A critical comparison of neurosurgical and otolaryngological approaches to acoustic neuromas

1978 ◽  
Vol 48 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Michael V. Ditullio ◽  
Dennis Malkasian ◽  
Robert W. Rand
Keyword(s):  
Pathological Process ◽  
Tumor Removal ◽  
Content Type ◽  
Critical Comparison ◽  
Complete Tumor Removal ◽  
Suboccipital Craniectomy ◽  
Acoustic Neuromas ◽  
Technical Requirements ◽  
Careful Comparison ◽  
Complete Tumor

✓ Neurosurgeons have traditionally advocated the transmeatal suboccipital craniectomy as the procedure of choice in treating acoustic neuromas of all sizes. With this technique, complete tumor removal was achieved in 91% of our patients. Facial motor activity was fully preserved in 59% and it was only partially deficient in an additional 29%. Conversely, recent otological reports have proposed a more flexible attitude in which the size of the tumor dictates the form of surgical therapy. In that scheme, the universally applicable and clinically proven suboccipital craniectomy is replaced by a series of procedures (translabyrinthine, middle fossa, transsigmoidal), each of which differs in its anatomical and technical requirements. This necessity for several operations seems to stem from the failure of any particular approach either to provide adequate visualization of the entire pathological process, or to afford maximum opportunity for complete tumor removal. By employing these various techniques, total capsular removal has been generally achieved in only 71% of cases. A careful comparison and analysis of these individual procedures reaffirms the superiority of the posterior fossa approach.

Extraspinal ependymomas

1979 ◽  
Vol 51 (3) ◽  
pp. 383-391 ◽  
Author(s):  
Robert A. Morantz ◽  
John J. Kepes ◽  
Solomon Batnitzky ◽  
Byron J. Masterson
Keyword(s):  
Anterior Approach ◽  
Ependymal Cell ◽  
Review Of The Literature ◽  
Tumor Removal ◽  
Nerve Roots ◽  
Content Type ◽  
The Third ◽  
Complete Tumor Removal ◽  
Pilonidal Cyst ◽  
Complete Tumor

✓ Spinal ependymomas may rarely arise from heterotopic ependymal cell clusters and thus occur in an extraspinal location. Presentation of three cases and a review of the literature reveal that these tumors have characteristic radiographic and clinical features. They occur mainly in patients in the third decade of life, and present either in the soft tissue posterior to the sacrum or in the pelvis. In the case of posterior tumors, the patient exhibits a mass which is usually mistaken for a pilonidal cyst. Patients whose tumor is pelvic in location present with sphincter disturbances or dysfunction of the sacral nerve roots. Conventional and computerized tomographic studies will reveal erosion of the sacrum. Myelography will demonstrate an extradural mass indenting the thecal sac from below. The protein in the cerebrospinal fluid will be normal. A combined posterior and anterior approach with the goal of complete tumor removal is the procedure of choice. If this is not feasible, then radiation therapy should be employed. Because of the increased incidence of systemic metastases, the average postoperative survival is approximately 10 years.

Management of acoustic neuromas, 1978–1983

1985 ◽  
Vol 63 (2) ◽  
pp. 175-179 ◽  
Author(s):  
Stephen G. Harner ◽  
Michael J. Ebersold
Keyword(s):  
Facial Nerve ◽  
Surgical Team ◽  
Tumor Removal ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Acoustic Neuromas ◽  
Bipolar Stimulation ◽  
Total Tumor Removal ◽  
Surgical Aspects ◽  
Facial Function

✓ The surgical aspects of 162 consecutive procedures for removal of acoustic neuromas, performed from 1978 through 1983, are reviewed. Nearly all of the procedures were done through a retrosigmoid suboccipital craniectomy. Most used the combined skills of a neurosurgeon and an otological surgeon. Total tumor removal was accomplished in 98% of cases. There have been two recurrences and one postoperative death. The facial nerve was preserved in 81% of procedures. Facial function returned in nearly all of these patients, but the degree of return was variable. The cochlear nerve was preserved in 55 patients, but hearing was present in only 14. The most common complication was cerebrospinal fluid otorhinorrhea (12%); about half of these patients required a secondary procedure. Other complications were meningitis (5%), aspiration (3%), and hemorrhage (2%). During the period reviewed, several changes occurred in management of this disorder. These procedures are now being done by a surgical team. The neurosurgeon performs the intracranial work and the otological surgeon accomplishes the temporal bone dissection. Most patients undergo the operation in the supine rather than the sitting position. During the operation, the facial nerve is monitored continuously by electromyography with intermittent bipolar stimulation. There appears to be continuing improvement in the management of these patients.

scholarly journals Fluorescein Sodium Use during Spinal Ependymoma Resection

2017 ◽  
Vol 3 (3) ◽  
pp. 123-134
Author(s):  
Zhenxing Sun ◽  
Dan Yuan ◽  
Yaxing Sun ◽  
Zhanquan Zhang ◽  
James Wang ◽  
...  
Keyword(s):  
Removal Rate ◽  
Sensory Function ◽  
Fluorescent Light ◽  
Surgical Removal ◽  
Fluorescein Sodium ◽  
Tumor Removal ◽  
Intramedullary Tumors ◽  
Complete Tumor Removal ◽  
Complete Tumor

Spinal ependymomas (SEs) are common adult intramedullary tumors; however, determining the absolute boundary between the tumor and the tumor residual may be difficult. We assessed outcomes following the use of fluorescein sodium (FS) during surgical removal of SEs. We performed a retrospective analysis of 112 patients with SEs who were treated at Beijing Tsinghua Changgung Hospital between December 2014 and December 2016. Each patient received intravenous FS (3–4 mg/kg) to determine the SE boundaries during surgery. Tumor removal efficiencies and tumor residuals were assessed using magnetic resonance imaging (MRI) at 10 days and 3 months after surgical recovery; McCormick's spinal function classification was also performed at the 3-month follow-up. The complete tumor removal rate was 92% (103/112). Ninety-four patients underwent tumor removal under fluorescent light, which provided distinctive tumor fluorescence. Tumor removal under white light was performed in 18 patients; fluorescent images were invisible or indistinctive in these 18 patients. At the 3-month follow-up, sensory function (85.8% (91/106)) and movement (84.3% (86/102)) were improved in patients with pre-surgical dysfunction; urination and defecation functions were improved in 66.7% (16/24). The McCormick spinal cord functional classifications, at the 3-month follow-up, showed significant differences in the percentages of patients with disease classified to each grade (I–IV), compared with preoperative classifications (each, P < 0.05). There was no MRI evidence of tumor relapse or residuals at the 3-month follow-up. FS use during the surgical treatment of SE enables complete tumor removal and detection of tumor residuals.

Meningioma Involving Meckel's Cave: Transpetrosal Surgical Anatomy and Clinical Considerations

2002 ◽  
Vol 111 (9) ◽  
pp. 850-854 ◽  
Author(s):  
Daniel I. Choo ◽  
David L. Steward ◽  
Myles L. Pensak
Keyword(s):  
Facial Pain ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Tumor Removal ◽  
Meckel’S Cave ◽  
Complete Tumor Removal ◽  
Meckel's Cave ◽  
Intimate Knowledge ◽  
Clinical Considerations ◽  
Complete Tumor

Meningiomas originating in Meckel's cave (MC) are uncommon lesions that represent 1% of all intracranial meningiomas. Innovations in skull base surgery have enabled resection of these lesions with less morbidity, but require an intimate knowledge of both lesional pathology and regional microneuroanatomy. To review the surgical and clinical considerations involved in the management of MC meningiomas, we retrospectively reviewed data from patients who underwent transpetrosal resection of primary MC meningiomas between 1984 and 1998. Of 146 patients who underwent transpetrosal removal of meningiomas, 7 were believed to have tumors originating in MC. All 7 patients presented with trigeminal dysfunction, facial pain, and/or headache. Complete tumor removal was achieved in 5 of the 7 patients. Facial hypoesthesia or anesthesia, paralysis of cranial nerve VI, and ophthalmoplegia were among the postoperative complications encountered. Meningiomas of MC represent treatable lesions whose diagnosis requires prompt imaging of patients with trigeminal dysfunction and symptoms of facial pain and headache.

Spinal Meningiomas: Review of 174 Operated Cases

Neurosurgery ◽  
1989 ◽  
Vol 25 (2) ◽  
pp. 153-160 ◽  
Author(s):  
Carlo L. Solero ◽  
Maurizio Fornari ◽  
Sergio Giombini ◽  
Giovanni Lasio ◽  
Giuseppe Oliveri ◽  
...  
Keyword(s):  
Neurological Impairment ◽  
Neurological Deficits ◽  
Long Term Results ◽  
Tumor Removal ◽  
Microsurgical Technique ◽  
Complete Tumor Removal ◽  
Spinal Meningiomas ◽  
Subtotal Removal ◽  
Complete Tumor

Abstract The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.

Primary polymorphous low-grade adenocarcinoma of the bronchus: Complete tumor removal with bronchoscopic resection

Lung Cancer ◽  
2009 ◽  
Vol 63 (2) ◽  
pp. 301-304 ◽  
Author(s):  
Viboon Boonsarngsuk ◽  
Thitiporn Suwatanapongched ◽  
Mana Rochanawutanon ◽  
Montian Ngodngamthaweesuk ◽  
Piemsak Prakardvudhisarn
Keyword(s):  
Low Grade ◽  
Tumor Removal ◽  
Complete Tumor Removal ◽  
Complete Tumor

Spinal en Plaque Meningiomas: A Contemporary Experience

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1275-1279 ◽  
Author(s):  
Emanuela Caroli ◽  
Michele Acqui ◽  
Raffaelino Roperto ◽  
Luigi Ferrante ◽  
Giancarlo D'Andrea
Keyword(s):  
Surgical Treatment ◽  
Surgical Removal ◽  
Tumor Removal ◽  
Medline Search ◽  
Complete Tumor Removal ◽  
Spinal Arachnoiditis ◽  
Surgical Cure ◽  
Spinal Meningiomas ◽  
Subtotal Removal ◽  
Complete Tumor

Abstract OBJECTIVE: Spinal en plaque meningiomas are rare and challenging lesions because of their tendency to induce spinal arachnoiditis. The surgical treatment of this type of meningioma is more complex than that of classic meningioma. METHODS: We report seven cases of spinal en plaque meningiomas and review all the cases reported in the literature accessible to us by a MEDLINE search. RESULTS: All patients underwent microsurgery. Complete tumor removal was achieved in three patients. Subtotal removal was performed in four patients. A permanent neurological worsening was observed in one patient. CONCLUSION: Spinal meningiomas en plaque bear a prognosis poorer than that of classic meningiomas with regard to the possibility of a definitive surgical cure because recurrence or postoperative arachnoiditis occurs frequently. Total surgical removal should be attempted only when a clear plane of cleavage between tumor and arachnoid exists.

Management of hydrocephalus secondary to posterior fossa tumors

1977 ◽  
Vol 46 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Leland Albright ◽  
Donald H. Reigel
Keyword(s):  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Csf Shunt ◽  
Safe Procedure ◽  
Tumor Removal ◽  
Posterior Fossa Tumors ◽  
Csf Shunts ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Methods Of Treatment

✓ The records of children with hydrocephalus secondary to posterior fossa tumors were reviewed and the methods of treatment compared with their subsequent clinical course. Of 86 patients evaluated, 47 had no treatment for hydrocephalus prior to tumor removal, 12 had external ventricular drainage, and 27 had cerebrospinal fluid (CSF) shunts before suboccipital craniectomy. Children with CSF shunts before tumor removal had significantly better postoperative conditions than the children without shunts (p < 0.01). Operative mortality of children without treatment of hydrocephalus before tumor surgery was 12.8%; it was 3.7% in the children with preexisting shunts. Treatment of hydrocephalus with a CSF shunt prior to suboccipital craniectomy was a safe procedure that significantly lowered the morbidity and mortality of subsequent tumor removal.

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