Medulloblastoma: freedom from relapse longer than 8 years — a therapeutic cure?

1991 ◽  
Vol 75 (4) ◽  
pp. 575-582 ◽  
Author(s):  
Mark G. Belza ◽  
Sarah S. Donaldson ◽  
Gary K. Steinberg ◽  
Richard S. Cox ◽  
Philip H. Cogen
Keyword(s):  
Medical Center ◽  
Survival Rates ◽  
Adjunctive Treatment ◽  
High Dose ◽  
Content Type ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Fine Print

✓ Seventy-seven patients presenting with medulloblastoma between 1958 and 1986 were treated at Stanford University Medical Center and studied retrospectively. Multimodality therapy utilized surgical extirpation followed by megavoltage irradiation. In 15 cases chemotherapy was used as adjunctive treatment. The 10- and 15-year actuarial survival rates were both 41% with an 18-year maximum follow-up period (median 4.75 years). There were no treatment failures after 8 years of tumor-free survival. Gross total removal of tumor was achieved in 22 patients (32%); the surgical mortality rate was 3.9%. No significant difference was noted in the incidence of metastatic disease between shunted and nonshunted patients. The classical form of medulloblastoma was present in 67% of cases while the desmoplastic subtype was found in 16%. Survival rates were best for patients presenting after 1970, for those with desmoplastic tumors, and for patients receiving high-dose irradiation (≥ 5000 cGy) to the posterior fossa. Although early data on freedom from relapse suggested a possible beneficial effect from chemotherapy, long-term follow-up results showed no advantage from this modality of treatment. The patterns of relapse and survival were examined; 64% of relapses occurred within the central nervous system, and Collins' rule was applicable in 83% of cases beyond the period of risk. Although patients treated for recurrent disease could be palliated, none were long-term survivors. The study data indicate that freedom from relapse beyond 8 years from diagnosis can be considered as a cure in this disease. Long-term follow-up monitoring is essential to determine efficacy of treatment and to assess survival patterns accurately.

Age at symptom onset and long-term survival in patients with neurofibromatosis Type 2

2003 ◽  
Vol 99 (3) ◽  
pp. 480-483 ◽  
Author(s):  
Goro Otsuka ◽  
Kiyoshi Saito ◽  
Tetsuya Nagatani ◽  
Jun Yoshida
Keyword(s):  
Symptom Onset ◽  
Survival Rates ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Vestibular Schwannomas ◽  
Content Type ◽  
Fine Print

Object. Neurofibromatosis Type 2 (NF2) is an intractable disorder predisposing to multiple, recurrent tumors of the central nervous system (CNS). To clarify the survival rate and characteristics that predict poor survival, we retrospectively reviewed clinical data in cases of NF2. Methods. From among 283 patients with neurofibromatosis who had been registered in a nationwide study in Japan between 1986 and 1987, 74 patients with bilateral vestibular schwannomas were analyzed. The mean duration of follow up after diagnosis was 121 months (range 2–287 months). Results of a Kaplan—Meier product-limit analysis indicated that overall 5-, 10-, and 20-year patient survival rates following diagnosis of NF2 were 85, 67, and 38%, respectively. Early onset of the initial symptom significantly compromised survival; 5-, 10-, and 20-year survival rates in patients with symptom onset at an age younger than 25 years were 80, 60, and 28%, respectively, whereas in patients with symptom onset at an age of 25 years or older the rates were 100, 87, and 62%, respectively. Patients with small vestibular schwannomas at diagnosis (< 2 cm in diameter) had better rates of survival. Other variables such as sex, additional tumors in the CNS, or dermal abnormalities did not significantly affect survival. Conclusions. This first report of long-term follow-up results concerning the survival of patients with NF2 indicates an adverse effect of early symptom onset.

Endoscopic thoracic microdiscectomy

2005 ◽  
Vol 3 (6) ◽  
pp. 459-464 ◽  
Author(s):  
Rod J. Oskouian ◽  
J. Patrick Johnson
Keyword(s):  
Hospital Length ◽  
Outcome Data ◽  
Hospital Length Of Stay ◽  
Content Type ◽  
Neurological Outcomes ◽  
Long Term Follow Up ◽  
Thoracic Disc ◽  
Fine Print

Object. The purpose of this clinical study was to evaluate prospectively surgical and neurological outcomes after endoscopic thoracic disc surgery. Methods. The authors assessed the following quantifiable outcome data in 46 patients: operative time, blood loss, duration of chest tube insertion, narcotic use, hospital length of stay (LOS), and long-term follow-up neurological function and pain-related symptoms. In patients who presented with myelopathy there was a postoperative improvement of two Frankel grades. Pain related to radiculopathy was improved by 75% and in one patient it worsened postoperatively. The authors also present operative data, surgical outcomes, and complications. Conclusions. Thoracoscopic discectomy can be used to achieve acceptable results. It has several distinct advantages such as reduced postoperative pain, morbidity, and LOS compared with traditional open procedures.

Bilateral high-frequency stimulation of the subthalamic nucleus in patients with multiple system atrophy—parkinsonism

2003 ◽  
Vol 98 (4) ◽  
pp. 882-887 ◽  
Author(s):  
Veerle Visser-Vandewalle ◽  
Yasin Temel ◽  
Henry Colle ◽  
Chris van der Linden
Keyword(s):  
Multiple System Atrophy ◽  
High Frequency ◽  
High Frequency Stimulation ◽  
Point Scale ◽  
Content Type ◽  
Long Term Follow Up ◽  
Frequency Stimulation ◽  
Fine Print

✓ The aim of this study was to investigate the effect of high-frequency stimulation (HFS) of the subthalamic nucleus (STN) in patients with a subtype of multiple system atrophy (MSA) in which levodopa-unresponsive MSA parkinsonism (MSA-P) is predominant. After a local anesthetic was administered, electrodes were stereotactically implanted bilaterally into the STN in four patients with MSA-P and predominantly akinetorigid symptoms. Unified Parkinson's Disease Rating Scale (UPDRS) scores were evaluated preoperatively, at 1 month, and at long-term follow up. At 1 month the median decrease in the UPDRS III motor score was 22 on the 56-point scale (decreases of 16, 13, 29, and 15 points compared with baseline for Cases 1, 2, 3, and 4, respectively). This was mainly due to an improvement in rigidity and akinesia. The median decrease in the UPDRS II score was 11 on the 52-point scale (respective decreases of 5, 7, 13, and 9 points). At 2 years (mean follow up 27 months) there was a median decrease in the UPDRS III score of 12 (respective decreases of 18, 13, 21, and 9 points), and in the UPDRS II score of 5 (with respective decreases of 2, 2, 17, and 2), both compared with the stimulation off state. At long-term follow up there was an increase in the individual Schwab and England scores of 10 to 15% in the stimulation on compared with the stimulation off condition. There was a beneficial effect of STN HFS in these four patients on both a short-term and a long-term basis. A larger prospective study is justified.

The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago

2000 ◽  
Vol 93 (3) ◽  
pp. 388-396 ◽  
Author(s):  
Victor A. Aletich ◽  
Gerard M. Debrun ◽  
Mukesh Misra ◽  
Fady Charbel ◽  
James I. Ausman
Keyword(s):  
Cerebral Aneurysms ◽  
Detachable Coil ◽  
Content Type ◽  
Guglielmi Detachable Coil ◽  
Alternative Approach ◽  
Long Term Follow Up ◽  
The University ◽  
Fine Print

Object. Reports in the literature have offered discussions of the feasibility, efficacy, and safety of balloon-assisted Guglielmi detachable coil (GDC) placement in wide-necked intracranial aneurysms, which was first described by Jacques Moret as the “remodeling technique.” In this article the authors summarize their results in a subset of aneurysms treated with GDCs using the remodeling technique.Methods. This report contains a retrospective analysis of 72 patients with 75 aneurysms who underwent 79 endovascular procedures performed using the remodeling technique. Morphological outcome was determined at the end of each procedure and by reviewing available follow-up angiograms. Clinical assessments and outcomes are reported using a modified Glasgow Outcome Scale.Coils were placed in 66 (88%) of 75 aneurysms selected for treatment. In eight aneurysms (11%) treatment failures occurred due to the tortuosity of the vessel used to reach the aneurysms or because of balloon inadequacies.Incorporating all available follow-up data the authors found that 50 (78%) of 64 aneurysms were completely or subtotally (> 95%) occluded and eight (12%) of 64 were incompletely (< 95%) occluded. Since the time of coil placement, eight aneurysms have progressed to complete occlusion and another five have exhibited progressive thrombosis on follow-up angiograms. In three aneurysms there has been neck remnant growth. Surgical clipping was performed to treat six aneurysms after an initial coil placement procedure. Permanent incidences of morbidity were limited to four patients and there were three deaths directly related to the procedure.Conclusions. The remodeling technique shows promise in increasing the number of cerebral aneurysms amenable to treatment by endovascular coil placement, and offers an alternative approach to aneurysms that have met with failed surgical treatment or are surgically inaccessible. Long-term follow-up review is needed to determine the final outcome of aneurysms treated by this technique.

Decompression of the posterior trigeminal root in trigeminal neuralgia

1982 ◽  
Vol 57 (1) ◽  
pp. 14-17 ◽  
Author(s):  
Palle Taarnhøj
Keyword(s):  
Trigeminal Neuralgia ◽  
Content Type ◽  
Long Term Follow Up ◽  
Trigeminal Root ◽  
Suboccipital Approach ◽  
Fine Print

✓ The author presents a long-term follow-up report of his experience with decompression of the posterior trigeminal root in 350 cases. He has found that the suboccipital approach results in fewer recurrences of pain than the temporal approach.

Intracranial aneurysm in infancy

1977 ◽  
Vol 46 (6) ◽  
pp. 832-834 ◽  
Author(s):  
Robert J. Morelli ◽  
Frederick Laubscher
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Intracranial Aneurysm ◽  
Anterior Cerebral Artery ◽  
Content Type ◽  
Long Term Follow Up ◽  
Surgical Cure ◽  
Fine Print

✓ Angiography demonstrated an aneurysm of the left anterior cerebral artery in a 4-month-old baby who was admitted for subarachnoid hemorrhage. A surgical cure with long-term follow-up course was achieved. Clinical and pathogenetic aspects are presented. The rarity of such lesions in childhood and their successful surgical treatment are discussed briefly.

Long-term follow-up review of patients who underwent laminectomy for lumbar stenosis: a prospective study

1998 ◽  
Vol 89 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Manucher J. Javid ◽  
Eldad J. Hadar
Keyword(s):  
Success Rate ◽  
Herniated Disc ◽  
Lumbar Stenosis ◽  
Content Type ◽  
Lateral Recess ◽  
Lateral Recess Stenosis ◽  
Significant Difference ◽  
Fine Print

Object. Decompressive laminectomy for stenosis is the most common operation performed in the lumbar spine in older patients. This prospective study was designed to evaluate long-term results in patients with symptomatic lumbar stenosis. Methods. Between January 1984 and January 1995, 170 patients underwent surgery for lumbar stenosis (86 patients), lumbar stenosis and herniated disc (61 patients), or lateral recess stenosis (23 patients). The male/female ratio for each group was 43:43, 39:22, and 14:9, respectively. The average age for all groups was 61.4 years. For patients with lumbar stenosis, the success rate was 88.1% at 6 weeks and 86.7% at 6 months. For patients with lumbar stenosis and herniated disc, the success rate was 80% at 6 weeks and 77.6% at 6 months, with no statistically significant difference between the two groups. For patients with lateral recess stenosis, the success rate was 58.7% at 6 weeks and 63.6% at 6 months; however, the sample was not large enough to be statistically significant. One year after surgery a questionnaire was sent to all patients; 163 (95.9%) responded. The success rate in patients with stenosis had declined to 69.6%, which was significant (p = 0.012); the rate for patients with stenosis and herniated disc was 77.2%; and that for lateral recess stenosis was 65.2%. Another follow-up questionnaire was sent to patients 1 to 11 years after surgery (average 5.1 years); 146 patients (85.9%) responded, 10 (5.9%) were deceased, and 14 (8.2%) were lost to follow-up review. At 1 to 11 years the success rate was 70.8% for patients with stenosis, 66.6% for those with stenosis and herniated disc, and 63.6% for those with lateral recess stenosis. Eleven patients who underwent reoperation were included in the group of patients whose surgeries proved unsuccessful, regardless of their ultimate outcome. There was no statistically significant difference in outcome between 1 year and 1 to 11 years with respect to stenosis, stenosis with herniated disc, and lateral recess stenosis. Conclusions. In conclusion, long-term improvement after laminectomy was maintained in two-thirds of these patients.

Long-term follow-up review of patients with acute and subacute subdural hematomas

1978 ◽  
Vol 48 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Jarl Rosenørn ◽  
Flemming Gjerris
Keyword(s):  
Survival Rate ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Content Type ◽  
Subdural Hematomas ◽  
Long Term Follow Up ◽  
Fine Print ◽  
Back To Work

✓ The authors present 149 patients suffering from acute (112) and subacute (37) subdural hematomas admitted during the 10-year period 1965 to 1974, with a follow-up period of 2 to 12 years. During the time of observation, 104 patients died and 45 survived; 73% of the patients with acute and 27% with subacute subdural hematomas died. Of the patients with an acute subdural hematoma, 11% went back to work, as against 32% of those with subacute subdural hematomas. The 5-year survival rate was 28% in patients with acute and 76% in patients with subacute subdural hematomas.

Microsurgical anterior cervical foraminotomy (uncinatectomy) for cervical disc herniation

2001 ◽  
Vol 94 (1) ◽  
pp. 121-125 ◽  
Author(s):  
Al O. Taşçioǧlu ◽  
Ayhan Attar ◽  
Beliz Taşçioǧlu
Keyword(s):  
Long Term Results ◽  
Cervical Disc ◽  
Disc Space ◽  
Content Type ◽  
Long Term Follow Up ◽  
Disc Herniations ◽  
Cervical Foraminotomy ◽  
Fine Print

✓ The authors present the long-term follow-up results in three cases in which pure lateral disc herniations were surgically treated via an anterior foraminotomy (uncinatectomy) that avoided entering the disc space. The pertinent anatomical details essential for a safe approach are discussed in light of nine cadaveric neck dissections of every segment between C-1 and C-7. The surgical technique was initially studied in the cadaveric specimens and then applied in patients. The long-term results (> 2 years) in the first three patients are as good as our short-term results in another eight cases.

Visual function following optic canal decompression via craniotomy

1985 ◽  
Vol 62 (5) ◽  
pp. 631-638 ◽  
Author(s):  
David R. Guyer ◽  
Neil R. Miller ◽  
Donlin M. Long ◽  
George S. Allen
Keyword(s):  
Visual Function ◽  
Epidural Hematoma ◽  
Optic Canal ◽  
Safe Procedure ◽  
Content Type ◽  
Visual Improvement ◽  
Long Term Follow Up ◽  
Fine Print

✓ Visual function was assessed in 15 eyes of 11 patients who underwent unilateral (seven patients) or bilateral (four patients) optic canal decompression for presumed compressive optic neuropathies. Both immediate and long-term postoperative vision was evaluated in all eyes. Over 90% of the eyes that had undergone nerve decompression had either the same or improved visual acuity and visual field immediately following surgery. In this group of patients there were no deaths and there was only one postoperative complication, a transient dysphasia caused by an epidural hematoma that was evacuated. Long-term follow-up evaluations revealed that most of the eyes retained their immediate postoperative visual function or showed gradual visual improvement with time. The results of this series as well as a review of the available literature indicate that optic canal decompression via craniotomy can be a safe procedure and that it appears to have lasting visual benefit in many patients.

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