Use of intraoperative sodium tetradecyl sulfate for the treatment of a spinal epidural hemangioma

2007 ◽  
Vol 7 (2) ◽  
pp. 264-269 ◽  
Author(s):  
Mirza N. Baig ◽  
Syed Saquib ◽  
Greg Christoforidis ◽  
Louis P. Caragine
Keyword(s):  
Mr Imaging ◽  
Gross Total Resection ◽  
Treatment Modalities ◽  
Sodium Tetradecyl Sulfate ◽  
Imaging Findings ◽  
Total Resection ◽  
Intraoperative Angiography ◽  
Posterior Aspect ◽  
Imaging Characteristics ◽  
Spinal Epidural

✓Spinal hemangiomas can be categorized into three different groups based on location. Vertebral body (VB) heman-giomas are frequent incidental findings on magnetic resonance (MR) imaging. There is a subdivision of these with spinal epidural extension that have been reported in the literature. Spinal hemangiomas can also be epidural without VB involvement; these are extremely rare with few reported cases in the thoracic epidural spinal column. The diagnosis and imaging characteristics as well as the surgical tools used in gross-total resection of spinal epidural hemangioma are not well understood. The authors present a detailed characterization of a spinal epidural hemangioma in a 30-year-old woman who presented with complaints of gradual onset of low-back pain that worsened over 1 year. The MR imaging findings indicated a large L2–S1 epidural spinal mass causing thecal sac compression. The patient underwent an L2–S1 laminectomy, and a vascular extradural mass was noted on the posterior aspect of the dura mater. Preoperative spinal angiography as well as intraoperative angiography was performed. Total resection of the tumor was achieved using intraoperative embolization with sodium tetradecyl sulfate and microscopic dissection. The postoperative MR imaging findings and clinical outcome were excellent. The findings and use of sodium tetradecyl sulfate in gross-total resection are discussed. The authors also review treatment modalities and demonstrate the utility and effectiveness of intraoperative sodium tetradecyl sulfate in gross-total resection of large difficult spinal epidural hemangiomas.

Central Neurocytoma Treatment Modalities: A Systematic Review Assessing the Outcomes of Combined Maximal Safe Resection and Radiotherapy with Gross Total Resection

2020 ◽  
Vol 137 ◽  
pp. e176-e182 ◽  
Author(s):  
Anil K. Mahavadi ◽  
Priyen M. Patel ◽  
Manish Kuchakulla ◽  
Ashish H. Shah ◽  
Dan Eichberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Central Neurocytoma ◽  
Gross Total Resection ◽  
Treatment Modalities ◽  
Total Resection

scholarly journals Adult Primary Spinal Epidural Extraosseous Ewing’s Sarcoma: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Mark Bustoros ◽  
Cheddhi Thomas ◽  
Joshua Frenster ◽  
Aram S. Modrek ◽  
N. Sumru Bayin ◽  
...  
Keyword(s):  
Epidural Space ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Gross Total Resection ◽  
Review Of The Literature ◽  
Total Resection ◽  
Improved Outcomes ◽  
Rare Malignancy ◽  
Extraosseous Ewing’S Sarcoma ◽  
Spinal Epidural

Background. Extraosseous Ewing’s sarcoma in the spinal epidural space is a rare malignancy, especially in adults.Case Presentation. A 40-year-old male presented with back pain and urinary hesitancy. MRI revealed a thoracic extradural mass with no osseous involvement. He underwent surgery for gross total resection of the mass, which was diagnosed as Ewing’s sarcoma. He was subsequently treated with chemoradiotherapy. He remains disease-free 1 year after surgery. Review of the literature indicated only 45 previously reported cases of spinal epidural extraosseous Ewing’s sarcoma in adults.Conclusions. Extraosseous Ewing’s sarcoma in the spinal epidural space is a rare clinical entity that should be included in the differential for spinal epidural masses. Its treatment is multidisciplinary but frequently requires surgical intervention due to compressive neurologic symptoms. Gross total resection appears to correlate with improved outcomes.

scholarly journals Early outcomes of endoscopic transsphenoidal surgery for adult craniopharyngiomas

2010 ◽  
Vol 28 (4) ◽  
pp. E9 ◽  
Author(s):  
John A. Jane ◽  
Erin Kiehna ◽  
Spencer C. Payne ◽  
Stephen V. Early ◽  
Edward R. Laws
Keyword(s):  
Mr Imaging ◽  
Transsphenoidal Surgery ◽  
Tumor Resection ◽  
Imaging Study ◽  
High Rate ◽  
Transsphenoidal Approach ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Total Resection ◽  
Endoscopic Transsphenoidal Surgery

Object Although the transsphenoidal approach for subdiaphragmatic craniopharyngiomas has been performed for many years, there are few reports describing the role of the endoscopic transsphenoidal technique for suprasellar craniopharyngiomas. The purpose of this study was to report the outcomes of the endoscopic transsphenoidal approach for adults with craniopharyngiomas in whom the goal was gross-total resection. Methods Twelve patients were identified who were older than 18 years at the time of their pure endoscopic transsphenoidal surgery. Their medical records and imaging studies were retrospectively reviewed. Results Gross-total resection was achieved in 42% of cases when assessed by intraoperative impression alone and in 75% when assessed by the first postoperative MR imaging study. However, 83% of patients achieved at least a 95% resection when assessed by both intraoperative impression and the first postoperative MR imaging study. Permanent diabetes insipidus occurred postoperatively in 44% of patients. Six (67%) of 9 patients who had a functioning hypothalamic-pituitary axis preoperatively developed panhypopituitarism after surgery. Visual improvement or normalization occurred in 78% of patients with preoperative visual deficits. Although no patient experienced a postoperative CSF leak, 1 patient was treated for meningitis. Conclusions The authors have achieved a high rate of radical resection and symptomatic improvement with the endoscopic transsphenoidal technique for both subdiaphragmatic (sellar/suprasellar) and supradiaphragmatic (suprasellar) craniopharyngiomas. However, this is also associated with a high incidence of new endocrinopathy. Endoscopic assessment of tumor resection may be more sensitive for residual tumor than the first postoperative MR imaging study.

Interpretation of magnetic resonance images in diffuse intrinsic pontine glioma: a survey of pediatric neurosurgeons

2011 ◽  
Vol 8 (1) ◽  
pp. 97-102 ◽  
Author(s):  
Todd C. Hankinson ◽  
Elizabeth J. Campagna ◽  
Nicholas K. Foreman ◽  
Michael H. Handler
Keyword(s):  
Mr Imaging ◽  
Online Survey ◽  
Multicenter Trial ◽  
Diffuse Intrinsic Pontine Glioma ◽  
Magnetic Resonance Images ◽  
Imaging Findings ◽  
Mr Images ◽  
Pontine Glioma ◽  
Tumor Biopsy ◽  
Imaging Characteristics

Object The current management paradigm for children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) is to establish a diagnosis and begin therapy based on MR imaging findings correlated with an appropriate clinical presentation, and without a tissue diagnosis. This strategy assumes that pediatric neurosurgeons and neurooncologists uniformly interpret MR imaging findings in this population. This study sought to examine the consistency of North American pediatric neurosurgeons in assessing MR images in this patient population, and in their surgical plans based on the interpretation of those images. Methods The authors created an online survey and invited all members of the American Society of Pediatric Neurosurgeons and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section for Pediatric Neurosurgery to participate. The survey consisted of 58 questions, and 48 pertained to representative MR images from 16 children who presented to The Children's Hospital of Colorado with diffuse pontine tumors. Based on the imaging presented and a standard clinical scenario, the respondent was asked if she or he believed a lesion to be “typical” or “atypical,” whether she or he would biopsy the lesion, and what surgical approach would be chosen. The remaining 10 questions pertained to respondent demographics and his or her practice regarding tissue preservation and interest in participating in a multicenter trial that included tumor biopsy in selected cases. Rates at which each lesion was considered to be typical or atypical and rates of recommended biopsy were calculated. Results Surveys were received by 269 individuals. Eighty-six responses were received (32.0%). No tumor was judged to be either typical or atypical by all respondents. Individual surgeons varied widely regarding how many of the tumors were judged as typical or warranted a biopsy. The percentage of respondents who disagreed with the majority opinion regarding whether a tumor qualified as typical ranged from 2.3% to 48.8%, with a median of 28.6%. More than 75% agreement regarding whether a tumor was typical or atypical was found in 7 (43.8%) of 16 cases. The κ statistic regarding typicality was 0.297 ± 0.0004 (mean ± SEM), implying only fair agreement. For every tumor, at least 1 respondent who believed the lesion to be typical in appearance would nevertheless biopsy the lesion. Of those respondents who considered a lesion to be typical, a median of 5.1% (range 1.2%–66.7%) would choose to biopsy this lesion. Of those respondents who considered a lesion atypical, a median of 18.3% (range 3.7%–100%) would choose not to biopsy the lesion. Of 85 responses to the question, “Would you be willing to biopsy a typical diffuse pontine glioma as a part of a multicenter trial?,” 59 (69.4%) of 85 respondents answered that they would. Conclusions Although making a diagnosis based on radiographic evidence alone represents a well-established management paradigm for children with suspected DIPG, this study demonstrates considerable inconsistency on the part of pediatric neurosurgeons in the application of this strategy to individual patients. As such, the practice of diagnosing DIPG based on imaging characteristics and clinical history alone does not reach the appropriate threshold to be considered a standard of care.

Role of diffusion tensor imaging in resection of thalamic juvenile pilocytic astrocytoma

2009 ◽  
Vol 4 (6) ◽  
pp. 495-505 ◽  
Author(s):  
Yaron A. Moshel ◽  
Robert E. Elliott ◽  
David J. Monoky ◽  
Jeffrey H. Wisoff
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Mr Imaging ◽  
Surgical Approach ◽  
Pilocytic Astrocytoma ◽  
Diffusion Tensor ◽  
Gross Total Resection ◽  
Total Resection ◽  
Juvenile Pilocytic Astrocytoma ◽  
White Matter Tractography

Object The choice of surgical approach during resection of a thalamic juvenile pilocytic astrocytoma (JPA) is dictated by the location of the displaced normal thalamus and posterior limb of the internal capsule (PLIC). Diffusion tensor (DT) imaging and white matter tractography can identify the location of the PLIC in relation to the tumor and may be useful in planning the operative trajectory. Methods Diffusion tensor imaging was used to localize the PLIC on preoperative MR imaging in 6 children undergoing resection of thalamic JPAs. After review of the standard T2-weighted MR imaging sequences, the anticipated position of the PLIC was determined. This result was compared with the location of the PLIC determined by a blinded radiologist with the use of DT imaging. The utility of DT imaging in determining the surgical approach to a thalamic JPA, degree of resection, and neurological outcomes were all evaluated. Results Diffusion tensor imaging confirmed the expected location of the PLIC as approximated on conventional T2-weighted images in all 6 cases. In 1 patient in particular, unexpected medial deviation of the PLIC was identified, and this proved useful in tailoring the approach to a more lateral trajectory. Gross-total resection of all cystic and solid tumor components was confirmed on postoperative imaging in all cases. All patients experienced mild to moderate worsening of neurological status immediately following resection, but 4 of 6 patients were back to their preoperative baseline at 6-month follow-up. Conclusions Diffusion tensor imaging and white matter tractography successfully identified the white matter fibers emanating from the precentral gyrus within the PLIC in children with thalamic JPAs prior to surgery. Diffusion tensor imaging served as a valuable tool for stereotactic planning of operative approaches to thalamic JPAs. Localizing the position of the PLIC helped minimize potential neurological morbidity and facilitated gross-total resection.

scholarly journals Imaging Features of Intracranial Meningiomas with Histopathological Correlation: A Relook into Old Disease

2013 ◽  
Vol 3 (1) ◽  
pp. 14-32
Author(s):  
K Gangadhar ◽  
D Santhosh ◽  
GM Fatterpekar
Keyword(s):  
Mr Imaging ◽  
Signs And Symptoms ◽  
Intracranial Meningioma ◽  
Imaging Features ◽  
Imaging Findings ◽  
Histopathological Correlation ◽  
Imaging Characteristics ◽  
Dural Tail ◽  
Atypical Meningiomas ◽  
Weighted Sequences

Background and Purpose: Imaging characteristics of meningiomas have been discussed previously in many studies; however complete imaging features involving general features, MRS and DWI of both typical and atypical meningiomas have been discussed in very few studies. CT and MR imaging findings in 46 cases of intracranial meningioma are reviewed to define specific imaging features. Methods: The present study was carried on 46 patients in the Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University during June 2009 to July 2011.The investigation was carried out by GE-VCT 64 Slice Scanner machine and Magnetic resonance imaging was contemplated using 1.5 Tesla SIEMENS-MAGNETOM AVANTO. CT and MR imaging studies were reviewed to characterize mass location, imaging characteristics, atypical features and advanced imaging features. Clinical presenting signs and symptoms were correlated with imaging findings. Results: a). Forty six cases of intra cranial meningiomas were studied prospectively in 24 women and 22men, aged 11 – 80 years. Meningiomas were stratified into typical and atypical and also depending upon intra cranial location. b). 73.91% of the cases in showed supratentorial location, rest were infratentorial (26.08%).CT/MRI revealed well defined margins in 84.78% with homogenous consistency in 73.91% of lesions. Foci of necrosis were noted in 32.60% of cases and 15.22% of cases showed calcification foci in meningioma. Sinus invasion noticed in 15.22% of cases, whereas adjacent bony reaction noticed in 30.43% of cases. c). Majority of Meningioma showed broad dural base (89.10%), adjacent white matter buckling (71.74%) and surrounding CSF cleft (52.17%). Displaced subarachnoid vessels were demonstrated in 30.43%, where as the pathognomonic dural tail was present in only 23.91% of the cases. d). All the cases of Meningioma demonstrated restriction on diffusion weighted sequences suggestive of high cellularity of the lesions. On CT angiography, neovascularity was noticed in 85.71% and tumor blush was noticed in 71.42% incidence. On MR Spectroscopy, all demonstrated choline peak and in one third cases alanine peak was discernible. Conclusion: In view of the observed evidence, it was concluded that understanding the classification, pathology and imaging appearance meningioma are essential for treatment planning. CT and MR imaging play indispensable role in the localization & characterization of these tumors, and MR have virtually yielded its position of dominance in characterizing these tumors. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 14-32 DOI: http://dx.doi.org/10.3126/njr.v3i1.8713

scholarly journals SURG-37. SYSTEMATIC REVIEW OF GAMMA-KNIFE RADIOSURGERY AND MICROSURGICAL RESECTION FOR BRAINSTEM CAVERNOUS MALFORMATIONS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii211-ii211
Author(s):  
Aditya Kondajji ◽  
Thien Nguyen ◽  
John Sheppard ◽  
Daniel Kulinich ◽  
Ansley Unterberger ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Therapeutic Benefit ◽  
Gross Total Resection ◽  
Treatment Modalities ◽  
Bleeding Events ◽  
Total Resection ◽  
Cavernous Malformations ◽  
Microsurgical Resection ◽  
Meta Analyses

Abstract BACKGROUND Although microsurgical resection (MR) remains the gold-standard for the treatment of symptomatic cavernous malformations, some authors have proposed the use of radiosurgical Gamma-Knife Surgery (GKS) for lesions that are deep or eloquent, such as those located in the brainstem. OBJECTIVE Here were analyze the literature regarding patient outcomes following MR or GKS for brain stem cavernous malformations. METHODS This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic literature review. A database search of PubMed, Scopus, Embase, and Web of Science was conducted in September 2019. This review included studies evaluating the outcomes of MR or GKS for cavernous malformations located in the brainstem. RESULTS Gross total resection was achieved in the majority of patients and effectively eliminated the risk of recurrent hemorrhage from the operative lesion in studies following the outcomes of MR. GKS reduces the annual hemorrhage rate for patients, although it does not eliminate the cavernous malformation. Both treatment modalities were effective in reducing prior symptomatology. Unlike resection, GKS only reduces the risk of future hemorrhage and does prevent it. CONCLUSIONS Both MR and GKS can improve or stabilize symptoms in patients. However, the therapeutic benefit of GKS may take months to years to take full-effect, resulting in a potential for subsequent hemorrhagic events. MR remains the best treatment option due to its ability to eliminate future bleeding events entirely and should be performed whenever gross total resection is possible.

scholarly journals The importance of surgery as part of multimodal therapy in rapid progressive primary extraosseous Ewing sarcoma of the cervical intra- and epidural space

2016 ◽  
Vol 6 (4) ◽  
Author(s):  
Richard Bostelmann ◽  
Mario Leimert ◽  
Hans Jakob Steiger ◽  
Kirstin Gierga ◽  
Athanasios K. Petridis
Keyword(s):  
Ewing Sarcoma ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Treatment Modalities ◽  
Cervical Region ◽  
Rapid Progression ◽  
Total Resection ◽  
Initial Surgery ◽  
Uncommon Case

Primary extraosseous Ewing sarcomas (EESs) are an extremely rare pathological entity. Less than 32 cases have been reported in the literature. Here we report an uncommon case with very rapid progression in the cervical region with extra- and intradural involvement. We present a thorough review of the literature and discuss possible treatment modalities. The Medline database was searched using the search terms: <em>Ewing sarcoma</em>, <em>extraosseus tumour</em>, <em>treatment</em>, <em>management</em>, <em>cervical spine</em>. A previously healthy 29-year-old man complained of right-sided radiculopathy (C7). Magnetic resonance imaging showed an enhancing foraminal, sandglass shaped neurinoma- like lesion. Surgery revealed an intraand extra-dural lesion, which was histologically diagnosed as Ewing sarcoma. Despite gross total resection, there was a massive symptomatic tumor recurrence within 6 weeks. A second gross total resection was realized. The patient was treated according to the EURO E.W.I.N.G.-Protocol (VIDE) and recovered very well (progression-free interval during therapy). Several decompressive re-surgeries were realized with adjuvant radio-chemotherapy. At the last follow-up (17 months after initial surgery) the patient was in remission with a good quality of live. This case is to illustrate that despite extensive therapeutic efforts, the progression- free survival in case of primary EES may be very short. To maintain neurological function and good quality of live as long as possible, a multimodal strategy seems to be adequate. Like in the present case this implies several surgeries and adjuvant chemo-and radiotherapy. Whether this improves overall survival remains unclear.

scholarly journals 18F-FET-PET-guided gross total resection improves overall survival in patients with WHO grade III/IV glioma: moving towards a multimodal imaging-guided resection

2021 ◽  
Author(s):  
Jonas Ort ◽  
Hussam Aldin Hamou ◽  
Julius M. Kernbach ◽  
Karlijn Hakvoort ◽  
Christian Blume ◽  
...  
Keyword(s):  
Multimodal Imaging ◽  
Tumor Volume ◽  
Oncological Outcome ◽  
Gross Total Resection ◽  
Treatment Modalities ◽  
Total Resection ◽  
Who Grade ◽  
Fet Pet ◽  
Who Grade Iii ◽  
Grade Iii

Abstract Purpose PET using radiolabeled amino acid [18F]-fluoro-ethyl-L-tyrosine (FET-PET) is a well-established imaging modality for glioma diagnostics. The biological tumor volume (BTV) as depicted by FET-PET often differs in volume and location from tumor volume of contrast enhancement (CE) in MRI. Our aim was to investigate whether a gross total resection of BTVs defined as < 1 cm3 of residual BTV (PET GTR) correlates with better oncological outcome. Methods We retrospectively analyzed imaging and survival data from patients with primary and recurrent WHO grade III or IV gliomas who underwent FET-PET before surgical resection. Tumor overlap between FET-PET and CE was evaluated. Completeness of FET-PET resection (PET GTR) was calculated after superimposition and semi-automated segmentation of pre-operative FET-PET and postoperative MRI imaging. Survival analysis was performed using the Kaplan–Meier method and the log-rank test. Results From 30 included patients, PET GTR was achieved in 20 patients. Patients with PET GTR showed improved median OS with 19.3 compared to 13.7 months for patients with residual FET uptake (p = 0.007; HR 0.3; 95% CI 0.12–0.76). This finding remained as independent prognostic factor after performing multivariate analysis (HR 0.19, 95% CI 0.06–0.62, p = 0.006). Other survival influencing factors such as age, IDH-mutation, MGMT promotor status, and adjuvant treatment modalities were equally distributed between both groups. Conclusion Our results suggest that PET GTR improves the OS in patients with WHO grade III or IV gliomas. A multimodal imaging approach including FET-PET for surgical planning in newly diagnosed and recurrent tumors may improve the oncological outcome in glioma patients.

Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes

2011 ◽  
Vol 14 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Jonathan M. Morris ◽  
Andrea Saladino ◽  
Jay N. Mandrekar ◽  
Giuseppe Lanzino
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Clinical Outcomes ◽  
Imaging Findings ◽  
Urinary Function ◽  
Arteriovenous Fistulas ◽  
Imaging Characteristics ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

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