Late results of radical excision of craniopharyngiomas in children

1975 ◽  
Vol 42 (1) ◽  
pp. 86-90 ◽  
Author(s):  
Edward L. Katz
Keyword(s):  
High Mortality ◽  
Surgical Excision ◽  
Late Results ◽  
Radical Excision ◽  
Initial Operation ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Fine Print

✓ The results of radical surgical excision of craniopharyngiomas in children operated on by Dr. Donald Matson beginning in 1950 are presented. The patients are analyzed in regard to survival and quality of survival. While 22 of 34 children so treated at the initial operation are presently alive and tumor-free, high mortality and morbidity followed in cases where reoperation was performed. Properly treated endocrinological deficits need not be a serious problem, but persistent hyperosmolality carried a grave prognosis. No predictive criteria are yet available to determine which tumors are amenable to radical surgical excision.

Intrinsic brain-stem tumors of childhood: surgical indications

1986 ◽  
Vol 64 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Fred Epstein ◽  
E. Larry McCleary
Keyword(s):  
Brain Stem ◽  
Radical Excision ◽  
Diffuse Astrocytoma ◽  
Large Area ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Malignant Astrocytomas ◽  
Diffuse Gliomas ◽  
Malignant Grade ◽  
Fine Print

✓ This report summarizes the first author's experience with radical excision of intrinsic non-exophytic brain-stem gliomas in 34 pediatric patients. On retrospective analysis, these tumors may be classified into three subgroups: focal, diffuse, and cervicomedullary. A focal neoplasm is a circumscribed mass less than 2 cm in diameter and without associated edema. Tumors of a larger size or in which the “focal” neoplasm is associated with a large area of apparent edema are classified as diffuse. Cervicomedullary neoplasms occur at the junction of the medulla and spinal cord and involve both of the structures but do not extend rostrally into the pons. A radical tumor excision was carried out in all patients, and the only mortality and morbidity occurred in children harboring diffuse gliomas. All of the diffuse gliomas were malignant (grade III or IV astrocytomas), whereas three of the four focal astrocytomas and all of the cervicomedullary tumors were grade II astrocytomas. No patient with a diffuse astrocytoma was benefitted by surgery, while two of the focal astrocytomas and all of the cervicomedullary neoplasms either became stable or improved postoperatively. It is concluded that, although surgery may be accomplished within the substance of the brain stem with low morbidity and mortality rates, it is not indicated for malignant astrocytomas as it has no impact on the biology of the neoplasm. Therefore, while primary radical excision is recommended for cervicomedullary neoplasms, which are often benign, the more traditional radiation therapy and/or chemotherapy remain appropriate for tumors above the medulla.

Intraoperative angiography in the resection of arteriovenous malformations

1994 ◽  
Vol 80 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Shigetaka Anegawa ◽  
Takashi Hayashi ◽  
Ryuichiro Torigoe ◽  
Katsuhiko Harada ◽  
Shun-ichi Kihara
Keyword(s):  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Three Dimensional ◽  
Initial Operation ◽  
Total Resection ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Fine Print

✓ Surgical resection of 13 operatively obscure arteriovenous malformations (AVM's) was accomplished with the assistance of intraoperative angiography, which was performed stereographically to provide three-dimensional orientation and was repeated until total resection of the AVM was confirmed. All films obtained were subtracted to improve clarity. The method presented here may be useful for the resection of all types of AVM. Only two patients had residual AVM after the initial operation. No complications attributable to angiography were noted.

Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life

2001 ◽  
Vol 94 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Helen C. Martin ◽  
Jagjit Sethi ◽  
Dorothy Lang ◽  
Glen Neil-Dwyer ◽  
Mark E. Lutman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Functioning ◽  
Acoustic Neuroma ◽  
Physical Functioning ◽  
Short Form ◽  
Content Type ◽  
Sf 36 ◽  
Postoperative Symptoms ◽  
Fine Print

Object. The aim of this study was to assess whether outcomes from excision of acoustic neuroma vary among patients and have a material impact on their quality of life (QOL). Methods. A questionnaire concerning postoperative symptoms and the Short Form 36 (SF-36) QOL instrument were mailed to 97 consecutive patients who had undergone acoustic neuroma surgery via the translabyrinthine approach. The survey response rate was 78% and the symptomatology was consistent with other reports, supporting the representativeness of the sample. The respondents' QOL was rated significantly below published norms and their work capacity was reportedly reduced. Specifically, the following SF-36 dimensions were reduced: physical functioning and role-physical, together with vitality, general health, and social functioning. Greater numbers of postoperative symptoms and larger tumors were associated with a worse rating of physical functioning. More severe balance problems were associated with lower ratings of social functioning. The disparity between the patient's self-estimate and self-measurement and the clinician's assessment of the patient's facial functioning raises doubts about the validity of subjective reports and assessment. Conclusions. The present study supports the use of generic QOL measures to assess outcome and to draw comparisons between different populations.

Outcome after complex neurosurgery: the caregiver's burden is forgotten

1999 ◽  
Vol 91 (3) ◽  
pp. 359-363 ◽  
Author(s):  
Dorothy A. Lang ◽  
Glenn Neil-Dwyer ◽  
John Garfield
Keyword(s):  
Quality Of Life ◽  
Major Change ◽  
Percutaneous Gastrostomy ◽  
Content Type ◽  
Petroclival Meningioma ◽  
Sf 36 ◽  
Permanent Neurological Deficit ◽  
The Impact ◽  
Fine Print

Object. The goals of this study were twofold: 1) to determine outcome, including quality of life, in patients who have undergone surgery for petroclival meningioma in which a standard skull base approach was used; and 2) to assess the impact of the patients' surgical treatment on their caregivers.Methods. Seventeen patients (13 women and four men ranging in age from 29 to 63 years) who underwent a transpetrosal approach for a petroclival meningioma during a 5-year period were prospectively included in this study. Pre- and postoperative data including adverse events were noted. The patients were assessed at 3, 6, and 12 months postoperatively, and annually thereafter, and they completed a postoperative SF-36 questionnaire. In addition, each patient's caregiver was interviewed to determine the effect of the patient's illness on the caregiver's life and responsibilities.Twenty-two operations were performed. A new permanent neurological deficit developed in five patients and in eight a temporary deficit or exacerbation of existing deficits occurred. Two patients underwent surgery to create a facial—hypoglossal nerve communication; five required a temporary percutaneous gastrostomy and/or tracheostomy; three required a shunt; and one underwent successful squint surgery. At 1 year postoperatively 13 patients had made a good or moderate recovery, three were severely disabled, and one had died—outcomes in keeping with other studies. By contrast, responses to the SF-36 questionnaire showed that, in all eight of its categories, between 43% and 75% of surviving patients were functioning below accepted norms. Fifty-six percent of caregivers experienced a major change in lifestyle and 38% experienced a major change with respect to their work.Conclusions. After transpetrosal excision of a petroclival meningioma, the quality of life for the patient is worse than that indicated in surgeons' reported results. The impact on the patient's caregiver is profound—a burden perhaps not fully appreciated by the surgeon.

Acoustic neuroma with malignant transformation

2001 ◽  
Vol 95 (3) ◽  
pp. 518-521 ◽  
Author(s):  
Kenichiro Hanabusa ◽  
Atsunori Morikawa ◽  
Tetsuya Murata ◽  
Waro Taki
Keyword(s):  
Malignant Transformation ◽  
Initial Treatment ◽  
Cerebellopontine Angle ◽  
Residual Tumor ◽  
Initial Operation ◽  
Content Type ◽  
Histological Studies ◽  
Mitotic Figures ◽  
Causal Sequence ◽  
Fine Print

✓ The authors describe the case of a 57-year-old woman who had a right-sided hearing disturbance that had remained untreated for 1 year. The diagnosis was of a right cerebellopontine angle tumor, and the patient underwent its removal via retrosigmoid approach. Pathologically, the tumor was a typical benign neuroma. Growth of residual tumor was detected 4 years after the initial operation, and it was treated with gamma knife surgery (GKS). Six months later, the tumor had grown, and the patient underwent surgery via a combined retrosigmoid—translabyrinthine approach. Abnormal mitotic figures were observed on histological studies, indicating that the tumor had become malignant. Thereafter, the tumor grew rapidly, and the patient died 6.5 years after the initial treatment. It cannot be ruled out that GKS affected the outcome, but the causal sequence was unclear. Because such a patient is rare, documentation of the case was considered clinically important.

A comparison of the gamma knife model C and the Automatic Positioning System with Leksell model B

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 25-28 ◽  
Author(s):  
Daniela Tlachacova ◽  
Michal Schmitt ◽  
Josef Novotny ◽  
Josef Novotny ◽  
Mustafa Majali ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Gamma Knife ◽  
Positioning System ◽  
Content Type ◽  
Ocular Lesions ◽  
Significant Difference ◽  
Model C ◽  
Automatic Positioning ◽  
Fine Print

Object. The authors sought to compare the quality of treatment planning, radiation protection, and the time taken for treatment in the Leksell gamma knife model B with that using the model C Automatic Positioning System (APS). Methods. Data were obtained in 463 patients treated with the B model and 518 patients treated with the C model. Data were analyzed in patients in whom the following diagnoses had been made: vestibular schwannoma, pituitary adenoma, meningioma, solitary metastasis, and other benign and malignant solitary tumors. Patients with arteriovenous malformations, ocular lesions, and functional diagnoses were excluded from this study. Conclusions. With the C model there was a better conformity for most treated targets, such as vestibular schwannomas (p = 0.005) and meningiomas (p = 0.015). The level of radiation exposures to personnel was significantly decreased when using the model C (p < 0.001). There was no significant difference in radiation exposure of extracranial structures for the same number of shots in patients treated by both models. The mean time saved using the C model with the APS was 41 minutes per treatment. It would seem that the gamma knife model C permits better dose conformity, shorter treatment times, and less radiation exposure to personnel.

Papillomas and carcinomas of the choroid plexus in children

1998 ◽  
Vol 88 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Philippe Pencalet ◽  
Christian Sainte-Rose ◽  
Arielle Lellouch-Tubiana ◽  
Chantal Kalifa ◽  
Francis Brunelle ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Surgical Excision ◽  
Preoperative Embolization ◽  
Older Children ◽  
Complete Excision ◽  
Choroid Plexus Tumors ◽  
Content Type ◽  
Intraventricular Tumors ◽  
Fluid Collections ◽  
Fine Print

Object. Choroid plexus tumors are rare intraventricular tumors (1% of all intracranial tumors) that occur mainly in children. The pathophysiological characteristics of associated hydrocephalus, surgical management, and oncological issues related to these tumors remain a matter of debate. To understand more about these tumors, the authors have reviewed their experience with the management of 38 children with choroid plexus tumors. Methods. There were 25 cases of papilloma and 13 of carcinoma. The mean age of the patients at presentation was 22.5 months, and one-half of the patients were younger than 2 years of age. Hydrocephalus was present in 33 patients and poorly correlated with the size, site, and pathological characteristics of the tumor. In nine children, a ventriculoperitoneal shunt was required after tumor excision, calling into question the notion that cerebrospinal fluid oversecretion is the only cause of hydrocephalus. Complete excision was achieved in 96% of the cases of papilloma and 61.5% of the cases of carcinoma. These surgical procedures were complicated by the risks of intraoperative hemorrhage, which proved to be fatal in two cases, and postoperative brain collapse, which led to subdural fluid collections requiring subdural shunt placement in six patients. Preoperative embolization was partially successful in four cases and significantly assisted surgery. Preoperative controlled drainage of excessively dilated ventricles and intraoperative gluing of the cortical incision have been used to address the problem of postoperative brain collapse. Patients with carcinomas were treated postoperatively by chemotherapy alone (seven cases), radiotherapy (one case), or chemotherapy plus radiotherapy (one case). The overall 5-year survival rate was 100% for patients with papillomas and 40% for those with carcinomas. Conclusions. Total surgical excision is curative in cases of papillomas. For carcinomas, the most effective treatment remains total surgical excision; however, adjuvant treatment in the form of chemotherapy in patients younger than age 3 years, supplemented by radiation therapy in older children, can moderately reduce the risk of recurrence.

Epidermoid and dermoid cysts

1977 ◽  
Vol 47 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Beniamino Guidetti ◽  
Franco M. Gagliardi
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Postoperative Complications ◽  
Clinical Data ◽  
Late Results ◽  
Content Type ◽  
Operating Technique ◽  
The Central Nervous System ◽  
Fine Print

✓ The authors report on the clinical data, operating technique, postoperative complications, and late results in a series of 31 epidermoid and 21 dermoid cysts of the central nervous system.

Results of surgical treatment for growth hormone-secreting pituitary adenomas

1993 ◽  
Vol 79 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Dudley H. Davis ◽  
Edward R. Laws ◽  
Duane M. Ilstrup ◽  
James K. Speed ◽  
Michela Caruso ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Radiation Therapy ◽  
Hormone Level ◽  
Growth Hormone Level ◽  
Surgical Excision ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Prior Surgery ◽  
Fine Print

✓ The results of surgical therapy for acromegaly were reviewed in a series of 175 patients treated between 1972 and 1983. Patients with prior surgery or radiation therapy were excluded from the study. Postoperative radiation therapy was given to 54 patients. The criterion of achieving a postoperative basal or glucose-suppressed growth hormone level of 2 ng/ml or less was used to indicate remission. Utilizing the most recently available growth hormone determinations, 90 (51.7%) of 174 patients were in remission. The actuarial probability of remission at 1 and 5 years after surgery was 48.8% and 62.7%, respectively. Tumor size and the preoperative basal growth hormone level were correlated with outcome. Surgical excision of a pituitary adenoma is the most effective therapy currently available for acromegaly.

Self-assessed quality of life after acoustic neuroma surgery

2003 ◽  
Vol 99 (5) ◽  
pp. 818-823 ◽  
Author(s):  
Simone A. Betchen ◽  
Jane Walsh ◽  
Kalmon D. Post
Keyword(s):  
Quality Of Life ◽  
Acoustic Neuroma ◽  
Hearing Level ◽  
Content Type ◽  
Sf 36 ◽  
Acoustic Neuroma Surgery ◽  
Persistent Headache ◽  
Facial Function ◽  
Fine Print

Object. The aim of this study was to determine if factors such as postoperative hearing, facial function, headaches, or other factors have an impact on self-assessed quality of life (QOL) after acoustic neuroma surgery. Methods. The SF-36 and seven additional questions on the impact of surgery on the QOL were sent to 135 consecutive patients who had undergone acoustic neuroma surgery. The Spearman rho correlations were calculated for each of the eight categories of the SF-36 (general health, physical functioning, physical role limitations, emotional role limitations, mental health, energy/vitality, pain, social functioning). The results were correlated with patients' sex, age, persistent headache, years since surgery, postoperative hearing level, and facial function. The response rate was 74.8%. The transformed scores of the eight categories of the SF-36 were lower than age-matched healthy controls in approximately half of the categories. The strongest trend toward lower scores with statistical significance in two categories was persistent headaches. Some categories demonstrated trends toward lower scores with females or age older than 55 years. Postoperative hearing and facial functioning, and time since surgery showed no statistically significant impact on QOL measured by the SF-36. Responses to the additional questions indicate that hearing, facial function, and headache influenced people's feelings about surgery and had an impact on their return to work. Conclusions. The QOL scores are not consistently lower than population normative values compared with different normative studies. The strongest correlation was between the presence of persistent headache and QOL. Other correlations were not consistent in all categories, and few were statistically significant. These trends in some categories do not explain the difference seen between patients after acoustic neuroma surgery in this study and normal populations in other studies.

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