Surgery for intracranial meningiomas in the elderly: a clinical—radiological grading system as a predictor of outcome

2005 ◽  
Vol 102 (2) ◽  
pp. 290-294 ◽  
Author(s):  
Manuela Caroli ◽  
Marco Locatelli ◽  
Francesco Prada ◽  
Federica Beretta ◽  
Filippo Martinelli-Boneschi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Grading System ◽  
Content Type ◽  
Female Sex ◽  
Intracranial Meningiomas ◽  
Radiological Grading ◽  
Fine Print

Object. A grading system, called the Clinical—Radiological Grading System (CRGS), has been developed to standardize surgical indications in elderly patients harboring intracranial meningiomas. Patients with a score lower than 10 had a bad prognosis regardless of surgical treatment, those with a score between 10 and 12 had a prognosis positively influenced by surgery, and those with a score higher than 12 had a good prognosis regardless of surgical treatment. The authors performed a prospective cross-sectional study to validate further the use of the CRGS as a clinical tool to orientate surgical decision making in elderly patients and to explore prognostic factors of survival. Methods. From 1990 to 2000 the authors consecutively recruited and surgically treated 90 patients 70 years of age or older with neuroimaging findings of intracranial meningiomas and a preoperative evaluation based on the CRGS. The surgical mortality rate, which covers deaths within 3 months after surgical intervention, was 7.8%, and the 1-year mortality rate was 15.6%. Female sex and a higher CRGS score were associated with a higher probability of survival. Among the different subset items of the CRGS score, no peritumoral edema for surgical survival and no concomitant diseases for 1-year survival provide the strongest predictive contribution, even if not at a statistically significant level. Conclusions. The CRGS score is a useful and practical tool for the selection of elderly patients affected by intracranial meningiomas as surgical candidates. A CRGS score higher than 10 and female sex are good prognostic factors of survival, whereas age is not a contraindication to surgery.

Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors

1995 ◽  
Vol 83 (5) ◽  
pp. 812-819 ◽  
Author(s):  
Christopher L. Taylor ◽  
Zhong Yuan ◽  
Warren R. Selman ◽  
Robert A. Ratcheson ◽  
Alfred A. Rimm
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Cerebral Aneurysm ◽  
Primary Diagnosis ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Aneurysm Formation ◽  
Unruptured Cerebral Aneurysm ◽  
Significant Protective Effect ◽  
Fine Print

✓ Cerebral arterial aneurysms are common in the general population and their rupture is a catastrophic event. Considerable uncertainty remains concerning the conditions that predispose individuals to aneurysm formation or rupture. The role of systemic hypertension in aneurysm formation and rupture has been especially controversial. Demographic variables have rarely been addressed because of the small sample sizes in previous studies. The authors describe the demographics and prevalence of hypertension in 20,767 Medicare patients with an unruptured aneurysm and compare these to a random sample of the hospitalized Medicare population. The prevalence of hypertension in patients with unruptured aneurysms was 43.2% compared with 34.4% in the random sample. Patients who survived their initial hospitalization were separated into two groups: those with an unruptured cerebral aneurysm as the primary diagnosis and those with an unruptured cerebral aneurysm as a secondary diagnosis. Follow-up data for 18,119 patients were examined to determine the risk of subarachnoid hemorrhage (SAH) associated with age, gender, race, hypertension, insulin-dependent diabetes mellitus, and surgical treatment. For patients with an unruptured cerebral aneurysm as the primary diagnosis, hypertension was found to be a significant risk factor for future SAH (risk ratio: 1.46, 95% confidence interval (CI): 1.01–2.11), whereas surgical treatment (risk ratio: 0.29, 95% CI: 0.09–0.97) had a significant protective effect. Advancing age had a small but significant protective effect in both groups. Elderly patients identified with unruptured aneurysms are more likely to have coexisting hypertension than the general hospitalized population. In elderly patients hospitalized with an unruptured cerebral aneurysm as their primary diagnosis, hypertension is a risk factor for subsequent SAH, whereas surgical treatment is a protective factor against SAH.

Surgical treatment of nerve root compression caused by scoliosis of the lumbar spine

1974 ◽  
Vol 41 (4) ◽  
pp. 449-454 ◽  
Author(s):  
Joseph A. Epstein ◽  
Bernard S. Epstein ◽  
Leroy S. Lavine
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Elderly Patients ◽  
Recovery Of Function ◽  
Radicular Pain ◽  
Surgical Decompression ◽  
Nerve Root Compression ◽  
Pathological Anatomy ◽  
Content Type ◽  
Fine Print

✓ Effective relief of radicular pain and recovery of function is reported in four elderly patients with lumbar scoliosis following surgical decompression of the lateral recesses of the spinal canal. The operation includes laminectomy or hemilaminectomy with unroofing of the lateral recesses and foramina by medial facetectomy or facetectomy. The patients tolerated surgery without morbidity, were walking within 2 or 3 days, and recovered without incident. The pathological anatomy and operative criteria are discussed.

Cerebral angiomas: the sequelae of surgical treatment

1972 ◽  
Vol 37 (5) ◽  
pp. 571-575 ◽  
Author(s):  
A. Loren Amacher ◽  
John M. Allcock ◽  
Charles G. Drake
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Mortality Rate ◽  
Content Type ◽  
Postoperative Death ◽  
Operative Results ◽  
Intractable Seizures ◽  
Indications For Operation ◽  
Fine Print

✓ Fifty patients underwent 55 operations upon intracerebral angiomas; 86% had suffered intracerebral or subarachnoid hemorrhage, 8% intractable seizures, and 6% intractable headache and progressive ischemic symptoms. There was one postoperative death, a mortality rate of 2%. The operative results are considered in relation to the indications for operation and the degree of removal. The importance of postoperative angiography is stressed.

A decade of pituitary microsurgery

1984 ◽  
Vol 61 (5) ◽  
pp. 814-833 ◽  
Author(s):  
Charles B. Wilson
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Pituitary Tumors ◽  
Postoperative Results ◽  
Content Type ◽  
Microsurgical Technique ◽  
Fine Print

✓ The author reviews his experience with surgical treatment of 1000 pituitary tumors, the majority of which were endocrine-active. The criteria of grading, the microsurgical technique used, and the postoperative results are presented. The mortality rate was 0.2% overall, with no deaths in the group of 774 patients with endocrine-active adenomas.

Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience

2005 ◽  
Vol 2 (5) ◽  
pp. 564-573 ◽  
Author(s):  
Richard B. North ◽  
Vito R. LaRocca ◽  
Jacob Schwartz ◽  
Catherine A. North ◽  
Marianna Zahurak ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Surgical Treatment ◽  
Spinal Metastases ◽  
Tumor Type ◽  
Content Type ◽  
Persistent Disease ◽  
Operative Site ◽  
Primary Radiotherapy ◽  
Fine Print

Object. Refinement of surgical techniques, especially anterior approaches, for the management of spinal metastases has improved patient outcomes, despite the fact that a complete analysis of the prognostic factors that would inform patient selection has not been undertaken. The authors sought to identify such prognostic factors for neurological outcome and life expectancy in patients with spinal metastases. Methods. The authors used Kaplan—Meier techniques, log-rank comparisons, and a multivariate model stratified by tumor type to identify prognostic factors for duration of ability to walk and survival in patients who underwent surgical treatment for spinal metastases during a decade when all current treatment options were available. Preoperatively, 53 (87%) of the 61 patients in the study population suffered neurological symptoms (for example, weakness) and 52 (85%) were ambulatory. Postoperatively, 59 (97%) were ambulatory. Most patients who survived 6 months (81%) remained ambulatory, as did 66% of those alive at 1.6 years. The median postoperative survival was 10 months. The risk factors for loss of ambulation were preoperative loss of ambulatory ability, recurrent or persistent disease after primary radiotherapy of the operative site, a procedure other than corpectomy, and tumor type other than breast cancer. Prognostic factors for reduced survival were surgical intervention extending over two or more spinal segments, recurrent or persistent disease after primary radiotherapy involving the operative site, diagnosis other than breast cancer, and a cervical spinal procedure. Conclusions. The results of this analysis allowed the authors to create a simple prognostic factor scoring system that can be applied to individual patients. The positive experience derived from this study supports an expanded role for the surgical treatment of metastatic spinal disease.

Ruptured giant intracranial aneurysms. Part II. A retrospective analysis of timing and outcome of surgical treatment

1998 ◽  
Vol 88 (3) ◽  
pp. 430-435 ◽  
Author(s):  
David G. Piepgras ◽  
Vini G. Khurana ◽  
Jack P. Whisnant
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Mayo Clinic ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Content Type ◽  
Medical Centers ◽  
Giant Intracranial Aneurysms ◽  
Fine Print

Object. This retrospective study was made to determine the relationship between surgical timing and outcome in all patients with ruptured giant intracranial aneurysms undergoing surgical treatment at the Mayo Clinic between 1973 and 1996. Methods. The authors studied 109 patients, 102 of whom were referred from other medical centers. The ruptured giant aneurysms were 25 to 60 mm in diameter. One hundred five of the patients survived the rupturing of the aneurysm to undergo operation, with direct surgery possible in 84% of cases. Excluding delayed referrals, the average time to surgery after admission to the Mayo Clinic was approximately 4 to 5 days. Patients admitted earlier tended to be in poorer condition, often undergoing earlier operation. On average, surgical treatment was administered later for patients with ruptured aneurysms of the posterior circulation than for those with aneurysms in the anterior circulation. Temporary occlusion of the parent vessel was necessary in 67% of direct procedures, with an average occlusion time of 15 minutes. Among surgically treated patients, a favorable outcome was achieved in 72% harboring ruptured anterior circulation aneurysms and in 78% with ruptured posterior circulation lesions. Conclusions. The overall management mortality rate was 21.1%, and the mortality rate for surgical management was 8.6%. The authors believe that because of the technical difficulties and risk of rebleeding associated with ruptured giant intracranial aneurysms, timely referral to and well-planned treatment at medical centers specializing in management of these lesions are essential to effect a more favorable outcome.

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

A proposed grading system for arteriovenous malformations

1986 ◽  
Vol 65 (4) ◽  
pp. 476-483 ◽  
Author(s):  
Robert F. Spetzler ◽  
Neil A. Martin
Keyword(s):  
Venous Drainage ◽  
Neurological Complications ◽  
Management Decision ◽  
Grading System ◽  
Content Type ◽  
Treatment Techniques ◽  
Clinical Series ◽  
Management Decision Making ◽  
Eloquent Cortex ◽  
Fine Print

✓ An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.

Surgical treatment of cerebral metastases from lung cancer

1971 ◽  
Vol 35 (4) ◽  
pp. 416-420 ◽  
Author(s):  
Edwin E. MacGee
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
Operative Mortality ◽  
Cerebral Metastases ◽  
Cerebral Metastasis ◽  
Metastatic Lung Cancer ◽  
Content Type ◽  
Intracranial Surgery ◽  
Metastatic Lung ◽  
Fine Print

✓ Results in 27 cases of intracranial surgery for metastatic lung cancer are evaluated with regard to both the quality and duration of survival; 56% of the patients lived more than 1 year, with the longest survivor still living 32 months after operation. The operative mortality was 26%. These data suggest that intracranial surgery is worthwhile in patients with lung cancer when the cerebral metastasis is either solitary or single.

Surgical experiences with giant intracranial aneurysms

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Visual Loss ◽  
Considerable Improvement ◽  
Brain Circulation ◽  
Content Type ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.

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