Tentorial Meningiomas: Clinical Results in 81 Patients Treated Microsurgically

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Tumor Location ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Presenting Symptoms ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Neuroimaging Data

Abstract OBJECTIVE: Even during the microsurgical era, tentorial meningiomas present a formidable surgical challenge when tumor involves critical neurovascular structures. We report our experience with tentorial meningioma with regard to clinical presentation, diagnostic workup, microsurgical technique, complications, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, neuroimaging data, and follow-up data of patients treated microsurgically for tentorial meningioma in our department between January 1989 and June 2002. Patients were routinely scheduled for clinical and radiological follow-up 6 months and 1 year after surgery. Thereafter, follow-up was performed every 1 or 2 years on the basis of the results of each follow-up examination. RESULTS: The main presenting symptoms of the patients (69 women and 12 men) were headache (75%), dizziness (49%), and gait disturbance (46%). The leading neurological signs were gait ataxia (52%) and cranial nerve deficits (28%). Extent of tumor resection was Simpson Grade I in 29 patients, Grade II in 45 patients, Grade III in 1 patient, Grade IV in 4 patients, and unknown in 2 patients. Permanent surgical morbidity and mortality were 19.8 and 2.5%, respectively. Clinical and magnetic resonance imaging follow-up was available in 74 patients for a period ranging from 1 to 13 years (mean, 5.9 yr). Of these, 64 patients (86%) have resumed normal life activity. Seven patients had tumor recurrence and four underwent reoperation. CONCLUSION: Careful preoperative planning of the surgical approach tailored to tumor location and extent is a prerequisite to achieve radical microsurgical tumor resection with minimal morbidity and mortality. Resection of an infiltrated but patent venous sinus is not recommended.

Surgical Management of Anterolateral and Posteromedial Incisural Tentorial Meningioma

2017 ◽  
Vol 15 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Andrea Talacchi ◽  
Antonio Biroli ◽  
Stefano Medaglia ◽  
Francesca Locatelli ◽  
Mario Meglio
Keyword(s):  
Residual Tumor ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Surgical Approaches ◽  
Clinical Aspects ◽  
Incomplete Resection ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Deep Site

Abstract BACKGROUND Tentorial meningiomas are a broad and consistent category of tumors but their definition is still unclear and their classification uncertain. OBJECTIVE To report the clinical and surgical characteristics of tentorial hiatus meningiomas based on a revised classification of tentorial meningiomas. METHODS We reviewed the records of 14 patients who had undergone microsurgical removal of incisural tentorial meningioma. Two tumor subgroups, anterolateral (AL) and posteromedial (PM), were distinguished according to their site of attachment: the middle third and the posterior third of the tentorial free margin, respectively. Clinical presentation, radiological findings, surgical approaches, extent of resection, and outcome were compared. RESULTS The 2 subgroups differed by tumor size (larger in PM), incidence of the direction of growth (infratentorial in PM), and hydrocephalus (only in PM), as well as by some clinical aspects. Surgical approach depended on tumor location: lateral (pterional, subtemporal, and retromastoid) for AL lesions; medial (occipital or supracerebellar infratentorial) for PM lesions. Total removal (Simpson grade I-II) was performed in 64% of cases and complications occurred in 14%. Stereotactic radiosurgery was performed in cases of incomplete resection. At a mean follow-up of 104.5 mo, clinical improvement with low recurrence (9%) was achieved. CONCLUSION Reallocation of tentorial edge meningiomas is the premise to compare treatment and further improve the approach case-by-case. In spite of their deep site, good outcomes can be achieved in both AL and PM tentorial meningiomas. Also of note is the indolent behavior of residual tumor.

scholarly journals Two Decades of Contemporary Surgery of Primary Cardiac Tumors

2018 ◽  
Vol 04 (04) ◽  
pp. e176-e181
Author(s):  
Khalil Jawad ◽  
Tamer Owais ◽  
Stefan Feder ◽  
Sven Lehmann ◽  
Martin Misfeld ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Golden Rule ◽  
Tumor Location ◽  
Cardiac Tumors ◽  
Complete Excision ◽  
Presenting Symptoms ◽  
Single Center Experience ◽  
Cardiac Procedures ◽  
Primary Cardiac Tumors

Objective The decision to operate cardiac tumors is an issue of balancing surgical outcome and survival with quality of life (QOL). We report our single-center experience in managing primary cardiac tumors between 1994 and 2014. Methods and Results In this study, 269 patients were subjected to our standardized operative protocols, preoperative preparations, postoperative follow-up, and consents of participation. Demographic and preoperative/intraoperative/postoperative variables were collected with focus on long-term follow-up and survival. A total of 72,000 cardiac procedures were performed within 20 years at our institution. Two hundred sixty-nine patients were diagnosed with primary cardiac tumors (0.37%), with a male:female ratio of 1:1.68, mean age of 57.4 ± 19.5 years, and body mass index of 25.49 ± 6.5. The most presenting symptoms were dyspnea (n = 94), arrhythmias (n = 53), embolic event (n = 36), and chest pain (n = 29), and 33 patients were accidentally discovered. Isolated tumor excision and concomitant ablation were performed on 181 patients, while the rest needed additional procedures such as coronary artery bypass grafting (n = 27) or valve surgery (n = 61). Focus on pathology, tumor location was done reporting the commonest pathology such as myxoma (n = 177) and fibroelastoma (n = 56). The frequent site was the left atrium (n = 162). Our primary results showed incidence of bleeding in 9 patients (3.3%), arrhythmias in 76 patients (28.25%), and mortality in 49 patients (18.2%). Five patients (1.8%) showed recurrence and 220 patients (81.8%) showed complaint-free survival. Conclusion Complete excision of primary cardiac tumors is the golden rule in management as it improves survival and decreases morbidity expected from the progressing tumors process. The progression of minimally invasive techniques improves QOL and should be performed whenever possible.

Diffuse Pigmented Villonodular Synovitis Around the Ankle

2018 ◽  
Vol 108 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Keiichi Muramatsu ◽  
Ryuta Iwanaga ◽  
Yasuhiro Tominaga ◽  
Takahiro Hashimoto ◽  
Toshihiko Taguchi
Keyword(s):  
Ankle Joint ◽  
Tumor Resection ◽  
Tumor Location ◽  
Pigmented Villonodular Synovitis ◽  
Growth Patterns ◽  
Treatment Modalities ◽  
Villonodular Synovitis ◽  
Lateral Incision ◽  
Pigmented Villonodular

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Methods: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2–4.6 years). Results: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4–10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Conclusions: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.

scholarly journals Treatment of choroid plexus tumors: a 20-year single institutional experience

2012 ◽  
Vol 10 (5) ◽  
pp. 398-405 ◽  
Author(s):  
Chetan Bettegowda ◽  
Owoicho Adogwa ◽  
Vivek Mehta ◽  
Kaisorn L. Chaichana ◽  
Jon Weingart ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Choroid Plexus ◽  
Multivariate Regression ◽  
Tumor Recurrence ◽  
Multivariate Regression Analysis ◽  
Tumor Location ◽  
Choroid Plexus Tumors ◽  
Presenting Symptoms ◽  
Institutional Experience

Object Choroid plexus tumors (CPTs) are rare intracranial neoplasms that constitute approximately 2%–5% of all pediatric brain tumors. Most of these tumors present with severe hydrocephalus. The optimal perioperative management and oncological care remain a matter of debate. The authors present the epidemiological and clinical features of CPTs from a 20-year single-institutional experience. Methods A total of 39 consecutive patients with pathologically proven CPTs (31 choroid plexus papillomas [CPPs] and 8 choroid plexus carcinomas [CPCs]) were included in this series. Patient demographics, clinical presentation, comorbidities, indications for surgery, radiological studies, tumor location, and all operative variables were reviewed for each case. Multivariate regression analysis was performed to identify independent predictors of tumor recurrence and survival. Results The overall mean age (± SD) was 13.13 ± 19.59 years (15.27 ± 21.10 years in the CPP group and 3.66 ± 3.59 years in the CPC group). Hydrocephalus was noted at presentation in 34% of patients. The most common presenting symptoms were headache (32%) and nausea/vomiting (26%). Gross-total resection (GTR) was achieved in 86% of CPPs and in 71% of CPCs (p = 0.57). There was 100% survival in patients with CPPs observed at the 5- and 10-year follow-up and 71% survival in patients with CPCs at the 5-year follow-up. In a multivariate regression analysis, a diagnosis of papilloma, preoperative vision changes, or hydrocephalus; right ventricle tumor location; and GTR were all independently associated with a decreased likelihood of tumor recurrence at last follow-up. Conclusions The authors' study suggests that patients with CPCs are more likely to experience local recurrence and metastasis; hence, GTR with chemotherapy and radiotherapy, particularly for CPCs, is pivotal in preventing recurrence and prolonging survival. While GTR was important for local control following resection of CPPs, it had a minimal effect on prolonging survival in this patient cohort.

Spinal Cord Intradural Arteriovenous Fistulae: Anatomic, Clinical, and Therapeutic Considerations in a Series of 32 Consecutive Patients Seen between 1981 and 2000 with Emphasis on Endovascular Therapy

Neurosurgery ◽  
2005 ◽  
Vol 57 (5) ◽  
pp. 973-983 ◽  
Author(s):  
Georges Rodesch ◽  
Michel Hurth ◽  
Hortensia Alvarez ◽  
Marc Tadie ◽  
Pierre Lasjaunias
Keyword(s):  
Spinal Cord ◽  
Adult Population ◽  
Clinical Status ◽  
Clinical Results ◽  
Cervical Cord ◽  
Karnofsky Performance Scale ◽  
Presenting Symptoms ◽  
Arteriovenous Shunts ◽  
Thoracolumbar Region

Abstract OBJECTIVE: To review our series of intradural spinal cord arteriovenous fistulas (SCAVFs), analyzing symptoms and related angioarchitecture, and to study the morphological and clinical results of embolization. METHODS: Thirty-two SCAVFs (in 22 adults and 10 children) were treated between 1981 and 2000. These lesions were classified as microarteriovenous fistulas (mAVFs) or macroarteriovenous fistulas (MAVFs) according to shunt morphology. Location, architecture, presenting symptoms, and age group were detailed. The selection of patients for endovascular versus surgical treatments was analyzed, as were the anatomic and clinical results obtained by embolization with n-butylcyanoacrylate. Clinical status was evaluated according to the Karnofsky Performance Scale score. RESULTS: Ten SCAVFs were found in the pediatric population (four mAVFs and six MAVFs). All four mAVFs presented with acute symptoms. Three mAVFs (two cervical and one thoracic) presented hematomyelia; in one patient with a thoracic AVF, subarachnoid hemorrhage was suspected. All six MAVFs were located in the thoracolumbar cord (five associated with hereditary hemorrhagic telangiectasias). Four of the six MAVFs presented with hemorrhage. In the adult population, there were 21 mAVFS (95%) and one MAVF (5%). Only two mAVFs were found in the cervical cord, all other shunts affecting the thoracolumbar region. Hemorrhage was present in 6 of the 22 cases seen in adults (27%). The symptoms of SCAVFs did not differ from those found in spinal cord arteriovenous shunts of nidus type. Pial venous reflux and congestion were the most frequently encountered features in both the adult and pediatric groups. Arterial aneurysms (different from false aneurysms) were not found in association with hemorrhagic presentation of SCAVFs. Mean follow-up in our series was 3.3 years. Of the MAVFs, 86% were embolized, with 67% cured. The others had more than 75% occlusion. All patients followed up improved significantly. Of the mAVFs, 48% were treated endovascularly. Successful embolization was performed in 75% of patients. One patient was not embolized because of vasospasm, whereas 67% percent of mAVFs were completely occluded, 22% were more than 90% occluded, and 11% were 75% occluded. Complementary surgery was deemed unnecessary. All patients with mAVFs improved significantly at follow-up. Transient complications occurred in 22% of all patients, with no permanent morbidity or mortality. No patient bled or rebled after embolization. Thirty-six percent of mAVFs were operated on because of anticipated technical difficulties for endovascular approach or distal localization of the shunt. CONCLUSION: Endovascular treatment of SCAVFs stabilizes, normalizes, or improves neurological symptoms in all patients at long-term follow-up, with no bleeds or rebleeds. Embolization of SCAVFs with glue is a safe treatment that compares favorably with other approaches and significantly improves the poor natural history of the disease.

Arthroscopic Excision of the Os Trigonum: A New Technique with Preliminary Clinical Results

1997 ◽  
Vol 18 (12) ◽  
pp. 777-784 ◽  
Author(s):  
Jay M. Marumoto ◽  
Richard D. Ferkel
Keyword(s):  
Clinical Results ◽  
Surgical Morbidity ◽  
Os Trigonum ◽  
Distraction Device ◽  
Arthroscopic Excision ◽  
Small Joint ◽  
Average Patient ◽  
Prolonged Recovery ◽  
A New Technique

Open excision of a painful os trigonum can be associated with prolonged recovery. An arthroscopic technique has been developed to decrease scarring, diminish surgical morbidity, and promote a faster recovery. Eleven patients were retrospectively evaluated after removal of the os trigonum after a mean follow-up of 35 months. Small joint arthroscopy equipment was utilized in a supine position with a distraction device. Average patient scores improved on the AOFAS Ankle/Hindfoot Scale from 45 to 86 points. All patients went home the same day, and no complications occurred during the procedure. All patients reached maximum recovery level within the first 3 months after surgery. Arthroscopic excision of a painful os trigonum yields good results with minimal surgical morbidity and shorter recovery time.

scholarly journals Retrosigmoid intradural suprameatal approach to Meckel's cave and the middle fossa: surgical technique and outcome

1999 ◽  
Vol 7 (6) ◽  
pp. E1
Author(s):  
Madjid Samii ◽  
Marcos Tatagiba ◽  
Gustavo A. Carvalho
Keyword(s):  
Tumor Resection ◽  
Petrous Bone ◽  
Neurological Deficits ◽  
Subtotal Resection ◽  
Middle Fossa ◽  
Meckel’S Cave ◽  
Simpson Grade ◽  
Petroclival Meningiomas ◽  
Meckel's Cave

Object The goal of this study was to determine whether some petroclival tumors can be safely and efficiently treated using a modified retrosigmoid petrosal approach that is called the retrosigmoid intradural suprameatal approach (RISA). Methods The RISA was introduced in 1983, and since that time 12 patients harboring petroclival meningiomas have been treated using this technique. The RISA includes a retrosigmoid craniotomy and drilling of the suprameatus petrous bone, which is located above and anterior to the internal auditory meatus, thus providing access to Meckel's cave and the middle fossa. Radical tumor resection (Simpson Grade I or II) was achieved in nine (75%) of the 12 patients. Two patients underwent subtotal resection (Simpson Grade III), and one patient underwent complete resection of tumor at the posterior fossa with subtotal resection at the middle fossa. There were no deaths or severe complications in this series; all patients did well postoperatively, being independent at the time of their last follow-up examinations (mean 5.6 years). Neurological deficits included facial paresis in one patient and worsening of hearing in two patients. Conclusions The approach described here is a useful modification of the retrosigmoid approach, which allows resection of large petroclival tumors without the need for supratentorial craniotomies. Although technically meticulous, this approach is not time consuming; it is safe and can produce good results. This is the first report on the use of this approach for petroclival meningiomas.

scholarly journals Cerebral tumor resection assisted by electromagnetic tracking frameless stereotactic system

2018 ◽  
Vol 21 (2) ◽  
pp. 93-98
Author(s):  
Eduardo E. Lovo ◽  
Rafael Martínez Cortez ◽  
Rodolfo Milla Flor ◽  
Héctor Moreira
Keyword(s):  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Location ◽  
Cerebral Tumor ◽  
Advantages And Disadvantages ◽  
Stereotactic System ◽  
Brain Tumor Resection ◽  
Eloquent Cortex ◽  
Tracking Device

Introduction: Electromagnetic (EM) technology used as a tracking device in neurosurgery is relatively new and less common than its optical counterpart: only a few companies manufacture such devices. The main objective is to describe the technology that is used in EM tracking (Compass Cygnus), and its advantages and disadvantages in brain tumor resection as it is incorporated in a neuro-oncology program. Methods: We used the Compass Cygnuss-PFS frameless stereotactic system which performs EM tracking (EMFSS); we analyzed the technology used in the system and describe how a procedureis carried out, signalizing its advantages and disadvantages. We then report our initial experience in tumor resections using this technology from august 2008 to january 2009 in the Neuro-oncology Program of the Hospital de Diagnóstico of El Salvador. Results: The EMFSS operates by using a Flock ofBirds Technology (FOB). Twenty patients were operated on using the EMFSS: 18 of them harbored a tumor either primary or secondary in origin. Its precision was considered adequate in 16 cases (88.8 %) when compared to non-mobile, non-deformable structures (cranial base floor, tentorium, falx, etc). Intraoperative ultrasound in two cases: it was considered inadequatedue to brain shift/deformation, in two cases (11.1%) and a re-registration process had to be carried out during surgery. Tumor location was: 5 (27.7%) in non eloquent, 8 (44.4%) near eloquent, and 5 (27.7%) in eloquent cortex. Volumetric tumor resection was 87% (40-100%). Five patients (27.7%) had complications, 4 (80%) of them transient and resolved during 30 day follow-up. One (5.5%) patient had definite neurological worsening. Thirty day mortality was 0. Preoperative Karnofsky Physiological Score (KPS) and at discharge and at one month follow up was 80 (60-90), 80 (60-90) and 80(60-100) respectively. Conclusions: EM tracking is a reliable system when its accuracy is tested against non-mobile structures and ultrasound. It is compact and the “line of sight” does not have to be taken into consideration. Its big advantages are “tailored” craniotomy design and spatial orientations in deepseated tumors, where ultrasound is not efective; its biggest limitation is its incapacity to re-register with anatomical points or landmarks and image fusion or transition.

scholarly journals Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
First Case ◽  
Common Location ◽  
Skeletal Defects ◽  
Common Diagnosis

Abstract Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

Cavernous Malformations in and Around the Third Ventricle: Indications, Approaches, and Outcomes

2019 ◽  
Vol 18 (6) ◽  
pp. 736-746
Author(s):  
M Neil Woodall ◽  
Joshua S Catapano ◽  
Michael T Lawton ◽  
Robert F Spetzler
Keyword(s):  
Third Ventricle ◽  
Lateral Wall ◽  
Clinical Results ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Presenting Symptoms ◽  
The Third

Abstract BACKGROUND Cavernous malformations in structures in and around the third ventricle are a challenging conceptual and surgical problem. No consensus exists on the ideal approach to such lesions. OBJECTIVE To perform a retrospective review of our institutional database to identify and evaluate approaches used to treat cavernous malformations located in and around the third ventricle. METHODS Information was extracted regarding lesion size and location, extent of resection, time to last follow-up, surgical approach, presenting symptoms, preoperative and postoperative neurological status, and specific approach-related morbidity. RESULTS All 39 neurosurgical operations (in 36 patients) were either an anterior interhemispheric (AIH) (44%, 17/39) or a supracerebellar infratentorial (SCIT) (56%, 22/39) approach. Gross-total resection was achieved in 23 of 39 procedures (59%), a near-total resection in 1 (3%), and subtotal resection in 15 (38%). For the 31 patients with at least 3 mo of follow-up, the mean modified Rankin Scale (mRS) score was 1.5. Of the 31 patients, 25 (81%) had an mRS score of 0 to 2, 4 had a mRS score of 3 (13%), and 1 each had a mRS score of 4 (3%) or 5 (3%). CONCLUSION Most approaches to cavernous malformations in and around the third ventricle treated at our institution have been either an AIH or a SCIT approach. The AIH approach was used for lesions involving the lateral wall of the third ventricle or the midline third ventricular floor, whereas the SCIT approach was used for lesions extending from the third ventricle into the dorsolateral midbrain, with acceptable clinical results.

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