Meningiomas of the posterior petrous bone: functional outcome after microsurgery

2004 ◽  
Vol 100 (6) ◽  
pp. 1014-1024 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Mr Imaging ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Bone ◽  
Surgical Anatomy ◽  
Impaired Hearing ◽  
Imaging Data ◽  
Content Type ◽  
Hearing Function ◽  
Fine Print

Object. The aim of this study was to analyze a subgroup of patients harboring cerebellopontine angle meningiomas originating from the posterior petrous bone in regard to clinical presentation, surgical anatomy, complications, and long-term functional postoperative results. Methods. Data in a series of 51 patients with meningiomas of the posterior petrous bone who had undergone microsurgical treatment at the authors' institution between 1989 and 2002 were retrospectively reviewed. The patient population consisted of 46 women and five men with a mean age of 53 years (range 22–70 years). The main symptom on first admission was impaired hearing in 41%, dizziness in 20%, and tinnitus in 18% of the patients. Results of physical examination and audiological testing revealed hypacusis in 65% of patients, cerebellar ataxia in 31%, and impairment of the fifth cranial nerve in 26%. All patients underwent surgical treatment via a lateral suboccipital approach. Intraoperatively, the tumor was found to be attached to the postmeatal dura in 37%, the premeatal dura in 27.5%, the suprameatal dura in 19.6%, the inframeatal dura in 7.8%, and centered on the porus acusticus in 5.9% of cases. Tumor extension into the internal acoustic meatus was present in seven patients. Tumor resection was categorized as Grade I in 14 patients, Grade II in 29, Grade III in six, and Grade IV in two patients, according to the Simpson classification system. The site of displacement of the cranial nerves was predictable in up to 84% of patients, depending on the dural origin of the tumor as depicted on preoperative magnetic resonance (MR) imaging studies. Postoperatively, a new and permanent facial paresis was observed in five patients (9.8%). In 38 patients in whom both pre- and postoperative audiological data were available, hearing function deteriorated after surgery in 18.4% and improved in 7.9%. Clinical and MR imaging postsurgical data from a mean period of 5.8 years (range 13 months–13 years) were available in all patients. Forty-four patients (86%) resumed normal daily activity. Tumor recurrence was observed in two patients (3.9%), and both underwent a second surgery. Conclusions. Preoperative detailed analysis of MR imaging data gives the surgeon a clue about the dislocation of critical neurovascular structures, particularly the cranial nerves. Nonetheless, the exact relationship of the cranial nerves to the tumor (dislocation, adherence, infiltration, and splaying of nerves) can only be fully appreciated during surgery.

Investigations using magnetic resonance imaging: is neurovascular compression present in patients with essential hypertension?

2002 ◽  
Vol 96 (6) ◽  
pp. 1006-1012 ◽  
Author(s):  
Sylvia A. Säglitz ◽  
Michael R. Gaab
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Renal Hypertension ◽  
Cranial Nerves ◽  
Imaging Method ◽  
Neurovascular Compression ◽  
Content Type ◽  
Fine Print

Object. A possible relationship between neurovascular compression of the rostral ventrolateral medulla oblongata (RVLM) and essential hypertension is investigated using a specifically designed magnetic resonance (MR) imaging method. In conjunction with the ninth and 10th cranial nerves, baroreceptor afferents enter the RVLM, which represents a crucial relay for regulation of autonomic blood pressure. In 1985 Jannetta and coworkers proposed a causal relationship between essential hypertension and intraoperatively observed neurovascular compression of the left RVLM. Methods. Currently, MR imaging is the method of choice for the assessment of neurovascular relationships at the brainstem. By obtaining axial images of a thin-slice turbo inversion-recovery sequence and three-dimensional time-of-flight MR angiograms (fast imaging with steady-state precision), the authors documented the occurrence of neurovascular contacts with the RVLM at the level of the root entry zones (REZs) of the ninth and 10th cranial nerves in 25 patients with essential hypertension, 30 normotensive volunteers, and 10 patients with renal hypertension. Neurovascular contacts with the REZ at the left RVLM were found in 32% of patients with essential hypertension, 37% of normotensive volunteers, and 20% of patients with renal hypertension. In total, neurovascular contacts on either side of the RVLM were documented in 68% of patients with essential hypertension, 53% of normotensive volunteers, and 50% of patients with renal hypertension. Conclusions. The results do not support the theory of neurovascular compression in cases of essential hypertension. Findings of neurovascular contacts on MR images are not indications for decompression surgery. For further clarification, however, prospective MR imaging studies should be considered in young patients with essential hypertension in whom the history of high blood pressure is short.

Intraoperative magnetic resonance imaging during transsphenoidal surgery

2001 ◽  
Vol 95 (3) ◽  
pp. 381-390 ◽  
Author(s):  
Rudolf Fahlbusch ◽  
Oliver Ganslandt ◽  
Michael Buchfelder ◽  
Werner Schott ◽  
Christopher Nimsky
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Early Stage ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Tumor Removal ◽  
Content Type ◽  
Early Evaluation ◽  
Flexible Coil ◽  
Fine Print

Object. The aim of this study was to evaluate whether intraoperative magnetic resonance (MR) imaging can increase the efficacy of transsphenoidal microsurgery, primarily in non—hormone-secreting intra- and suprasellar pituitary macroadenomas. Methods. Intraoperative imaging was performed using a 0.2-tesla MR imager, which was located in a specially designed operating room. The patient was placed supine on the sliding table of the MR imager, with the head placed near the 5-gauss line. A standard flexible coil was placed around the patient's forehead. Microsurgery was performed using MR-compatible instruments. Image acquisition was started after the sliding table had been moved into the center of the magnet. Coronal and sagittal T1-weighted images each required over 8 minutes to acquire, and T2-weighted images were obtained optionally. To assess the reliability of intraoperative evaluation of tumor resection, the intraoperative findings were compared with those on conventional postoperative 1.5-tesla MR images, which were obtained 2 to 3 months after surgery. Among 44 patients with large intra- and suprasellar pituitary adenomas that were mainly hormonally inactive, intraoperative MR imaging allowed an ultra-early evaluation of tumor resection in 73% of cases; such an evaluation is normally only possible 2 to 3 months after surgery. A second intraoperative examination of 24 patients for suspected tumor remnants led to additional resection in 15 patients (34%). Conclusions. Intraoperative MR imaging undoubtedly offers the option of a second look within the same surgical procedure, if incomplete tumor resection is suspected. Thus, the rate of procedures during which complete tumor removal is achieved can be improved. Furthermore, additional treatments for those patients in whom tumor removal was incomplete can be planned at an early stage, namely just after surgery.

Fluorescence-guided resection of glioblastoma multiforme utilizing 5-ALA-induced porphyrins: a prospective study in 52 consecutive patients

2000 ◽  
Vol 93 (6) ◽  
pp. 1003-1013 ◽  
Author(s):  
Walter Stummer ◽  
Alexander Novotny ◽  
Herbert Stepp ◽  
Claudia Goetz ◽  
Karl Bise ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Mr Imaging ◽  
Aminolevulinic Acid ◽  
Univariate Analysis ◽  
Tumor Resection ◽  
Mr Images ◽  
Content Type ◽  
Tissue Fluorescence ◽  
Solid Fluorescence ◽  
Fine Print

Object. It has been established that 5-aminolevulinic acid (5-ALA) induces the accumulation of fluorescent porphyrins in glioblastoma multiforme (GBM), a phenomenon potentially exploitable to guide tumor resection. In this study the authors analyze the influence of fluorescence-guided resection on postoperative magnetic resonance (MR) imaging and survival in a series of patients who underwent surgery in the authors' department.Methods. Fifty-two consecutive patients with GBM received oral doses of 5-ALA (20 mg/kg body weight) 3 hours before induction of anesthesia. Intraoperatively, tumor fluorescence was visualized using a modified operating microscope. Fluorescing tissue was removed whenever it was considered safely possible. Residual enhancement on early postoperative MR imaging was quantified and related to each patient's characteristics to determine which factors influenced resection. Survival was analyzed using the Kaplan—Meier method and multivariate analysis was performed in which the Karnofsky Performance Scale (KPS) score, residual fluorescence, patient age, and residual enhancement on MR images were considered.Intraoperatively, two fluorescence qualities were perceived: solid fluorescence generally reflected coalescent tumor, whereas vague fluorescence mostly corresponded to infiltrative tumor. Complete resection of contrast-enhancing tumor was accomplished in 33 patients (63%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 18 of the 19 remaining patients. Age, residual solid fluorescence, and absence of contrast enhancement in MR imaging were independent explanatory factors for survival, whereas the KPS score was significant only in univariate analysis. No perioperative deaths and one case of permanent morbidity were encountered.Conclusions. The observations in this study indicate the usefulness of 5-ALA—induced tumor fluorescence for guiding tumor resection. The completeness of resection, as determined intraoperatively from residual tissue fluorescence, was related to postoperative MR imaging findings and to survival in patients suffering from GBM.

Neuroradiographic changes following convection-enhanced delivery of the recombinant cytotoxin interleukin 13—PE38QQR for recurrent malignant glioma

2005 ◽  
Vol 102 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Ian F. Parney ◽  
Sandeep Kunwar ◽  
Michael McDermott ◽  
Mitchel Berger ◽  
Michael Prados ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Malignant Glioma ◽  
Tumor Resection ◽  
Therapeutic Agents ◽  
Grading System ◽  
Recurrent Malignant Glioma ◽  
Mr Images ◽  
Convection Enhanced Delivery ◽  
Content Type ◽  
Fine Print

Object. Convection-enhanced delivery (CED) is a novel method for delivering therapeutic agents to infiltrative brain tumor cells. For agents administered by CED, changes on magnetic resonance (MR) imaging directly resulting from catheter placement, infusion, and the therapeutic compound may confound any interpretation of tumor progression. As part of an ongoing multiinstitutional Phase I study, 14 patients with recurrent malignant glioma underwent CED of interleukin (IL) 13—PE38QQR, a recombinant cytotoxin consisting of human IL-13 conjugated with a truncated Pseudomonas exotoxin. Serial neuroradiographic changes were assessed in this cohort of patients. Methods. Patients were treated in two groups: Group 1 patients received IL13—PE38QQR before and after tumor resection; Group 2 patients received infusion only after tumor resection. Preoperative and postinfusion MR images were obtained prospectively at specified regular intervals. Changes were noted along catheter tracks on postresection MR images obtained in all patients. A simple grading system was developed to describe these changes. When MR imaging changes appeared to be related to IL13—PE38QQR, patients were followed up without instituting new antitumor therapy. Conclusions. As CED of therapeutic agents becomes more common, clinicians and investigators must become aware of associated neuroimaging changes that should be incorporated into toxicity assessment. We have developed a simple grading system to facilitate communication about these changes among investigators. Biological imaging modalities that could possibly distinguish these changes from recurrent tumor should be evaluated. In this study the authors demonstrate the challenges in determining efficacy when surrogate end points such as time to tumor progression as defined by new or progressive contrast enhancement on MR imaging are used with this treatment modality.

Surgical treatment of superior sulcus tumors with spinal and brachial plexus involvement

2002 ◽  
Vol 97 (3) ◽  
pp. 301-309 ◽  
Author(s):  
Mark H. Bilsky ◽  
Todd W. Vitaz ◽  
Patrick J. Boland ◽  
Manjit S. Bains ◽  
Viswanathan Rajaraman ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Brachial Plexus ◽  
Tumor Resection ◽  
Incomplete Resection ◽  
Content Type ◽  
Superior Sulcus Tumors ◽  
Epidural Compression ◽  
Superior Sulcus ◽  
Complete Tumor ◽  
Fine Print

Object. Non—small cell lung carcinomas with spinal and brachial plexus involvement have traditionally been considered to be Stage IIIb lesions and therefore unresectable. Advances in spinal surgery, the application of magnetic resonance (MR) imaging, and improvements in neoadjuvant therapy require a reassessment of the potential for complete resection. Methods. The authors conducted a retrospective review of all procedures involving the resection of superior sulcus tumors with spinal or brachial plexus involvement performed between 1985 and 1999. Assessment or resectability and operative planning were based on an MR imaging classification scheme in which the extent of spinal involvement was considered. Class A tumors involved the periosteum of the vertebral body (VB) (16 patients); Class B, distal neural foramen without epidural compression (eight patients); Class C, proximal neural foramen with epidural compression (four patients); and Class D, bone involvement (VB or posterior elements) with or without epidural involvement (14 patients). Brachial plexus involvement was present in 21 patients, including 17 with T-1 nerve root only and four with C-8 or lower-trunk infiltration. Complete tumor resection was achieved in 27 patients and incomplete resection in 15. Complications occurred in 14 patients, two of which were related to instrumentation failures. The overall median survival was 1.44 years. The median survival for the complete and incomplete resection groups were 2.84 and 0.79 years, respectively (p = 0.0001). There was no statistical difference in survival among classification groups. Conclusions. Complete tumor resection of superior sulcus tumors is possible in selected patients in whom involvement of the spinal column and/or brachial plexus is present. Preoperative MR imaging is essential for evaluation of the spine and surgical planning. Survival and cure are dependent on complete resection, regardless of the extent of spinal involvement.

Temporal bone neoplasms: a report on 20 surgically treated cases

1992 ◽  
Vol 76 (4) ◽  
pp. 578-587 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Shlomo Pomeranz ◽  
Ivo P. Janecka ◽  
Barry Hirsch ◽  
Sai Ramasastry
Keyword(s):  
Cranial Nerves ◽  
Bone Neoplasms ◽  
Petrous Bone ◽  
Benign Tumors ◽  
Tumor Spread ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Fast Growing ◽  
Tumor Pathology ◽  
Fine Print

✓ The surgical resection of neoplasms involving the petrous bone and surrounding areas in 20 patients is reported. Technical advances described include the total resection of several tumors previously considered inoperable due to involvement of dura and brain, petrous internal carotid artery (ICA), the vein of Labbé, and adjacent areas such as the clivus and the cavernous sinus. Areas of reconstruction after resection included the ICA, the seventh and 11th cranial nerves, and the cranial base, often requiring the use of vascularized flaps. There were no intraoperative deaths. Many patients experienced significant temporary morbidity related primarily to wound healing and to lower cranial nerve palsy; however, all but three patients (all with fast-growing malignancies) returned to their preoperative functional status. During a median follow-up period of 30 months (range 17 to 63 months), the 10 patients with benign tumors and slow-growing malignancies fared well, seven being alive and disease-free. The 10 patients with fast-growing malignancies fared poorly, only two being alive without disease. This outcome appeared to be related to tumor pathology and extent of invasion; both survivors harbored tumors confined to the petrous bone. An anatomical classification system of tumor spread is introduced, which should be considered concomitantly with tumor pathology.

A brainstem stereotactic atlas in a three-dimensional magnetic resonance imaging navigation system: first experiences with atlas-to-patient registration

1999 ◽  
Vol 90 (5) ◽  
pp. 891-901 ◽  
Author(s):  
Klaus Niemann ◽  
Roland van den Boom ◽  
Katja Haeselbarth ◽  
Farhad Afshar
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Three Dimensional ◽  
Imaging Data ◽  
Mr Images ◽  
Content Type ◽  
Patient Registration ◽  
Scale Factors ◽  
Stereotactic Atlas ◽  
Fine Print

Object. The authors describe a computer-resident digital representation of a stereotactic atlas of the human brainstem, its semiautomated registration to sagittal fast low—angle shot three-dimensional (3-D) magnetic resonance (MR) imaging data sets in 27 healthy volunteers and 24 neurosurgical patients, and an analysis of the subsequent transforms needed to refine the initial registration.Methods. Contour drawings from the atlas, which offer the 70th percentile of variation of anatomical structures, were interpolated into an isotropic 3-D representation. Initial atlas-to-patient registration was based on the fastigium/ventricular floor plane reference system. The quality of the fit was evaluated using superimposition of the atlas and MR images. If necessary, the atlas was tailored to the individual anatomy by using additional transforms. On average, the atlas had to be stretched by 2 to 6% in the three directions of space. Scale factors varied over a broad range from −8 to +19% and the benefit of visual interactive control of the atlas-to-patient registration was evident. Analysis of distances within the pons measured in the midsagittal MR imaging slices and the required scale factors revealed significant correlations that may be used to reduce the amount of user interaction in the coregistration substantially. In 70.6% of the cases, the atlas had to be shifted in a cranial direction along the brainstem axis (in 25.5% of cases 3–4 mm, in 45.1% of cases 1–2 mm). This was due to a more caudal position of the fastigium cerebelli on the MR images compared with the atlas.Conclusions. This observation, in conjunction with the variability of the height of the fourth ventricle in our MR imaging data (range 6.1–15.2 mm, mean 10.1 mm, standard deviation 1.8 mm) calls into question the role of the fastigium cerebelli as an anatomical landmark for localization within the brainstem.

Operative management of tumors involving the cavernous sinus

1986 ◽  
Vol 64 (6) ◽  
pp. 879-889 ◽  
Author(s):  
Laligam N. Sekhar ◽  
Aage R. Møller
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Preoperative Evaluation ◽  
Operative Procedure ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Petrous Apex ◽  
Content Type ◽  
The Third ◽  
Fine Print

✓ In the past, neurosurgeons have been reluctant to operate on tumors involving the cavernous sinus because of the possibility of bleeding from the venous plexus or injury to the internal carotid artery (ICA) or the third, fourth, or sixth cranial nerves. The authors describe techniques for a more aggressive surgical approach to neoplasms in this area that are either benign or locally confined malignant lesions. During the last 2 years, seven tumors involving the cavernous sinus have been resected: six totally and one subtotally. The preoperative evaluation included axial and coronal computerized tomography, cerebral angiography, and a balloon-occlusion test of the ICA. Intraoperative monitoring of the third, fourth, sixth, and seventh cranial nerves was used to assist in locating the nerves and in avoiding injury to them. The first major step in the operative procedure was to obtain proximal control of the ICA at the petrous apex and distal control in the supraclinoid segment. The cavernous sinus was then opened by a lateral, superior, or inferior approach for tumor resection. Temporary clipping and suture of the ICA was necessary in one patient. None of the patients died or suffered a stroke postoperatively. Permanent trigeminal nerve injury occurred in three patients; in two, this was the result of tumor invasion. One patient suffered temporary paralysis of the third, fourth, and sixth cranial nerves, and in another the sixth cranial nerve was temporarily paralyzed. Preoperative cranial nerve deficits were improved postoperatively in three patients. Radiation therapy was administered postoperatively to four patients. These seven patients have been followed for 6 to 18 months to date and none has shown evidence of recurrence of the intracavernous tumor.

Rapid identification of the primary motor area by using magnetic resonance axonography

2002 ◽  
Vol 97 (3) ◽  
pp. 558-567 ◽  
Author(s):  
Kyousuke Kamada ◽  
Kiyohiro Houkin ◽  
Yoshinobu Iwasaki ◽  
Fumiya Takeuchi ◽  
Shinya Kuriki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Three Dimensional ◽  
Motor Area ◽  
Imaging Data ◽  
Primary Motor Area ◽  
Content Type ◽  
Normal Volunteers ◽  
Somatosensory Evoked Fields ◽  
Fine Print

Object. To identify the primary motor area (PMA) quickly and correctly, the authors used magnetic resonance (MR) axonography, including anisotropic diffusion-weighted (DW) MR imaging and three-dimensional anisotropic contrast (3DAC) imaging, which was performed to visualize the corticospinal tract mainly originating from the PMA. Methods. All studies were obtained in 10 normal volunteers and in 17 patients with brain tumors affecting the central motor system. Data sets of anisotropic DW imaging and anatomical and functional (f)MR imaging were acquired while the participants executed simple hand movements. Offline processing of 3DAC MR axonography images was subsequently done to extract only the anisotropic components of the tract fibers. Somatosensory evoked fields (SSEFs) and intraoperative cortical somatosensory evoked potentials (SSEPs) were recorded after electrical stimulation of the median nerve. Conclusions. In normal volunteers, anisotropic DW imaging, 3DAC imaging, fMR imaging, and magnetoencephalography consistently localized the PMA in both hemispheres. In contrast, fMR imaging and SSEFs failed to identify the PMA in seven and one of the 17 patients, respectively, because of cortical dysfunctions due to brain tumor. The anisotropic DW imaging data acquired within 30 seconds with no patient tasks successfully identified the PMA in 12 patients, and failed in five patients because of the lesions involving the frontal lobe. The anisotropic axonal components were distinctly visualized on 3DAC images and indicated the PMA location, which was confirmed on intraoperative SSEPs in all 17 affected hemispheres. Swift and noninvasive PMA identification by rapid scanning with MR axonography is a promising method for routine clinical use and is especially beneficial for patients who have severe cortical dysfunction in the PMA.

Surgical resection of intrinsic insular tumors: complication avoidance

2001 ◽  
Vol 95 (4) ◽  
pp. 638-650 ◽  
Author(s):  
Frederick F. Lang ◽  
Nancy E. Olansen ◽  
Franco DeMonte ◽  
Ziya L. Gokaslan ◽  
Eric C. Holland ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Neurological Complications ◽  
Surgical Anatomy ◽  
Motor Dysfunction ◽  
Temporal Lobectomy ◽  
Content Type ◽  
Frontal Operculum ◽  
Fine Print

Object. Surgical resection of tumors located in the insular region is challenging for neurosurgeons, and few have published their surgical results. The authors report their experience with intrinsic tumors of the insula, with an emphasis on an objective determination of the extent of resection and neurological complications and on an analysis of the anatomical characteristics that can lead to suboptimal outcomes. Methods. Twenty-two patients who underwent surgical resection of intrinsic insular tumors were retrospectively identified. Eight tumors (36%) were purely insular, eight (36%) extended into the temporal pole, and six (27%) extended into the frontal operculum. A transsylvian surgical approach, combined with a frontal opercular resection or temporal lobectomy when necessary, was used in all cases. Five of 13 patients with tumors located in the dominant hemisphere underwent craniotomies while awake. The extent of tumor resection was determined using volumetric analyses. In 10 patients, more than 90% of the tumor was resected; in six patients, 75 to 90% was resected; and in six patients, less than 75% was resected. No patient died within 30 days after surgery. During the immediate postoperative period, the neurological conditions of 14 patients (64%) either improved or were unchanged, and in eight patients (36%) they worsened. Deficits included either motor or speech dysfunction. At the 3-month follow-up examination, only two patients (9%) displayed permanent deficits. Speech and motor dysfunction appeared to result most often from excessive opercular retraction and manipulation of the middle cerebral artery (MCA), interruption of the lateral lenticulostriate arteries (LLAs), interruption of the long perforating vessels of the second segment of the MCA (M2), or violation of the corona radiata at the superior aspect of the tumor. Specific methods used to avoid complications included widely splitting the sylvian fissure and identifying the bases of the periinsular sulci to define the superior and inferior resection planes, identifying early the most lateral LLA to define the medial resection plane, dissecting the MCA before tumor resection, removing the tumor subpially with preservation of all large perforating arteries arising from posterior M2 branches, and performing craniotomy with brain stimulation while the patient was awake. Conclusions. A good understanding of the surgical anatomy and an awareness of potential pitfalls can help reduce neurological complications and maximize surgical resection of insular tumors.

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