Cerebellopontine angle meningiomas

1984 ◽  
Vol 60 (3) ◽  
pp. 500-505 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Peter J. Jannetta
Keyword(s):  
Computerized Tomography ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Mortality ◽  
Preoperative Evaluation ◽  
Content Type ◽  
Surgical Microscope ◽  
Fine Print

✓ During the years 1974 through 1981, 22 patients with cerebellopontine angle meningiomas underwent surgery: 14 tumors were excised completely, and eight subtotally. A retromastoid approach was used in 19 cases and a subtemporal approach in three cases. There was no operative mortality and the quality of survival was good. Five patients suffered new cranial nerve deficits as a result of the operation. The average follow-up period was 5 years. One tumor thought to be completely removed has recurred, but has not required another operation so far. One subtotally excised tumor required reoperation. Computerized tomography and arteriography were important in preoperative evaluation. Good neuroanesthesia, the use of the surgical microscope and microtechnique, and an understanding of the pathological relationships were factors contributing to good results.

Stereotactic radiotherapy for the treatment of acoustic neuromas

2004 ◽  
Vol 101 (Supplement3) ◽  
pp. 362-372 ◽  
Author(s):  
Michael T. Selch ◽  
Alessandro Pedroso ◽  
Steve P. Lee ◽  
Timothy D. Solberg ◽  
Nzhde Agazaryan ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Tumor Size ◽  
Cranial Nerve ◽  
Target Volume ◽  
Tumor Control ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Acoustic Neuromas ◽  
Fine Print

Object. The authors sought to assess the safety and efficacy of stereotactic radiotherapy when using a linear accelerator equipped with a micromultileaf collimator for the treatment of patients with acoustic neuromas. Methods. Fifty patients harboring acoustic neuromas were treated with stereotactic radiotherapy between September 1997 and June 2003. Two patients were lost to follow-up review. Patient age ranged from 20 to 76 years (median 59 years), and none had neurofibromatosis. Forty-two patients had useful hearing prior to stereotactic radiotherapy. The fifth and seventh cranial nerve functions were normal in 44 and 46 patients, respectively. Tumor volume ranged from 0.3 to 19.25 ml (median 2.51 ml). The largest tumor dimension varied from 0.6 to 4 cm (median 2.2 cm). Treatment planning in all patients included computerized tomography and magnetic resonance image fusion and beam shaping by using a micromultileaf collimator. The planning target volume included the contrast-enhancing tumor mass and a margin of normal tissue varying from 1 to 3 mm (median 2 mm). All tumors were treated with 6-MV photons and received 54 Gy prescribed at the 90% isodose line encompassing the planning target volume. A sustained increase greater than 2 mm in any tumor dimension was defined as local relapse. The follow-up duration varied from 6 to 74 months (median 36 months). The local tumor control rate in the 48 patients available for follow up was 100%. Central tumor hypodensity occurred in 32 patients (67%) at a median of 6 months following stereotactic radiotherapy. In 12 patients (25%), tumor size increased 1 to 2 mm at a median of 6 months following stereotactic radiotherapy. Increased tumor size in six of these patients was transient. In 13 patients (27%), tumor size decreased 1 to 14 mm at a median of 6 months after treatment. Useful hearing was preserved in 39 patients (93%). New facial numbness occurred in one patient (2.2%) with normal fifth cranial nerve function prior to stereotactic radiotherapy. New facial palsy occurred in one patient (2.1%) with normal seventh cranial nerve function prior to treatment. No patient's pretreatment dysfunction of the fifth or seventh cranial nerve worsened after stereotactic radiotherapy. Tinnitus improved in six patients and worsened in two. Conclusions. Stereotactic radiotherapy using field shaping for the treatment of acoustic neuromas achieves high rates of tumor control and preservation of useful hearing. The technique produces low rates of damage to the fifth and seventh cranial nerves. Long-term follow-up studies are necessary to confirm these findings.

Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery

2000 ◽  
Vol 93 (4) ◽  
pp. 586-593 ◽  
Author(s):  
Johann Romstöck ◽  
Christian Strauss ◽  
Rudolf Fahlbusch
Keyword(s):  
Detailed Analysis ◽  
Cranial Nerve ◽  
Cerebellopontine Angle ◽  
Operative Procedure ◽  
Cranial Nerves ◽  
Postoperative Outcome ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Lower Cranial Nerves ◽  
Fine Print

Object. Electromyography (EMG) monitoring is expected to reduce the incidence of motor cranial nerve deficits in cerebellopontine angle surgery. The aim of this study was to provide a detailed analysis of intraoperative EMG phenomena with respect to their surgical significance.Methods. Using a system that continuously records facial and lower cranial nerve EMG signals during the entire operative procedure, the authors examined 30 patients undergoing surgery on acoustic neuroma (24 patients) or meningioma (six patients). Free-running EMG signals were recorded from muscles targeted by the facial, trigeminal, and lower cranial nerves, and were analyzed off-line with respect to waveform characteristics, frequencies, and amplitudes. Intraoperative measurements were correlated with typical surgical maneuvers and postoperative outcomes.Characteristic EMG discharges were obtained: spikes and bursts were recorded immediately following the direct manipulation of a dissecting instrument near the cranial nerve, but also during periods when the nerve had not yet been exposed. Bursts could be precisely attributed to contact activity. Three distinct types of trains were identified: A, B, and C trains. Whereas B and C trains are irrelevant with respect to postoperative outcome, the A train—a sinusoidal, symmetrical sequence of high-frequency and low-amplitude signals—was observed in 19 patients and could be well correlated with additional postoperative facial nerve paresis (in 18 patients).Conclusions. It could be demonstrated that the occurrence of A trains is a highly reliable predictor for postoperative facial palsy. Although some degree of functional worsening is to be expected postoperatively, there is a good chance of avoiding major deficits by warning the surgeon early. Continuous EMG monitoring is superior to electrical nerve stimulation or acoustic loudspeaker monitoring alone. The detailed analysis of EMG-waveform characteristics is able to provide more accurate warning criteria during surgery.

Radiosurgery of vestibular schwannomas: summary of experience in 829 cases

2005 ◽  
Vol 102 ◽  
pp. 195-199 ◽  
Author(s):  
L. Dade Lunsford ◽  
Ajay Niranjan ◽  
John C. Flickinger ◽  
Ann Maitz ◽  
Douglas Kondziolka
Keyword(s):  
Quality Of Life ◽  
Gamma Knife ◽  
Cranial Nerve ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Content Type ◽  
Dose Planning ◽  
Fine Print

Object.Management options for vestibular schwannomas (VSs) have greatly expanded since the introduction of stereotactic radiosurgery. Optimal outcomes reflect long-term tumor control, preservation of cranial nerve function, and retention of quality of life. The authors review their 15-year experience.Methods.Between 1987 and 2002, some 829 patients with VSs underwent gamma knife surgery (GKS). Dose selection, imaging, and dose planning techniques evolved between 1987 and 1992 but thereafter remained stable for 10 years. The average tumor volume was 2.5 cm3. The median margin dose to the tumor was 13 Gy (range 10–20 Gy).No patient sustained significant perioperative morbidity. The average duration of hospital stay was less than 1 day. Unchanged hearing preservation was possible in 50 to 77% of patients (up to 90% in those with intracanalicular tumors). Facial neuropathy risks were reduced to less than 1%. Trigeminal symptoms were detected in less than 3% of patients whose tumors reached the level of the trigeminal nerve. Tumor control rates at 10 years were 97% (no additional treatment needed).Conclusions.Superior imaging, multiple isocenter volumetric conformal dose planning, and optimal precision and dose delivery contributed to the long-term success of GKS, including in those patients in whom initial microsurgery had failed. Gamma knife surgery provides a low risk, minimally invasive treatment option for patients with newly diagnosed or residual VS. Cranial nerve preservation and quality of life maintenance are possible in long-term follow up.

CyberKnife stereotactic radiosurgical treatment of spinal tumors for pain control and quality of life

2005 ◽  
Vol 2 (5) ◽  
pp. 540-549 ◽  
Author(s):  
Jeffrey W. Degen ◽  
Gregory J. Gagnon ◽  
Jean-Marc Voyadzis ◽  
Donald A. McRae ◽  
Michael Lunsden ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Well Being ◽  
Spinal Tumors ◽  
Content Type ◽  
Cyberknife Radiosurgery ◽  
The Mean ◽  
Initial Score ◽  
Fine Print

Object. The authors conducted a study to assess safety, pain, and quality of life (QOL) outcomes following CyberKnife radiosurgical treatment of spinal tumors. Methods. Data obtained in all patients with spinal tumors who underwent CyberKnife radiosurgery at Georgetown University Hospital between March 2002 and March 2003 were analyzed. Patients underwent examination, visual analog scale (VAS) pain assessment, and completed the 12-item Short Form Health Survey (SF-12) before treatment and at 1, 3, 6, 8, 12, 18, and 24 months following treatment. Fifty-one patients with 72 lesions (58 metastatic and 14 primary) were treated. The mean follow-up period was 1 year. Pain was improved, with the mean VAS score decreasing significantly from 51.5 to 21.3 at 4 weeks (p < 0.001). This effect on pain was durable, with a mean score of 17.5 at 1 year, which was still significantly decreased (p = 0.002). Quality of life was maintained throughout the study period. After 18 months, physical well-being was 33 (initial score 32; p = 0.96) and mental well-being was 43.8 (initial score 44.2; p = 0.97). (The mean SF-12 score is 50 ± 10 [standard deviation].) Adverse effects included self-limited dysphagia (three cases), diarrhea (two cases), lethargy (three cases), paresthesias (one case), and wound dehiscence (one case). Conclusions. CyberKnife radiosurgery improves pain control and maintains QOL in patients treated for spinal tumors. Early adverse events are infrequent and minor. The authors await long-term follow-up data to determine late complications and tumor control rates.

Arteriovenous malformations of the brain

1972 ◽  
Vol 37 (5) ◽  
pp. 562-570 ◽  
Author(s):  
David M. C. Forster ◽  
Ladislau Steiner ◽  
Sten Håkanson
Keyword(s):  
Arteriovenous Malformations ◽  
Indications For Surgery ◽  
Content Type ◽  
Long Run ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The quality of survival of 150 patients with arteriovenous malformations of the brain is presented. The mean period of follow-up was over 15 years. The surgically operated and conservatively managed groups are compared, a comparison that in the long run appears to favor the operated cases. The results are discussed and indications for surgery summarized.

Surgery of intact intracranial aneurysms

1974 ◽  
Vol 40 (4) ◽  
pp. 495-498 ◽  
Author(s):  
Kewal K. Jain
Keyword(s):  
Carotid Artery ◽  
Cranial Nerve ◽  
Intracranial Aneurysms ◽  
Operative Mortality ◽  
Common Symptom ◽  
Cranial Nerve Involvement ◽  
Content Type ◽  
Nerve Involvement ◽  
Fine Print

✓ The author reports his experience with 15 cases involving intact intracranial aneurysms. The most common symptom was headache; less common symptoms were seizures and cranial nerve involvement. Twelve patients were treated surgically without any operative mortality or morbidity. Relief of headaches occurred in the eight patients in whom the aneurysm was clipped or the carotid artery was ligated in the neck. It is recommended that most intact intracranial aneurysms be treated surgically. Certain contraindications are discussed.

CCNU chemotherapy in adult patients with tumors of the basal ganglia and brain stem

1980 ◽  
Vol 53 (3) ◽  
pp. 361-363 ◽  
Author(s):  
Alfredo Pompili ◽  
Antonio Riccio ◽  
Bruno Jandolo ◽  
Maurizio Fontana
Keyword(s):  
Radiation Therapy ◽  
Basal Ganglia ◽  
Brain Stem ◽  
Computerized Tomography ◽  
Surgical Decompression ◽  
Control Group ◽  
Content Type ◽  
Brain Stem Tumors ◽  
Fine Print

✓ The present investigation evaluates those few patients of our series with basal ganglia and brain-stem tumor who refused either surgical decompression and biopsy or radiation therapy. Four patients were suffering from tumors of the basal ganglia and three from brain-stem tumors; all the tumors were diagnosed by classical neuroradiological investigations and computerized tomography. The patients were given CCNU by mouth, 13 mg/sq m every 6 weeks. No toxicity was recorded. Mean survival was 19 weeks for patients with basal ganglia tumors and 48 weeks for those with brain-stem tumors. All patients were evaluated with respect to the quality of survival. Results were compared with those obtained in a control group of patients who received methylprednisolone therapy only.

Ventricular shunt removal: the ultimate treatment of the slit ventricle syndrome

1998 ◽  
Vol 88 (3) ◽  
pp. 478-484 ◽  
Author(s):  
Jonathan J. Baskin ◽  
Kim H. Manwaring ◽  
Harold L. Rekate
Keyword(s):  
Third Ventriculostomy ◽  
Slit Ventricle Syndrome ◽  
Content Type ◽  
Number Of Patients ◽  
Csf Diversion ◽  
Shunt Removal ◽  
Slit Ventricle ◽  
Fine Print

Object. The aim of this study was to assess the effectiveness of an algorithm used to evaluate and prescribe treatment for patients having slit ventricle syndrome (SVS). Methods. All patients included in this protocol underwent fiberoptic intracranial pressure monitoring after removal or externalization of their ventricular shunt systems. A significant number of patients did not need extracranial cerebrospinal fluid (CSF) diversion and tolerated removal of their shunt systems without requiring further intervention. Patients who demonstrated a need for CSF drainage underwent an endoscopic third ventriculostomy, regardless of the putative cause of their hydrocephalus. Sixteen (72.7%) of 22 patients experienced resolution of or significant improvement in their SVS complaints after their inclusion in the protocol. Concomitantly, 14 (64%) of 22 patients were no longer shunt dependent after a mean follow-up period of 21.4 months. Conclusions. A significant number of patients debilitated by SVS may experience improvement in their symptoms and undergo shunt removal according to this protocol, improving their quality of life and simplifying their medical follow up.

Long-term benefits in quality of life provided by bilateral subthalamic stimulation in patients with Parkinson disease

2005 ◽  
Vol 103 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Kelly E. Lyons ◽  
Rajesh Pahwa
Keyword(s):  
Quality Of Life ◽  
Parkinson Disease ◽  
Motor Function ◽  
Well Being ◽  
Strongly Correlated ◽  
Content Type ◽  
Fine Print

Object. The goals of this study were to evaluate long-term benefits in quality of life in patients with Parkinson disease (PD) after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and to evaluate the relationship between improvements in motor function and quality of life. Methods. Seventy-one patients who received bilateral STN stimulation implants and participated in follow-up review for at least 12 months were included in the study. Fifty-nine patients participated in a 12-month follow-up review and 43 patients in a follow-up review lasting at least 24 months. Patients' symptoms were assessed preoperatively by using the Unified PD Rating Scale (UPDRS) in the “medication-on” and “medication-off” conditions and quality of life was examined using the 39-item PD Questionnaire (PDQ-39). Patient evaluations were repeated postoperatively during periods of stimulation. The UPDRS activities of daily living (ADL) and motor scores as well as the PDQ-39 total, mobility, ADL, emotional well-being, stigma, and bodily discomfort scores were significantly improved at 12 months compared with baseline scores; the UPDRS ADL and motor scores as well as the PDQ-39 total, mobility, ADL, stigma, and bodily discomfort scores were significantly improved at the longest follow-up examination compared with baseline scores. There was a strong correlation between UPDRS motor and ADL scores and the PDQ-39 total, mobility, and ADL scores. Further analyses indicated that improvements in tremor were only correlated with PDQ-39 ADL subscale scores and rigidity was not correlated with any aspect of quality of life. Nevertheless, bradykinesia was strongly correlated with improvements in the PDQ-39 total, mobility, and ADL scores. Conclusions. Improvements in quality of life following bilateral DBS of the STN are maintained in the long term. These improvements are strongly correlated with improvements in motor function, primarily with regard to bradykinesia.

Ossification of autologous pericranium used in duraplasty

2001 ◽  
Vol 95 (2) ◽  
pp. 350-352 ◽  
Author(s):  
Devon A. Hoover ◽  
Asim Mahmood
Keyword(s):  
Computerized Tomography ◽  
Gunshot Wound ◽  
Osteogenic Potential ◽  
Review Of The Literature ◽  
Content Type ◽  
Dural Closure ◽  
The Many ◽  
Tomography Scanning ◽  
Fine Print

✓ Pericranium is frequently used in duraplasty and is considered superior to the many other alternatives because of its easy availability and because it offers a watertight dural closure while minimizing the problems of adhesion, infection, and rejection. Although the osteogenic potential of all periosteal tissues is recognized, a review of the literature did not reveal a reported case of osseous formation following use of pericranium for duraplasty. The authors report the case of a 17-year-old man who presented with a self-inflicted gunshot wound to the head. He was obtunded, but moving all extremities purposefully. Computerized tomography scanning demonstrated bifrontal injury. A bicoronal craniotomy with debridement was performed on an emergency basis, with vascularized pericranium used for a duraplasty. Follow-up cranioplasty demonstrated significant ossification of the pericranium 5 months after the original surgery. Pericranium is an attractive material for duraplasty; however, its osteogenic potential may interfere with future cranioplasty and cosmesis. This may be especially relevant in young persons.

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