Factors Affecting Survival of Children with Malignant Gliomas

Neurosurgery ◽  
1987 ◽  
Vol 20 (3) ◽  
pp. 416-420 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Nayef R. F. Al-Rodhan ◽  
Robert L. Phillips ◽  
Mohammed El-Senossi ◽  
John L. Fox
Keyword(s):  
Brain Stem ◽  
Cerebral Hemisphere ◽  
Survival Curve ◽  
Malignant Gliomas ◽  
Neurological Deficits ◽  
Survival Times ◽  
Factors Affecting ◽  
Computed Tomographic ◽  
Level Of Consciousness

Abstract Forty-four patients (23 male and 21 female, aged 2 to 20 years (mean, 9.6)), harboring pathologically proven malignant glioma (Grades III and IV) were treated between 1976 and 1985. Tumor sites included the cerebral hemisphere (26 patients), thalamus (6 cases), brain stem (7 cases), and the cerebellum (5 cases). All patients underwent operation and initial treatment with steroids. Irradiation was given in 35 patients; 3 had adjuvant chemotherapy. At the time of study, 22 were deceased. The longest period of follow-up was 65 months. Survival curves were calculated from the date of the first visit to the date of the last evaluation or death. The mean survival times were 30 months for all patients, 14 months for cerebellar cases, 17 months for brain stem cases, 26 months for thalamic cases, and 33 months for cerebral hemisphere cases. However, the differences between mean survival times were not statistically significant. The patient's age was the single most significant factor, with those 5 to 10 years old having the worst survival curve (P= 0.0036). Irradiation was associated with an improved mean survival time (34 vs. 19 months); however, this was not statistically significant (P= 0.15). Girls had shorter mean survival times than boys (16.5 vs. 37 months, P= 0.0511). Otherwise, there was no clinical or radiological factor that indicated a better prognosis. This was also confirmed by x2analyses comparing 72 factors between patients with more than 24 months of survival and those with less than 24 months of survival. In particular, tumor size (greater or less than 5 cm), the presence of neurological deficits, the level of consciousness, increased intracranial pressure, hydrocephalus, calcium or cyst on a computed tomographic scan, and histological grading (III or IV) showed no significant correlations.

Pseudoaneurysm of the Inferior Gluteal Artery Presenting as Sciatic Nerve Compression

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 926-928 ◽  
Author(s):  
Stephen M. Papadopoulos ◽  
John E. McGillicuddy ◽  
Louis M. Messina
Keyword(s):  
Sciatic Nerve ◽  
Pelvic Trauma ◽  
Clinical Findings ◽  
Nerve Compression ◽  
Neurological Deficits ◽  
Inferior Gluteal Artery ◽  
Aneurysm Neck ◽  
Computed Tomographic ◽  
Internal Iliac

ABSTRACT A pseudoaneurysm of the inferior gluteal artery presenting as sciatic nerve compression is reported in a 40-year-old woman. Following a transvaginal needle biopsy for endometriosis, the patient developed left sciatic pain and a nonpulsatile mass palpable in the left buttock thought to represent a pyriformis hematoma. Sequential computed tomographic scans were consistent with this diagnosis. Persistent pain and progression of neurological deficits led to surgical exploration. Posterior exposure of the pyriformis muscle and proximal sciatic nerve revealed a large pseudoaneurysm of the inferior gluteal artery compressing the nerve. A laparotomy was performed and the internal iliac artery was ligated, followed by evacuation of the aneurysm contents and repair of the aneurysm neck via a posterior approach. The patient has remained pain-free with progressive improvement in neurological function after 1 year follow-up. Aneurysms of the gluteal artery are unusual, predominantly occur after significant pelvic trauma, and rarely present as sciatica. Pertinent aspects of the patient history and clinical findings are atypical for discogenic sciatica. Because of the rarity of this entity, preoperative diagnosis is usually not achieved. Angiography or magnetic resonance imaging should be performed in patients with atypical sciatica and a mass in the region of the proximal sciatic nerve, particularly after trauma.

scholarly journals Primary central nervous system lymphoma and 5-aminolevulinic acid

2020 ◽  
Vol 11 ◽  
pp. 122 ◽  
Author(s):  
Pierre Ferrer ◽  
Pablo Barbero ◽  
Gonzalo Monedero ◽  
Anna Lo Presti ◽  
Bartolome Bejarano ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Aminolevulinic Acid ◽  
Malignant Gliomas ◽  
Central Nervous System Lymphoma ◽  
High Grade Glioma ◽  
Complete Resection ◽  
Neurological Deficits ◽  
Pathological Examination

Background: Despite surgical resection of primary central nervous system lymphomas (PCNSL) having been always discouraged, recent evidence supports that it might improve prognosis in this patient population. Five- aminolevulinic acid-derived fluorescence is widely used for the resection of malignant gliomas, but its role in PCNSL surgery remains unclear. Case Description: We present two patients with a solitary solid intraparenchymal mass. As high-grade glioma leaded the list of differential diagnosis (other possibilities were metastasis, abscess, and PCNSL), a five- aminolevulinic acid-guided complete resection (with strong fluorescence in both cases) was done. Surgery was uneventfully carried on with complete resection until five-aminolevulinic acid-induced fluorescence was no longer evident. After surgery, patients have no neurological deficits and had good recovery. Pathological examination revealed that both tumors were PCNSL. Adjuvant radiotherapy and chemotherapy were started. After 1 year of follow-up, patients have good evolution and have no recurrences. Conclusion: These cases add to the growing literature which shows that surgery might play an important role in the management of PCNSL with an accessible and single lesion. Five-aminolevulinic acid could also be a useful tool to achieve complete resection and improve prognosis in this group of patients.

Avulsion Fracture of the Foramen Magnum Treated with Occiput-to-C1 Fusion: Technical Case Report

Neurosurgery ◽  
2005 ◽  
Vol 57 (3) ◽  
pp. E600-E600 ◽  
Author(s):  
Peter H. Maughan ◽  
Eric M. Horn ◽  
Nicholas Theodore ◽  
Iman Feiz-Erfan ◽  
Volker K.H. Sonntag
Keyword(s):  
Avulsion Fracture ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Rare Injury ◽  
Computed Tomographic ◽  
Inferior Aspect ◽  
Lateral Mass Screws ◽  
Occipital Condyles ◽  
Neurologically Intact

ABSTRACT OBJECTIVE AND IMPORTANCE: A 31-year-old woman presented with an avulsion fracture of the foramen magnum via bilateral occipital condyles with extension through the inferior aspect of the clivus. CLINICAL PRESENTATION: The patient had no neurological deficits and was initially immobilized in a halo brace. INTERVENTION: To preserve rotational motion at C1–C2, we performed an occiput-to-C1 fusion with bilateral C1 lateral mass screws attached with rods to occipital keel screws. Postoperatively, the patient remained neurologically intact. Three-month follow-up imaging revealed no abnormal motion. Follow-up computed tomographic scan showed an intact construct and bony fusion. CONCLUSION: This rare injury, a bony variant of occipitoatlantal dislocation, was successfully treated with a unique occiput-to-C1 fusion.

The parametric estimation procedure to predict long-term efficacy on survival from publication data of clinical trials for metastatic colorectal cancer (mCRC).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 541-541
Author(s):  
Kyongsun Pak ◽  
Yu Sunakawa ◽  
Masahiro Takeuchi ◽  
Wataru Ichikawa ◽  
Masashi Fujii
Keyword(s):  
Clinical Trials ◽  
Clin Oncol ◽  
Survival Curve ◽  
Estimation Procedure ◽  
Parametric Estimation ◽  
Survival Times ◽  
Term Efficacy ◽  
Kaplan Meier

541 Background: In comparative clinical trials with time-to-event outcomes, the long-term treatment effect profile is clinically crucial. The conventional non-parametric measures, i.e., the median survival times and the t-year survival rates are informative but sometimes cannot be observed due to the limited study follow-up. For example, in the PEAK trial (Schwartzberg LS et al. J Clin Oncol 2014), the group contrast over 3 years could not be adequately confirmed due to the short follow-up. To predict the subsequent survival prognosis with the limited outcome data, one may estimate the survival curve using a parametric model. Here, we illustrate the parametric estimation procedure to predict long-term efficacy using the results of two randomized controlled trials for the patients with wild-type KRAS mCRC, i.e., PRIME (Douillard JY et al. J Clin Oncol 2010, Douillard JY et al. Ann Oncol 2014) and PEAK trials. Methods: We considered both the primary and updated results for the PRIME to assess the validity of the procedure, and then estimated the long-term efficacy in the two trials. We used the reconstructed overall survival (OS) data obtained by scanning the Kaplan-Meier curves in the literature. Fitting the data to the Weibull distribution, we estimated the parametric group contrast measures including the difference in the 3- and 5-years restricted mean survival times and mean survival times. Results: The extrapolated parametric OS curves from the primary PRIME results fitted well with the observed Kaplan-Meier curves for OS in the updated results. The parametric estimations demonstrated that, in the PRIME trial, panitumumab plus FOLFOX arm increased 2.0 (95% CI: 0.1-4.0), 4.0 (0.5-7.5), and 5.4 (0.3-10.5) months in survival on average over 3-, 5-years and the entire time, respectively, compared to FOLFOX arm. In PEAK trial, compared to bevacizumab plus FOLFOX arm, panitumumab plus FOLFOX arm increased 3.6 (0.7-6.5), 7.9 (2.1-13.7), and 12.8 (0.5-25.1) months in survival on average, respectively. Conclusions: The estimators for parametric survival curve would provide the informative summaries for long-term survival profile to the clinicians and patients.

THE USE OF ALLOGRAFT OR AUTOGRAFT AND EXPANDABLE TITANIUM CAGES FOR THE TREATMENT OF VERTEBRAL OSTEOMYELITIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 122-130 ◽  
Author(s):  
Daniel C. Lu ◽  
Vincent Wang ◽  
Dean Chou
Keyword(s):  
Iliac Crest ◽  
Posterior Instrumentation ◽  
Vertebral Osteomyelitis ◽  
Neurological Deficits ◽  
X Rays ◽  
Coccidioides Immitis ◽  
Imaging Studies ◽  
Computed Tomographic ◽  
Titanium Cages

Abstract OBJECTIVE The results of the surgical treatment of osteomyelitis with expandable titanium cages and either allograft or autograft are presented. METHODS Thirty-six patients with vertebral osteomyelitis are presented. There were 7 cervical, 17 thoracic, 4 thoracolumbar (involving T12–L1), 5 lumbar, and 3 lumbosacral (involving L5–S1) lesions. The most frequently identified organisms were Staphylococcus aureus, Mycobacterium tuberculosis, and Coccidioides immitis. Imaging studies included x-rays, computed tomographic scans, and magnetic resonance imaging scans. All patients were treated with corpectomies and expandable cage reconstruction. Fusion was performed with rib autograft, iliac crest autograft, or allograft. Most patients who had an anterior approach also underwent posterior instrumentation, whereas a few had anterior instrumentation only. Four patients underwent a posterior approach (transpedicular corpectomy) only. RESULTS The median follow-up period was 21 months. There were no implant failures. Two recurrences of infection were noted: 1 case involved allograft, and the other involved autograft. At follow-up, neurological deficits improved in all patients, and 81% of patients were pain-free. CONCLUSION This study suggests that the treatment of vertebral column osteomyelitis can be performed with expandable titanium cages, and allograft does not appear to increase the rate of recurrence, as compared with autograft.

Supratentorial intra-arachnoid cyst

1971 ◽  
Vol 35 (4) ◽  
pp. 477-482 ◽  
Author(s):  
Nitya R. Ghatak ◽  
Grace J. Mushrush
Keyword(s):  
Brain Stem ◽  
Arachnoid Cyst ◽  
Cerebral Hemisphere ◽  
Arachnoid Cysts ◽  
Neurological Deficits ◽  
Pathological Features ◽  
Content Type ◽  
The Brain ◽  
Clinical And Pathological Features ◽  
Fine Print

✓ The clinical and pathological features of a primary supratentorial arachnoid cyst are described. Expansion of the cyst led to progressive neurological deficits that terminated fatally. There was severe compression and marked distortion of the brain with secondary brain stem hemorrhage. It is suggested that intra-arachnoid cysts may represent a distinct pathological entity among the heterogeneous cysts overlying the cerebral hemisphere.

Central nervous system gangliogliomas

1993 ◽  
Vol 79 (6) ◽  
pp. 867-873 ◽  
Author(s):  
Frederick F. Lang ◽  
Fred J. Epstein ◽  
Joseph Ransohoff ◽  
Jeffrey C. Allen ◽  
Jeffrey Wisoff ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Survival Rate ◽  
Brain Stem ◽  
Cerebral Hemisphere ◽  
Histological Grade ◽  
Event Free Survival ◽  
Term Survival ◽  
Free Survival

The records of 58 patients with gangliogliomas surgically treated between January 1, 1980, and June 30, 1990, were retrospectively reviewed in order to determine long-term survival, event-free survival, and functional outcome resulting after radical resection and to assess the impact of histological grading on outcome. Tumors were located in the cerebral hemisphere in 19 cases, the spinal cord in 30, and the brain stem in nine. Forty-four patients had gross total resection and 14 had radical subtotal resection. Only six patients underwent postoperative irradiation or chemotherapy and, therefore, the outcome was generally related to surgery alone. Of the 58 gangliogliomas, 40 were classified as histological grade I, 16 were grade II, and two were grade III. The median follow-up period was 56 months. There were no operative deaths, and the operative morbidity rate was 5%, 37%, and 33% for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas, respectively. The 5-year actuarial survival rates for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas were 93%, 84%, and 73%, respectively (p = 0.7). The event-free survival rate at 5 years was 95% for cerebral hemisphere gangliogliomas and 36% for spinal cord gangliogliomas (p < 0.05); for brain-stem gangliogliomas the event-free survival rate at 3 years was 53% (p < 0.05). Neurological function at recent follow-up evaluation was stable or improved in 81% of patients. Multivariate analysis (Cox linear regression) revealed tumor location to be the only variable predictive of outcome, with spinal cord and brain-stem gangliogliomas having a 3.5- and 5-fold increased relative risk of recurrence, respectively, compared to cerebral hemisphere gangliogliomas. Histological grade was not predictive of outcome, although in each location there was a trend for higher-grade tumors to have a shorter time to recurrence. It is concluded that radical surgery leads to long-term survival of patients with gangliogliomas, regardless of location, and adjuvant therapy can probably be reserved for special cases.

Factors Affecting the Use and Consequences of Management Accounting Practices in A Transitional Economy: The Case of Vietnam

2016 ◽  
pp. 54-73 ◽  
Author(s):  
Anh Doan Ngoc Phi
Keyword(s):  
Significant Influence ◽  
Quantitative Data ◽  
Structural Equation ◽  
Qualitative Data ◽  
Management Accounting ◽  
Transitional Economy ◽  
Equation Modeling ◽  
Enterprise Performance ◽  
Factors Affecting

This study seeks to help fill an important gap in the literature by investigating factors that have facilitated the use of management accounting practices (MAPs) in Vietnam - a transitional economy. Data were collected from 220 medium-to-large enterprises. Follow-up interviews were conducted with 20 accounting heads/vice heads to obtain further information and clarification. The quantitative data collected was analyzed using both descriptive and inferential statistics (including t-tests and structural equation modeling), while the qualitative data was used to shed further light on the various relationships described by the quantitative analysis. This paper reveals that both decentralization and competition have a positive, significant influence on the use of new MAPs except for the old ones. Consequently, the use of MAPs has a positive, significant influence on enterprise performance.

STRUCTURAL AND DYNAMIC FEATURES OF EAR-LY DISABILITY DUE TO MENTAL DISEASES

2020 ◽  
pp. 62-67
Author(s):  
Shmakova O.P.
Keyword(s):  
People With Disabilities ◽  
Child And Adolescent Psychiatry ◽  
Child Psychiatrist ◽  
Childhood And Adolescence ◽  
Disabled Children ◽  
Dynamic Features ◽  
Factors Affecting ◽  
Number Of Children ◽  
Number Of Patients

Prevention of disability is one of the most significant tasks of child and adolescent psychiatry. Obtaining data on the dynamics of the number of people with disabilities and the factors affecting this indicator seems to be one of the relevant aspects. Aim: to trace the dynamics of the number of children with disabili-ties and to assess the change in the structure of early disability over the past decades. Materials and Meth-ods. A comparative analysis of two cohorts of patients was carried out: 1st - patients born in 1990-1992. (1203 patients (men - 914, 76%; women - 289, 24%)) who applied to the district neuropsychiatric dispensa-ry for outpatient care in childhood and adolescence; II - children and adolescents born in 2005 - 2018 (602 patients (male - 410, 68%; female - 192, 32%), ob-served at the time of the study by a child psychiatrist in the neuropsychiatric dispensary. Research methods: clinical and psychopathological; follow-up; statisti-cal. Results. Comparison of the number and nosologi-cal distribution of disabled children in two cohorts showed that over the 15th year there has been a shift towards an increase in the proportion of disabled children among patients observed by child and ado-lescent psychiatrists. The increase in the number of children with disabilities was due to those suffering from childhood autism and other disorders of general development. There were no statistically significant differences in the number of people with disabilities who received benefits before the age of 7, as well as differences in gender ratios among disabled people in the two cohorts. Conclusion. Early disability is a mul-tifactorial phenomenon, prevalence, dynamics, the structure of which depends not only on clinical, but also on socio-administrative realities. Children with autism require increased attention, since there has been a multiple increase in the number of patients with this diagnosis.

Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

Sign in / Sign up

Export Citation Format

Share Document