Infiltrating ependymomas of the cauda equina

1974 ◽  
Vol 41 (4) ◽  
pp. 446-448 ◽  
Author(s):  
Michael Scott
Keyword(s):  
Cauda Equina ◽  
Conservative Surgery ◽  
Long Term Results ◽  
Content Type ◽  
Radical Removal ◽  
Benign Course ◽  
Fine Print

✓ The author reports the long-term results of combined conservative surgery and radiotherapy in the treatment of three patients with infiltrating papillary ependymomas Of the cauda equina. Seventeen to 20 years later they have relatively minimal complaints and dysfunction. This long benign course emphasizes the folly of attempting radical removal with its potential for serious mutilation of the cauda equina.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

Long-term results of gamma knife surgery for growth hormone—producing pituitary adenoma: is the disease difficult to cure?

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 119-123 ◽  
Author(s):  
Tatsuya Kobayashi ◽  
Yoshimasa Mori ◽  
Yukio Uchiyama ◽  
Yoshihisa Kida ◽  
Shigeru Fujitani
Keyword(s):  
Growth Hormone ◽  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Content Type ◽  
The Mean ◽  
Dose Radiation ◽  
Fine Print

Object. The authors conducted a study to determine the long-term results of gamma knife surgery for residual or recurrent growth hormine (GH)—producing pituitary adenomas and to compare the results with those after treatment of other pituitary adenomas. Methods. The series consisted of 67 patients. The mean tumor diameter was 19.2 mm and volume was 5.4 cm3. The mean maximum dose was 35.3 Gy and the mean margin dose was 18.9 Gy. The mean follow-up duration was 63.3 months (range 13–142 months). The tumor resolution rate was 2%, the response rate 68.3%, and the control rate 100%. Growth hormone normalization (GH < 1.0 ng/ml) was found in 4.8%, nearly normal (< 2.0 ng/ml) in 11.9%, significantly decreased (< 5.0 ng/ml) in 23.8%, decreased in 21.4%, unchanged in 21.4%, and increased in 16.7%. Serum insulin-like growth factor (IGF)—1 was significantly decreased (IGF-1 < 400 ng/ml) in 40.7%, decreased in 29.6%, unchanged in 18.5%, and increased in 11.1%, which was almost parallel to the GH changes. Conclusions. Gamma knife surgery was effective and safe for the control of tumors; however, normalization of GH and IGF-1 secretion was difficult to achieve in cases with large tumors and low-dose radiation. Gamma knife radiosurgery is thus indicated for small tumors after surgery or medication therapy when a relatively high-dose radiation is required.

Long-term outcome of anterior decompression and spinal fixation after placement of the Wellesley Wedge for thoracic and lumbar spinal metastasis

2002 ◽  
Vol 96 (1) ◽  
pp. 6-9 ◽  
Author(s):  
David Yen ◽  
Vikas Kuriachan ◽  
Jeff Yach ◽  
Andrew Howard
Keyword(s):  
Selection Process ◽  
Spinal Metastasis ◽  
Neurological Status ◽  
Long Term Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Lumbar Spinal ◽  
Fine Print

Object. The authors assessed the long-term results of anterior decompressive and vertebral body reconstructive surgery in which the Wellesley Wedge was applied in patients with metastatic spinal lesions over the life span of these individuals. Methods. The authors performed a retrospective review of the outcome of 27 consecutively treated patients who underwent surgery for thoracic or lumbar spine metastases. Decompressive surgery was performed via an anterior thoracotomy and/or retroperitoneal approach depending on the level of the lesion. The spine was reconstructed using a U-shaped plate with an interposed methylmethacrylate strut known as the Wellesley Wedge. Results. Thirty percent of patients suffered medical complications whereas 22% experienced postoperative improvement, as reflected by an improved Frankel grade. Used in patients with a variety of primary tumor types, a spectrum of ages and neurological status, and extensive preoperative osseous spinal involvement and deformity, the Wellesley Wedge resulted in spinal stability for the duration of patients' lives in 92%. Conclusions. In this series the patient selection process for surgery was a challenge yet to be solved; however, considering the durability of the Wellesley Wedge itself, the authors will continue to use it in selected patients.

Long-term outcome of hypothalamic/chiasmatic astrocytomas in children treated with conservative surgery

1995 ◽  
Vol 83 (4) ◽  
pp. 583-589 ◽  
Author(s):  
Leslie N. Sutton ◽  
Patricia T. Molloy ◽  
Heidi Sernyak ◽  
Joel Goldwein ◽  
Peter L. Phillips ◽  
...  
Keyword(s):  
Radical Surgery ◽  
Conservative Surgery ◽  
Low Grade ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

✓ The feasibility of radical surgery for astrocytomas of the optic chiasm/hypothalamus has been reported by several groups. Such surgery carries significant risks, however, including permanent damage to the pituitary gland, optic apparatus, hypothalamic structures, and carotid arteries. The benefits of radical surgery, both in terms of efficacy and toxicity, should, therefore, be evaluated against standard therapy, as is usually done for new chemotherapeutic protocols. To this end, a retrospective review was performed of 33 patients treated at Children's Hospital of Philadelphia between 1976 and 1991 who met criteria that would have made them eligible for radical surgery in many centers today, but were treated with either no surgery or conservative surgery (< 50% resection) or biopsy followed by adjuvant therapy with local radiation therapy (29 patients) and/or chemotherapy with actinomycin-D and vincristine (18 patients). The review encompassed all children with a globular enhancing mass of at least 2 cm in the hypothalamic/chiasmatic region, no evidence of optic nerve involvement or involvement of the optic radiations by computerized tomography or magnetic resonance imaging, and follow up of at least 3 years. All but one patient had tissue confirmation of a low-grade or pilocytic astrocytoma. Thirteen of the patients were 2 years of age or younger at diagnosis. Five individuals died: three of tumor progression, one of acute shunt malfunction, and one of intercurrent infection. The remaining 28 were alive at last follow up, a mean of 10.9 years from diagnosis. Twenty-three surviving patients have functional vision in at least one eye, 12 require no endocrine replacement, and 16 are in or have completed schooling with regular academic requirements. If radical surgery is to become standard care for children with low-grade astrocytomas of the hypothalamic/chiasmatic region, long-term survival and functional outcome will have to equal or surpass those of historical controls who were treated conservatively.

CT-guided stereotactic fibrinolysis of spontaneous and hypertensive cerebellar hemorrhage: long-term results

1990 ◽  
Vol 73 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Mohsen Mohadjer ◽  
Rudolf Eggert ◽  
Johannes May ◽  
Lothar Mayfrank
Keyword(s):  
Long Term Results ◽  
Postoperative Phase ◽  
Ct Guided ◽  
Cerebellar Hemorrhage ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Fine Print ◽  
Stereotactic Puncture

✓ The surgical indication for spontaneous cerebellar hemorrhage is not as controversial as the operative management of intracranial hemorrhage. Timing of the operation is crucial: intervening too early can produce an additional strain on the patient and an increased risk, while waiting too long to evacuate the hematoma can be fatal. This dilemma may be a factor in the relatively high mortality and morbidity rates following both operative and conservative treatment that have been reported in the literature (42.5% and 30%, respectively). In long-term studies on 14 patients, the authors have shown that stereotactic puncture and fibrinolysis for cerebellar hemorrhage is a valuable alternative to treatments used currently. The method consists of computerized tomography (CT)-guided stereotactic puncture and partial evacuation of the hematoma. After fibrinolysis with urokinase, the residual hematoma can be completely evacuated via a catheter introduced into the cavity of the hematoma. Only one of the 14 patients died in the direct postoperative phase; the remaining patients were enjoying a good to very good quality of life 6 months after the acute event. Two patients subsequently died as a result of pneumonia and cerebral infarction, respectively; both conditions were unrelated to the hemorrhage. The authors conclude that the CT-guided stereotactic method is simple, effective, and safe, and can be applied to patients of any age.

Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantile hydrocephalus

1979 ◽  
Vol 50 (2) ◽  
pp. 179-186 ◽  
Author(s):  
Thomas R. Keucher ◽  
John Mealey
Keyword(s):  
Late Complications ◽  
Long Term Results ◽  
Infection Rates ◽  
Infantile Hydrocephalus ◽  
Content Type ◽  
Vp Shunt ◽  
Ventriculoperitoneal Shunting ◽  
Fine Print

✓ This series of 228 patients with infantile non-neoplastic hydrocephalus who received either a ventriculoatrial (VA) or a ventriculoperitoneal (VP) shunt before 2 years of age was followed for an average of 7 years, and the results with the two types of shunt were compared. Mortality and infection rates were similar for both groups of patients, but children with VP shunts required significantly fewer revisions and had a much greater likelihood of not having any revisions during the follow-up period. Late complications occurred more frequently with VA shunts and were more serious. It is concluded that VP shunts offer significant advantages over VA systems in this population.

The treatment of posttraumatic tremor by stereotactic surgery

1994 ◽  
Vol 80 (5) ◽  
pp. 810-819 ◽  
Author(s):  
Joachim K. Krauss ◽  
Mohsen Mohadjer ◽  
Fritz Nobbe ◽  
Fritz Mundinger
Keyword(s):  
Head Trauma ◽  
Functional Disability ◽  
Rating Scale ◽  
Stereotactic Surgery ◽  
Long Term Results ◽  
Severe Head Trauma ◽  
Content Type ◽  
Fine Print

✓ The authors report the long-term results of stereotactic surgery for severe posttraumatic appendicular tremor in 35 patients. The tremors developed after severe head trauma in 33 patients (94%) and after mild to moderate head trauma in two (6%). In all but one, the tremor was most evident during activity. The amplitude of the kinetic tremor was greater than 5 cm in 33 patients (94%) and greater than 12 cm in 19 patients (54%). All were severely incapacitated in their daily living activities due to the tremors. The 35 patients underwent 42 stereotactic operations; five patients were reoperated on the same side and two were treated with a bilateral staged procedure. The contralateral zona incerta was the stereotactic target in 12 patients and was targeted in combination with the base of the ventrolateral (oroventral) thalamus in 23 patients. Long-term postoperative follow-up review was obtained in 32 patients (mean follow-up period 10.5 years). Persistent improvement of tremor was noted in 88%. The tremor was absent or markedly reduced in 65%. Functional disability was assessed and quantified with a modified form of an established rating scale for patients with tremor; it was reduced from a mean value of 57% of maximum disability to 37% over the long term (p < 0.001). Follow-up lesion assessment was obtained in 18 patients by multiplanar magnetic resonance imaging and at autopsy in one patient whose death was unrelated to surgery. As in previous studies, the frequency of persistent side effects was relatively high (38%). These consisted mainly of aggravation of preoperative symptoms. The results are compared to those of a total of 55 patients reported from 1960 to 1992. The occurrence of dystonia and dystonic postures is discussed. Stereotactic surgery is a powerful tool to alleviate posttraumatic tremor and to improve functional disability. However, as there is considerable risk of persistent morbidity in patients after severe head trauma, the operation should be restricted to selected cases with disabling tremor.

Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression

2002 ◽  
Vol 96 (3) ◽  
pp. 527-531 ◽  
Author(s):  
Elizabeth C. Tyler-Kabara ◽  
Amin B. Kassam ◽  
Michael H. Horowitz ◽  
Louise Urgo ◽  
Constantinos Hadjipanayis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Long Term Results ◽  
Content Type ◽  
Significant Pain ◽  
Fine Print

Object. Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. Methods. The results of 2675 MVDs in 2264 patients were reviewed using information obtained from the department database. The authors examined immediate postoperative relief in 2003 patients with typical and 672 with atypical TN, and long-term follow-up results in patients for whom more than 5 years of follow-up data were available (969 with typical and 219 with atypical TN). Outcomes were divided into three categories: excellent, pain relief without medication; good, mild or intermittent pain controlled with low-dose medication; and poor, no or poor pain relief with large amounts of medication. The results for typical and atypical TN were compared and patient history and pain characteristics were evaluated for possible predictive factors. Conclusions. In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.

Functional performance following selective posterior rhizotomy: long-term results determined using a validated evaluative measure

2002 ◽  
Vol 97 (3) ◽  
pp. 510-518 ◽  
Author(s):  
Sandeep Mittal ◽  
Jean-Pierre Farmer ◽  
Borhan Al-Atassi ◽  
Kathleen Montpetit ◽  
Nathalie Gervais ◽  
...  
Keyword(s):  
Functional Performance ◽  
Self Care ◽  
Performance Outcomes ◽  
Long Term Results ◽  
Spastic Cerebral Palsy ◽  
Content Type ◽  
Dorsal Rhizotomy ◽  
Selective Posterior Rhizotomy ◽  
Fine Print

Object. Selective posterior rhizotomy (SPR) may result in considerable benefit for children with spastic cerebral palsy. To date, however, there have been few studies in which validated functional outcome measures have been used to report surgical results beyond 3 years. The authors analyzed data obtained from the McGill Rhizotomy Database to determine long-term functional performance outcomes in patients who underwent lumbosacral dorsal rhizotomy performed using intraoperative electrophysiological monitoring. Methods. The study population was composed of children with debilitating spasticity who underwent SPR and were evaluated by a multidisciplinary team preoperatively and at 6 months and 1 year postoperatively. Quantitative standardized assessments of activities of daily living (ADL) were obtained using the Pediatric Evaluation of Disability Inventory (PEDI). Of 57 patients who met the entry criteria for the study, 41 completed the 3-year assessments and 30 completed the 5-year assessments. Statistical analysis demonstrated significant improvement in the mobility and self-care domains of the functional skills dimension at 1 year after SPR. The preoperative and 1-, 3-, and 5-year postoperative scaled scores for the mobility domain were 56, 64, 77.2, and 77.8, respectively. The scaled score for the self-care domain increased from 59 presurgery to 67.9, 81.6, and 82.4 at the 1-, 3-, and 5-year postoperative assessments, respectively. Conclusions. The results of this study support the presence of significant improvements in functional performance, based on PEDI scores obtained 1 year after SPR. The improvements persisted at the 3- and 5-year follow-up examinations. The authors conclude that SPR performed using intraoperative stimulation is valuable in the augmentation of motor function and self-care skills essential to the performance of ADL.

Initial experience with gamma knife radiosurgery for advanced glaucoma

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 180-183 ◽  
Author(s):  
Vilibald Vladyka ◽  
Roman Liščk ◽  
Oldřich Šubrt ◽  
Jozef Vymazal ◽  
Jiri Pilbauer ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Long Term Results ◽  
Initial Experience ◽  
Ocular Pain ◽  
Content Type ◽  
Advanced Glaucoma ◽  
Fine Print

Object. The authors assessed the affect of gamma knife radiosurgery on patients with glaucoma. Methods. Fifteen eyes in 14 patients were treated with gamma knife radiosurgery during a 14-month period. Ocular pain was alleviated in all patients and intraocular pressure was decreased. There were no early side effects. Conclusions. Further studies are needed to elucidate the best treatment parameters, long-term results, and some of the pathophysiological effects.

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