Management of extensive and difficult cranial defects

1988 ◽  
Vol 69 (2) ◽  
pp. 210-212 ◽  
Author(s):  
Bahman Guyuron ◽  
Melvin Shafron ◽  
Benedict Columbi
Keyword(s):  
Radiation Therapy ◽  
Bone Resorption ◽  
Bone Graft ◽  
Donor Site ◽  
Turn Of The Century ◽  
Content Type ◽  
Reconstruction Surgery ◽  
Fine Print

✓ The procedure of split-skull cranioplasty was first investigated at the turn of the century. The present authors first reported their technique of split-skull cranioplasty in 1983, and describe here their experience with this procedure in the management of extensive and difficult cranial defects. Twenty-nine patients (11 females and 18 males) are reviewed. Ten patients had histories of infection before reconstruction surgery. Eleven patients received radiation therapy at the grafted areas. The postoperative follow-up period ranged from 6 months to 4½ years. There was no evidence of bone resorption during that time, and minor complications occurred in only two of the patients. This procedure offered several advantages: 1) the bone graft, an autogenous material, can be used in previously infected areas; 2) the reconstruction contour is smooth and natural; 3) there was no morbidity or scarring at the donor site; 4) surgery time is much shorter than with split-rib cranioplasty. The primary disadvantage of split-skull cranioplasty is the decreased thickness of the skull at the donor site.

Successful management of an intracranial arteriovenous malformation by conventional irradiation

1985 ◽  
Vol 63 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Francesco Tognetti ◽  
Alvaro Andreoli ◽  
Anna Cuscini ◽  
Claudio Testa
Keyword(s):  
Radiation Therapy ◽  
Arteriovenous Malformation ◽  
Successful Management ◽  
Intracranial Arteriovenous Malformation ◽  
Content Type ◽  
Conventional Radiation ◽  
Complete Obliteration ◽  
Conventional Radiation Therapy ◽  
Fine Print

✓ The reduction of an intracranial arteriovenous malformation (AVM) by conventional radiation therapy is described in a patient who refused surgery. The 2-year follow-up angiogram documented nearly complete obliteration of the nidus of the AVM, accompanied by progressive narrowing of the arteries supplying the lesion. The scanty literature dealing with this form of treatment is summarized.

Vulnerability of the subcostal nerve to injury during bone graft harvesting from the iliac crest

2004 ◽  
Vol 1 (1) ◽  
pp. 87-89 ◽  
Author(s):  
Dean Chou ◽  
Phillip B. Storm ◽  
James N. Campbell
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Donor Site ◽  
Autologous Bone Graft ◽  
Content Type ◽  
Bone Harvesting ◽  
Cutaneous Branch ◽  
Bone Graft Harvesting ◽  
Autologous Bone ◽  
Fine Print

Object. Autologous bone graft harvesting from the iliac crest remains the gold standard for fusion surgery. One disadvantage of autologous bone harvesting is the patient's enduring postoperative pain at the donor site. Nerve injury is one of the postulated mechanisms that may account for this pain. The object of this study was to determine whether the lateral cutaneous branch of the subcostal nerve is vulnerable to injury in the process of obtaining grafts from the anterior iliac crest. Methods. Anatomical dissections were performed on 10 cadaveric specimens to ascertain the size of the T-12 subcostal nerve and its position in relation to the iliac crest. Conclusions. The lateral cutaneous branch of the subcostal nerve may lie as close as 6 cm from the anterior superior iliac spine. This nerve is very vulnerable to injury when harvesting bone from the anterior iliac crest. Knowledge of the anatomy may decrease the risk of injury to this nerve.

The long-term side effects of radiation therapy for benign brain tumors in adults

1990 ◽  
Vol 73 (4) ◽  
pp. 502-512 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Jane E. Kersh ◽  
Anupam Routh ◽  
Robert R. Smith
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Brain Tumors ◽  
Adult Patients ◽  
Intracranial Tumors ◽  
Content Type ◽  
Pituitary Dysfunction ◽  
Fine Print

✓ Radiation therapy plays an integral part in managing intracranial tumors. While the risk:benefit ratio is considered acceptable for treating malignant tumors, risks of long-term complications of radiotherapy need thorough assessment in adults treated for benign tumors. Many previously reported delayed complications of radiotherapy can be attributed to inappropriate treatment or to the sensitivity of a developing child's brain to radiation. Medical records, radiological studies, autopsy findings, and follow-up information were reviewed for 58 adult patients (31 men and 27 women) treated between 1958 and 1987 with radiotherapy for benign intracranial tumors. Patient ages at the time of irradiation ranged from 21 to 87 years (mean 47.7 years). The pathology included 46 pituitary adenomas, five meningiomas, four glomus jugulare tumors, two pineal area tumors, and one craniopharyngioma. Average radiation dosage was 4984 cGy (range 3100 to 7012 cGy), given in an average of 27.2 fractions (range 15 to 45 fractions), over a period averaging 46.6 days. The follow-up period ranged from 3 to 31 years (mean 8.1 years). Findings related to tumor recurrence or surgery were excluded. Twenty-two patients had complications considered to be delayed side effects of radiotherapy. Two patients had visual deterioration developing 3 and 6 years after treatment; six had pituitary dysfunction; and 17 had varying degrees of parenchymal changes of the brain, occurring mostly in the temporal lobes and relating to the frequent presentation of pituitary tumors (two of these also had pituitary dysfunction). One clival tumor, with the radiographic appearance of a meningioma, developed 30 years post-irradiation for acromegaly. This study unveils considerable delayed sequelae of radiotherapy in a series of adult patients receiving what is considered “safe” treatment for benign brain tumors.

Anterior cervical discectomy without interbody bone graft

1972 ◽  
Vol 37 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Michael G. Murphy ◽  
Mokhtar Gado
Keyword(s):  
Bone Graft ◽  
Clinical Result ◽  
Anterior Cervical Discectomy ◽  
Incomplete Fusion ◽  
Cervical Disc ◽  
Content Type ◽  
Cervical Discectomy ◽  
Good Clinical Result ◽  
Fine Print

✓ Twenty-six patients had anterior cervical discectomy without interbody bone graft for lateral cervical disc syndrome. Twenty-four (92%) had a good clinical result. Radiological follow-up was obtained in 20 cases. The incidence of fusion was 72% for discectomy at a single level. Patients undergoing discectomy at two adjacent levels were too few to permit a statement regarding the incidence of fusion. In those cases of incomplete fusion, dynamic films demonstrated stability at the operated site. Half of the cases who had posterior osteophytes preoperatively showed some degree of resorption after 12 months. Neither incomplete fusion nor failure of osteophyte resolution was incompatible with a good clinical result.

A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results

2000 ◽  
Vol 93 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Robert J. Hacker
Keyword(s):  
Interbody Fusion ◽  
Donor Site ◽  
Anterior Cervical Fusion ◽  
Cervical Disc ◽  
Control Group ◽  
Cervical Fusion ◽  
Content Type ◽  
Solid Fusion ◽  
Fine Print

Object. Despite variations in technique, inherent problems persist with current approaches to anterior cervical fusion. This study was performed to determine whether anterior cervical fusion performed using an investigational device was safe and effective in the treatment of degenerative cervical disc disorders and whether this device offered advantages over current techniques. Methods. Fifty-four patients with radiculopathy with or without mild myelopathy due to one- or two-level cervical degenerative disc disease were randomized as part of a Food and Drug Administration device study. Following microsurgical discectomy, the control group was treated with iliac crest graft fusion; the experimental study group underwent insertion of an interspace cage and placement of a local autograft. All patients received postoperative follow-up care for at least 2 years. Good or excellent results were found in approximately 97% of the experimental group and 88% of the control group. A solid fusion was achieved in all patients who underwent one-level cage placement, and a solid fusion at one or both levels was achieved in over 90% of both groups. Chronic donor site pain was reported by 31% of the control group. Conclusions. In this study, the use of an interbody fusion cage avoided donor site morbidity and placement of autograft achieved a high rate of good or excellent results. Interbody fusion cages appear safe and effective, and their use helps to avoid some of the inherent problems in performing current anterior cervical fusion techniques.

Induction chemotherapy followed by reduced-volume radiation therapy for newly diagnosed central nervous system germinoma

1998 ◽  
Vol 88 (1) ◽  
pp. 66-72 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroki Shirato ◽  
Jun Ikeda ◽  
Mitsuhiro Tada ◽  
Nobuaki Ishii ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Therapy ◽  
Risk Groups ◽  
Complete Response ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Local Radiation ◽  
Fine Print

Object. Although curative, radiation, which is conventionally administered for germinomas, causes significant neurological sequelae. This study aimed at reducing the volume and dose of radiation to a localized level of 24 Gy by pretreating the patient with chemotherapy. Methods. Seventeen patients were divided into two risk groups based on serological findings and the extent of tumor. They were treated with chemotherapy prior to receiving localized radiation therapy. Six patients with solitary pure germinomas were treated with three or four cycles of cisplatin and etoposide (EP regimen) followed by 24-Gy local radiation therapy. Eleven patients with human chorionic gonadotropin (HCG)—secreting, multifocal, or disseminated germinomas received four to five cycles of ifosfamide, cisplatin, and etoposide (ICE regimen) followed by 24-Gy local radiation therapy. Craniospinal ports were used only in three cases of germinomas with dissemination. Gross-total resection was performed in three patients. Fourteen patients were able to be evaluated for their responses to chemotherapy. All patients achieved a complete response within three cycles. At a median follow-up duration of 24 months, 16 patients (94%) were alive without recurrence. One patient with an HCG-secreting germinoma experienced recurrence 38 months after surgery. That patient underwent successful salvage therapy using the same protocol. Thus, all 17 patients became free of disease with a 70 to 100% Karnofsky Performance Scale status. Toxicities associated with this study's chemotherapy regimen were mostly transient. No patient showed neurological or endocrinological deterioration during the follow-up period. Conclusions. The EP and ICE regimens were highly effective in treating the central nervous system germinomas and permitted dose and volume reduction of the radiotherapy. Localized 24-Gy irradiation was sufficient for disease control.

Choroid plexus papillomas: long-term follow-up results in a surgically treated series

1988 ◽  
Vol 69 (6) ◽  
pp. 843-849 ◽  
Author(s):  
Stephen J. McGirr ◽  
Michael J. Ebersold ◽  
Bernd W. Scheithauer ◽  
Lynn M. Quast ◽  
Edward G. Shaw
Keyword(s):  
Radiation Therapy ◽  
Choroid Plexus ◽  
Surgical Excision ◽  
Perioperative Period ◽  
Content Type ◽  
Long Term Follow Up ◽  
Subtotal Removal ◽  
Choroid Plexus Papillomas ◽  
Fine Print

✓ The medical records and histological specimens from 26 patients with choroid plexus papillomas operated on at one institution were reviewed retrospectively. Four patients died perioperatively, and 21 of the remaining 22 patients were followed through March, 1986; the patient lost to follow-up review was last seen 14 years postoperatively. Of the 14 patients who underwent gross total removal of their tumor, one had a recurrence at 11 years postoperatively and two died in the perioperative period. Of the 12 patients who underwent subtotal removal of their tumor, two died in the perioperative period. The two patients who did not have radiation therapy postoperatively are free of apparent disease at 6 and 8 years after their operation. Eight patients underwent radiation therapy after subtotal removal of their tumor; four of these remain alive and well, and four have died of progressive disease. The role of irradiation in the treatment of subtotally resected lesion remains controversial, but this therapy is thought to be indicated for recurrent disease after a surgical excision that is as complete as possible. Histopathologically, the presence of occasional mitotic figures, microscopic infiltration, ependymal differentiation, or mild to moderate atypia was not correlated with likelihood of complete resectability or tendency to recurrence.

Cranial chordomas in children and young adults

1983 ◽  
Vol 59 (6) ◽  
pp. 1043-1047 ◽  
Author(s):  
Lester E. Wold ◽  
Edward R. Laws
Keyword(s):  
Young Adults ◽  
Radiation Therapy ◽  
Content Type ◽  
Rare Tumors ◽  
Follow Up Studies ◽  
Pathological Evaluation ◽  
Children And Young Adults ◽  
Fine Print

✓ A series of 12 surgically treated and pathologically proven cranial chordomas presenting in children and young adults is reviewed. These rare tumors occur in relation to the path of the primitive notochord; four were parasellar, six were mid-clival, and two were inferior clival in location. Pathological evaluation revealed five of the tumors to have a significant chondroid component. Follow-up studies ranging from 1 month to 21 years revealed that eight patients were alive, all of whom had received radiation therapy following surgery.

Management of intracranial plasmacytoma

1995 ◽  
Vol 83 (2) ◽  
pp. 218-221 ◽  
Author(s):  
Ajay K. Bindal ◽  
Rajesh K. Bindal ◽  
Harry van Loveren ◽  
Raymond Sawaya
Keyword(s):  
Multiple Myeloma ◽  
Radiation Therapy ◽  
Skull Base ◽  
Surgical Resection ◽  
Postoperative Period ◽  
Definitive Treatment ◽  
Content Type ◽  
Complete Surgical Resection ◽  
Fine Print

✓ The authors report on a study of eight cases of intracranial plasmacytoma to identify the risk of progression to multiple myeloma and suggest the treatment required for cure of solitary lesions. The diagnosis of multiple myeloma or myelomatous changes was made in the immediate postoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with complete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2–25 years); one patient underwent subtotal surgical resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during the long term in patients with intracranial plasmacytoma who do not develop multiple myeloma or myelomatous changes in the early postoperative period. However, lesions that infiltrate the skull base are not likely to be solitary, and patients who harbor these neoplasms should undergo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possible with subtotal surgical resection despite radiation therapy. Definitive treatment should consist of complete surgical resection with adjuvant radiation therapy.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

Sign in / Sign up

Export Citation Format

Share Document