secreting tumor can occur. In this paper, we analyze the long-term follow-up of 119 consecutively treated women who underwent transsphenoidal microsurgery for PRL-secreting adenomas. Apparent total removal of the tumor was achieved in 98 patients who had enclosed tumors (58 with Grade-I tumors and 40 with Grade II). In the remaining patients, the removal was considered partial. Persistent normal basal PRL levels were achieved in 61 patients who had apparent total removal of the adenoma (44 with Grade I tumors and 17 with Grade II). Of the remaining 37 patients in whom surgical removal of the adenomatous tissue was thought to be total, 30 had persistent nonevolutive, high PRL levels ranging from 21 to 196 ng/ml, without clinical and radiological signs of tumor regrowth, and 7 with PRL levels ranging from 56 to 560 ng/ml had a recurrence of the PRL-secreting tumor. These data seem to indicate that a slightly elevated postsurgical PRL value does not imply that tumoral tissue is still present. Nontumoral conditions (i.e., a secondary empty sella) could induce functional hyperprolactinemia.

scholarly journals Pre-Operative Factors Affecting Resectability of Giant Intracranial Meningiomas

2009 ◽  
Vol 36 (5) ◽  
pp. 623-630 ◽  
Author(s):  
Alfredo Quiñones-Hinojosa ◽  
Tania Kaprealian ◽  
Kaisorn L. Chaichana ◽  
Nader Sanai ◽  
Andrew T. Parsa ◽  
...  
Keyword(s):  
San Francisco ◽  
Superior Sagittal Sinus ◽  
Perioperative Complications ◽  
Radical Resection ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Factors Affecting ◽  
Sagittal Sinus ◽  
Intracranial Meningiomas

Objective:Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability.Methods:Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis.Results:Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38.044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56.135),p=0.006] were independently associated with GTR.Conclusions:This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

True petroclival meningiomas: results of surgical management

2014 ◽  
Vol 120 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Rami Almefty ◽  
Ian F. Dunn ◽  
Svetlana Pravdenkova ◽  
Mohammad Abolfotoh ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Maximum Diameter ◽  
Surgical Removal ◽  
Total Removal ◽  
Cranial Nerve Deficit ◽  
Petroclival Meningiomas ◽  
Significant Difference ◽  
The Mean

Object The relentless natural progression of petroclival meningiomas mandates their treatment. The management of these tumors, however, is challenging. Among the issues debated are goals of treatment, outcomes, and quality of life, appropriate extent of surgical removal, the role of skull base approaches, and the efficacy of combined decompressive surgery and radiosurgery. The authors report on the outcome in a series of patients treated with the goal of total removal. Methods The authors conducted a retrospective analysis of 64 cases of petroclival meningiomas operated on by the senior author (O.A.) from 1988 to 2012, strictly defined as those originating medial to the fifth cranial nerve on the upper two-thirds of the clivus. The patients' average age was 49 years; the average tumor size (maximum diameter) was 35.48 ± 10.09 mm (with 59 tumors > 20 mm), and cavernous sinus extension was present in 39 patients. The mean duration of follow-up was 71.57 months (range 4–276 months). Results In 42 patients, the operative reports allowed the grading of resection. Grade I resection (tumor, dura, and bone) was achieved in 17 patients (40.4%); there was no recurrence in this group (p = 0.0045). Grade II (tumor, dura) was achieved in 15 patients (36%). There was a statistically significant difference in the rate of recurrence with respect to resection grade (Grades I and II vs other grades, p = 0.0052). In all patients, tumor removal was classified based on postoperative contrast-enhanced MRI, and gross-total resection (GTR) was considered to be achieved if there was no enhancement present; on this basis, GTR was achieved in 41 (64%) of 64 patients, with a significantly lower recurrence rate in these patients than in the group with residual enhancement (p = 0.00348). One patient died from pulmonary embolism after discharge. The mean Karnofsky Performance Status (KPS) score was 85.31 preoperatively (median 90) and improved on follow-up to 88, with 30 patients (47%) having an improved KPS score on follow-up. Three patients suffered a permanent deficit that significantly affected their KPS. Cerebrospinal fluid leak occurred in 8 patients (12.5%), with 2 of them requiring exploration. Eighty-nine percent of the patients had cranial nerve deficits on presentation; of the 54 patients with more than 2 months of follow-up, 21 (32.8%) had persisting cranial nerve deficits. The overall odds of permanent cranial nerve deficit of treated petroclival meningioma was 6.2%. There was no difference with respect to immediate postoperative cranial nerve deficit in patients who had GTR compared with those who had subtotal resection. Conclusions Total removal (Grade I or II resection) of petroclival meningiomas is achievable in 76.4% of cases and is facilitated by the use of skull base approaches, with good outcome and functional status. In cases in which circumstances prevent total removal, residual tumors can be followed until progression is evident, at which point further intervention can be planned.

scholarly journals Zastosowanie śrub biowchłanialnych w porównaniu ze śrubami metalowymi w truamatologii dziecięcej

2018 ◽  
Vol 64 (4) ◽  
Author(s):  
Gabriela Grochowska ◽  
Piotr Gajewski ◽  
Elżbieta Gawrych ◽  
Ireneusz Walaszek ◽  
Kaja Giżewska-Kacprzak
Keyword(s):  
Bone Fractures ◽  
Young Patients ◽  
Polyglycolic Acid ◽  
Control Group ◽  
Surgical Removal ◽  
Study Group ◽  
Safe Alternative ◽  
Pediatric Traumatology ◽  
Bioabsorbable Screws

ABSTRACTIntroduction: Metal stabilizing implants used in pediatric fractures have to be removed to not inhibit the growth of bones. Bioabsorbable implants can save children from surgical removal of the fixating material. As there have been only a few reports regarding children, we decided to evaluate the clinical advantages of bioabsorbable screws in the treatment of selected bone fractures in pediatric traumatology.Materials and methods: The study group included 35 patients with bone fractures aged 5–17 years (mean 13.2 years) fixed with LactoSorb® bioabsorbable screws made of polymeric lactic acid and polyglycolic acid. The follow-up was compared with a matched control group of 35 children that underwent operative fixation of the same type of fractures with metal screws. Results: Clinical and radiological follow-up showed that bone unions were obtained in all cases, with no signs of osteolysis. The time of immobilization was slightly shorter in the study group (5.5 weeks) than among controls (6.2 weeks; p = 0.038). There were no differences in complications, wound infections, pain management and time of hospitalization between both groups.Conclusions: The use of bioabsorbable material in the treatment of fractures in pediatric traumatology is a safe alternative to metal stabilizing devices, with clinical benefits for young patients including no necessity of a second surgery and anesthesia.

Petroclival meningiomas: surgical experience in 109 cases

1996 ◽  
Vol 84 (1) ◽  
pp. 20-28 ◽  
Author(s):  
William T. Couldwell ◽  
Takanori Fukushima ◽  
Steven L. Giannotta ◽  
Martin H. Weiss
Keyword(s):  
Cavernous Sinus ◽  
Surgical Approaches ◽  
Surgical Removal ◽  
Total Removal ◽  
Content Type ◽  
Cavernous Sinus Invasion ◽  
Petroclival Meningiomas ◽  
High Incidence ◽  
Progression Of Disease

✓ The surgical removal of petroclival meningiomas has historically been associated with a high incidence of morbidity and mortality. The 109 consecutive patients included in the present retrospective study represent a combined series of tumors operated on by the four authors during a period from 1980 to 1992. The series is composed of 40 men and 69 women ranging in age from 25 to 75 years (mean 51 years). Surgical approaches to tumors in this series included simple retromastoid (60 cases), combined supra- and infratentorial petrosal (22), transtemporal (primary transsigmoid retrolabyrinthine, translabyrinthine, or transcochlear (12)), subtemporal (11), and frontotemporal transcavernous (eight). Gross-total removal was achieved in 75 patients (69%). Recurrence or progression of disease occurred in 14 patients (13%) over a 6.1-year mean follow-up period, and it was found within the cavernous sinus in 12 of these cases. Four recurrent cases demonstrated histological compatibility with malignant meningioma. Perioperative death occurred in four patients, and there were 56 significant complications in 35 other patients. Review of this series, with the attendant complications, has facilitated the authors' decision-making when considering the risk of gross-total removal in selected patients with asymptomatic cavernous sinus invasion or tumor adherent to the brainstem.

scholarly journals Intracranial Meningiomas in the Elderly: Clinical, Surgical and Economic Evaluation. A Multicentric Experience

Cancers ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2685
Author(s):  
Delia Cannizzaro ◽  
Maria Pia Tropeano ◽  
Ismail Zaed ◽  
Mario De Robertis ◽  
Simone Olei ◽  
...  
Keyword(s):  
Complication Rate ◽  
The Elderly ◽  
Patient Specific ◽  
Karnofsky Performance Scale ◽  
Intracranial Meningioma ◽  
Surgical Timing ◽  
Intracranial Meningiomas ◽  
Combined Strategy ◽  
Clinical Conditions

Meningioma is one of the most common intracranial tumors. It is benign and slow growing in the majority of cases. Given the increase in life expectancy and the number of radiological tests performed, the incidence in the elderly population (≥65 years) is continuously increasing. The surgical outcomes and prognostic factors in this age group are unclear. A retrospective analysis of all the patients treated for intracranial meningiomas in two different Italian institutions was performed. The clinical, radiological, surgical and follow-up data were retrospectively reviewed. Statistical analyses were performed to identify relationships between factors and outcomes. We also carried out an economic analysis. We analyzed 321 patients with intracranial meningioma. The mean age was 72.6 years (range, 65–90), with a female predominance (F/M, 1.41). Pre-operative deficits, cognitive impairment and seizures (p < 0.001) were associated with a worse post-operative Karnofsky performance scale (KPS) score (<80). A high pre-operative KPS score was associated with a good clinical and neurological outcome (p < 0.001). Being aged between 65 and 74 years, low surgical timing and Simpson removal grades of I and II were associated with a good outcome (p < 0.001). The length of hospitalization was significantly related to the outcome (p < 0.001). The complication rate was 14.3%. At 6-month follow-up, the mortality rate was 2.5%. The average cost was higher in patients with a pre-operative KPS score lower than 80. The outcome of intracranial-meningioma resection in elderly individuals is favorable when the pre-operative KPS score is >80. Treatment should be patient-specific, and additional factors should be considered. Patients with poor pre-operative clinical conditions might benefit from a combined strategy with partial resection and radiosurgery in order to reduce surgical timing and the complication rate.

WP1-14 A systematic review to evaluate different management strategies for incidental intracranial meningiomas

2019 ◽  
Vol 90 (3) ◽  
pp. e5.2-e5
Author(s):  
M Mohan ◽  
A Islim ◽  
RDC Moon ◽  
N Srikandarajah ◽  
AR Brodbelt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Management Strategies ◽  
Intracranial Meningioma ◽  
Radiological Progression ◽  
Active Monitoring ◽  
Intracranial Meningiomas ◽  
Benign Histology ◽  
Definition Of

ObjectivesEvaluate the outcomes of differing management strategies for incidental intracranial meningiomas.DesignSystematic review.SubjectsStudies with ≥10 patients≥16 years of age diagnosed radiologically with an incidental intracranial meningioma.MethodsPRISMA compliant methods were used to scan 6 databases up to September 2017. PROSPERO ID: CRD42017077928.ResultsTwenty retrospective studies (n=2130 patients) were included. Initial management strategies at diagnosis were: 27% (n=560) surgery, 22% (n=450) SRS and 51% (n=1040) active monitroing with a mean follow-up of 49.5 months (SD=29.3). 21% (n=220) of patients in the active monitoring cohort eventually had or were recommended an intervention due to: radiological progression (n=153), development of symptoms (n=66) and patient preference (n=1). Mean time-to-intervention was 24.8 months (SD=18.2). 94% (n=207) of interventions were within 5 years. The definition of ‘growth’ and the radiological surveillance regimens varied widely. Morbidity rates following surgery and SRS, accounting for cross over, were 15% and 22% respectively. Surgery revealed benign histology in 94% of the cases. Quality of life is improperly examined.ConclusionsThe management of patients with incidental intracranial meningiomas varies widely. Most patients who develop clinical or radiological progression will do so within 5 years of diagnosis. Intervention at diagnosis may result in unnecessary overtreatment. Prospective data is needed to develop a risk calculator for managing incidental meningioma.

scholarly journals SURGICAL MANAGEMENT OF INTRACRANIAL MENINGIOMAS

2007 ◽  
Vol 14 (01) ◽  
pp. 170-176
Author(s):  
TARIQ AHNIAD ◽  
INAMULLAH ASGHAR ◽  
AKMAL HUSSAIN ◽  
Sibef Hasan ◽  
Habib Sultan
Keyword(s):  
Surgical Management ◽  
Total Removal ◽  
Medical College ◽  
Simpson Grade ◽  
Intracranial Meningiomas ◽  
Grade Ii ◽  
One Year ◽  
Study Setting ◽  
Neurovascular Structures

Objective: To study the surgical management and outcome of patients having intracranial meningiomas. Design: A retrospective study. Setting: The Department of Neurosurgery Punjab Medical College & Allied Hospital, Faisalabad. Duration From April 2004 to October 2005. Materials & Methods:Thirty patients suffering from intracranial meningiomas diagnosed on CT-scan and managed surgically were included in this study. Simpson grade I removal was possible in 21 patients. Grade II removal was done in Three patients while grade 111 removal was possible in four patients, grade IV removal was done in one patient and grade V in one patient. Post operative XRT was given in cases having grades II, 111, IV and V removal. Follow up was done at six monthly intervals. Outcome was assessed as Good .Fair, and poor depending upon clinical and radiological examinations. RESULTS: Out of 30 patients only one had recurrence after one year of follow up which was removed surgically and postoperative XRT was given.Twenty four patients had good outcome while 5 patients had fair outcome and one had poor outcome. CONCLUSION. Study showed that Simpson grade 1 removal of tumor is still effective treatment in the management of meningiomas. Postoperative XRT is used in Simpson grade 2, 3, 4 and 5 in which gross total removal is not possible due to involvement of neurovascular structures.

Outcomes after surgical removal of anterior epi-capsular plaque associated with persistent pupillary membranes in children

2021 ◽  
pp. 112067212110206
Author(s):  
Massimiliano Serafino ◽  
Rupal H Trivedi ◽  
Marion Edward Wilson ◽  
Muralidhar Ramappa ◽  
Divya Sree Ramya Achanta ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intraoperative Complications ◽  
Case Series ◽  
Early Period ◽  
Crystalline Lens ◽  
Surgical Removal ◽  
Age At Surgery ◽  
Device Use ◽  
Ophthalmic Viscosurgical Device

Introduction: Anteriorepi-capsular plaque (ACP) is usually eccentric and is associated with persistent iris strands arising from the collarette. Outcomes of lens preserving ACP peeling along with removal of persistent pupillary membrane (PPM) strands have seldom been reported with only a few cases within some case series appearing in the literature. Herein we aim to report outcome after surgical removal of ACP associated with PPM in children. Methods: Research was done in three different Institutes. Charts were reviewed for all children who had undergone ACP removal surgery from 2010. Age at surgery, gender, preoperative best corrected visual acuity (BCVA), preoperative refraction, morphologic details of ACP, intraoperative complications, ophthalmic viscosurgical device use, age at last follow-up, postoperative complications, and postoperative BCVA were reviewed. Results: A total of 16 patients, 10 male and 6 female, were included in study. Age at surgery ranged from 2 to 86 months old. Age at last follow up visit ranged from 2 to 14 years old. Postoperative complications were not observed in any of the 16 patients. Specifically, in all patients the crystalline lens remained clear at the last follow up visit. Conclusions: Congenital ACP of the lens associated with PPM and clear lens can be safely surgically removed with a very low risk of iatrogenic cataract in the early period after surgery.

Outcome of Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

2020 ◽  
Vol 19 (2) ◽  
pp. 64-68
Author(s):  
Mrinmoy Biswas ◽  
Sudip Das Gupta ◽  
Mohammed Mizanur Rahman ◽  
Sharif Mohammad Wasimuddin
Keyword(s):  
Urethral Stricture ◽  
Flow Rate ◽  
Surgical Outcome ◽  
Simple Technique ◽  
Anterior Segment ◽  
Maximum Flow ◽  
Anastomotic Site ◽  
Buccal Mucosal Graft ◽  
Male Patients

Objective: To assess the success of BMG urethroplasty in long segment anterior urethral stricture. Method: From January 2014 to December 2015, twenty male patients with long anterior segment urethral stricture were managed by BMG urethroplasty. After voiding trial they were followed up at 3 month with Uroflowmetry, RGU & MCU and PVR measurement by USG. Patients were further followed up with Uroflowmetry and PVR at 6 months interval.Successful outcome was defined as normal voiding with a maximum flow rate >15ml /sec and PVR<50 ml with consideration of maximum one attempt of OIU after catheter removal. Results: Mean stricture length was 5.2 cm (range 3-9 cm) and mean follow-up was 15.55 months (range 6-23 months). Only two patients developed stricture at proximal anastomotic site during follow-up. One of them voided normally after single attempt of OIU. Other one required second attempt of OIU and was considered as failure (5%). Conclusion: BMG urethroplasty is a simple technique with good surgical outcome. Bangladesh Journal of Urology, Vol. 19, No. 2, July 2016 p.64-68

Sign in / Sign up

Export Citation Format

Share Document