Search

Microcystic meningioma is a rare tumor with myxoid and microcystic features. Our objective was to evaluate the efficacy of surgical resection of microcystic meningioma. Between December 1985 and October 2000 we treated 25 microcystic meningioma patients with surgical resection. We retrospectively analyzed the results including the long-term follow-up of this patient population. We identified 15 women and 10 men with a mean age of 53.8 years (24–76 years) who had microcystic meningiomas treated with surgery. Based on the Simpson grade, we found four Grade I (16%), 16 Grade II (64%), three Grade III (12%) and two Grade IV (8%) resections. The mean preoperative Karnofsky Performance Scale (KPS) score was 80.3 (range 60–100). The mean postoperative KPS score was 90.4 (range 60–100). At a mean follow-up of 101.7 months (range 16–221) the KPS score improved to a mean of 93.8. The recurrence/progression free survival (RFS/PFS) rates at 3 and 5 years were 96% and 88%, respectively. The 3 and 5 year RFS/PFS rates based on the Simpson grade were evaluated. The 3 year RFS/PFS rates for Grade I, II, III and IV were 100%, 100%, 66.6% and 100%, respectively. The 5 year RFS/PFS rates were 66.6%, 90%, 66.6% and 100%, respectively. Microcystic meningioma is a rare tumor, which is characterized by extracellular microcystic spaces filled by edematous fluid and peritumoral edema. Following surgical resection these tumors have a positive prognosis with a benign course. The surgical outcomes seem to be associated with the risks related to the surgical procedure. [ABSTRACT FROM AUTHOR]

Abstract: Resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach represents a surgical challenge. It carries a risk of postoperative complications, due to the role of surrounding structures in control of eloquent functions. We reviewed the immediate morbidity and mortality associated with this approach. Between June 1993 and July 2007, 38 patients underwent resection of tumors of the third ventricle via the anterior interhemispheric transcallosal approach at The University of Texas M. D. Anderson Cancer Center. Their 30-day postoperative morbidity and mortality rates were retrospectively analyzed relative to clinical variables possibly affecting these rates. Complications were categorized as neurological, regional, and systemic and were subclassified as major or minor. The overall complication rate was 50%. Major complications occurred in 37% of patients; 34% suffered neurological complications (16% being major complications). Surgical mortality was 8%. Univariate analysis demonstrated that tumor hemorrhage (p =0.04), preoperative Karnofsky Performance Scale (KPS) score (p =0.04), tumor status (recurrent versus [vs.] new or residual; p =0.01), and cauterization of any of the bridging veins (p =0.04) were associated with the incidence of postoperative complications. Multivariate analysis showed that increased age at surgery (p =0.04), tumor status (p =0.03), preoperative KPS score (p =0.02), and the extent of tumor resection (p =0.05) correlated significantly with the incidence of postoperative complications. Resection of tumors of the third ventricle via the interhemispheric transcallosal approach is associated with significant postoperative morbidity. Preserving the venous structures is of paramount importance in minimizing major neurological complications. Our results have practical risk-predictive value and can serve as the foundation for subsequent outcome studies. [Copyright &y& Elsevier]

Multiple treatment options are available for patients with hypothalamic hamartoma (HH) including the frontotemporal approaches, the anterior transcallosal transseptal interforniceal approach, the transventricular endoscopic approach, and stereotactic radiosurgery. Relatively large patient series of the transcallosal resection/disconnection from Royal Children’s Hospital in Melbourne and the Barrow Neurological Institute in Phoenix, AZ, show, respectively, that 52% to 54% are 100% seizure free, and 24% to 35% have >90% seizure reduction. However, there appears to be an 8% to 14% risk of persisting memory problems. The surgery should ideally be performed in the early years of childhood before secondary generalized epilepsy develops and developmental delay and behavioral problems are established. Radiosurgery may be a preferable option for higher-functioning adolescent or adult patients with HH. The choice of treatment must be individualized depending on the age and clinical circumstances of the patient and the size and anatomic relationships of the hamartoma. The transcallosal resection of HH is an effective and safe treatment, but there is a small risk of short-term memory impairment. The endoscopic approach is an alternative to the transcallosal approach for smaller HH. [Copyright &y& Elsevier]

Abstract: Background: Although the bedside twist drill craniostomy is used to treat chronic subdural hematomas, the efficacy of this technique has not been compared with that of standard treatments (operative bur hole or craniotomy). Methods: Twist drill craniostomy was compared with operative bur hole or craniotomy in a prospective nonrandomized trial. The inclusion criteria were computed tomographic evidence of chronic subdural hematoma (isodense or hypodense compared with brain) and symptoms indicating the need for drainage. Selection of the procedure depended on the on-call surgeon''s preference. Clinical success of the procedure, recurrence, length of hospitalization, complications, and neurologic outcome were compared. Results: Between August 2001 and October 2002, 79 consecutive patients with 91 chronic subdural hematomas were treated (67 unilateral and 12 bilateral) at our institution. Fifty-five patients were treated with twist drill craniostomy and 24 with bur hole or craniotomy. There were no differences in the mean age of presentation, thickness of hematoma, length of hospitalization, reoperation rate, mortality rates, or ability to be discharged to home between the 2 groups. There was no difference in the neurologic outcomes in the 57 of the 79 patients available for follow-up. Conclusions: Twist drill craniostomy performed at the bedside is just as effective in treating chronic subdural hematomas as bur holes or craniotomy in the operating room. This procedure can most often be the first line of treatment in patients with symptomatic chronic subdural hematomas. [Copyright &y& Elsevier]

This article discusses the use of radiosurgery in the treatment of tumors of the jugular foramen, including glomus tumors; schwannomas involving cranial nerves (CNs) IX, X, and XI; and meningiomas. The appropriate role of radiosurgery, stereotactic radiotherapy, or both in the management of these tumors is controversial. Radiosurgery may be used as a primary treatment modality or as an adjunct after subtotal or partial extirpation of a tumor. Although long-term follow-up for as long as 7 years does not conclusively demonstrate the efficacy of radiosurgery in controlling tumors, results have been comparable to those achieved with conventional radiotherapy. Furthermore, radiosurgical outcomes compared favorably with CN morbidity and mortality of surgical series and with radiation-induced morbidity in radiotherapy series. Finally, the limitations and disadvantages of radiosurgery in the treatment of these lesions are discussed. [Copyright &y& Elsevier]

Abstract: Background: An alternative approach for the treatment of the degenerative or unstable lumbar spine using retroperitoneal lateral LIF with anterolateral screw-plate or screw-rod fixation is introduced. Special attention is given to application of this procedure in patients who have undergone prior lumbar surgery. Methods: Between 1998 and 2001, 14 patients underwent lateral LIF with anterolateral instrumentation to treat degenerative foraminal stenosis or spondylolisthesis. Eleven patients (79%) had undergone prior posterior lumbar surgery, 7 of whom were also fused at that time. All patients first presented with mechanical back pain, radicular pain, or both. The mean follow-up was 21 months (range, 8 to 36 months). Results: Radicular pain and mechanical back pain significantly improved in 71% and 54% of patients, respectively. Of the 9 patients with preoperative neurological deficits, 7 were intact or had improved at their follow-up examination. One patient developed postoperative radiculopathy contralateral to his original symptoms. Radiography confirmed good positioning of the hardware and evidence of fusion in all 14 patients. No major complications occurred. Conclusions: Retroperitoneal lateral LIF with anterolateral instrumentation is an attractive alternative for the treatment of the degenerative or unstable lumbar spine in the absence of significant spinal stenosis. This approach is particularly useful for treating spondylolisthesis or degenerative foraminal stenosis in the postoperative lumbar spine. [Copyright &y& Elsevier]

Epidural hematoma (EDH) can result in a catastrophic outcome of traumatic brain injury. Current management guidelines do not consider the source of hemorrhage in decision making. The purpose of this study was to examine the relationship between EDH location and the source of hemorrhage. We report retrospectively reviewed, prospectively obtained surgical data of patients with acute traumatic cranial EDH treated between 2007 and 2018. Computed tomography (CT) scans were used to categorize EDH location as lateral or medial. The source of hemorrhage was identified intraoperatively by a single surgeon. Overall, of 92 evacuated EDHs (in 87 patients), 71 (77.2%) were in the lateral location. Arterial bleeding was the cause of EDH in 63.4% of the lateral EDHs and 9.2% of the medial EDHs (P < 0.0001). In the cases where surgery was done primarily to treat EDH, 65.3% had an arterial bleed source (P < 0.0001). In those treated for primary reasons other than EDH evacuation, 75% had a venous bleed source (P = 0.002). The location of EDH correlates with the source of hemorrhage. The decision to operate on EDH may be influenced by this factor. [ABSTRACT FROM AUTHOR]

Atlanto-occipital transarticular screw fixation (AOTSF) has rarely been reported for fixation of the craniovertebral junction (CVJ). A retrospective chart review of all pediatric patients (less than 18 years of age) with an attempt of AOTSF for fixation of traumatic CVJ instability was conducted. A total of 4 patients (2 boys and 2 girls; ages 2, 3, 5, and 8 years) who suffered from acute traumatic CVJ instability managed during 2007–2018 underwent an attempted AOTSF. In 2 patients, this method was technically successful. In the other 2 instances, we were not able to engage the screw into the occipital condyle. These were converted to standard occipital plate, rod, and screw fixation. All were placed in a halo subsequently for a minimum of 3 months. Three patients were fused at last follow-up (range, 17–48 months). One patient after successful AOTSF did not fuse. There were no surgical complications or revision procedures. AOTSF was feasible in half of pediatric patients suffering from traumatic CVJ instability. Therefore, intraoperative salvage options and strategies should be on hand readily. In the pediatric population, where bony anatomy may pose challenges to fixation, this technique may offer a viable first-line option in selected cases, despite the overall modest success rate. [ABSTRACT FROM AUTHOR]

Chordomas are rare, slow-growing, locally aggressive, malignant tumors of the spine. Chordomas are conventionally treated with surgical resection with or without radiation. There is an absence of literature documenting the natural history of a primary sacral chordoma. A 65-year-old man presented with rectal pain, constipation, urinary and fecal incontinence, S1 radiculopathy, and a palpable rectal mass. A needle biopsy confirmed the pathologic diagnosis of sacral chordoma. The patient declined to have surgery because of the surgical risks involved. He was managed conservatively with supportive care only. The patient was routinely followed in clinic and had a subjective and objective excellent quality of life with adequate pain management. Meanwhile, his neurologic status did not deteriorate. During follow-up, some posterolateral aspects of the chordoma regressed. However, the bulk of the lesion continued to slowly progress. The patient survived for 7.5 years. He eventually succumbed to urosepsis and new-onset peritoneal metastasis. To our knowledge, the patient is the only documented case in the literature of an untreated biopsy-proven sacral chordoma. The patient's tumor was intended for resection, and therefore comparable with data from treated chordomas. The patient's survival is similar to the median survival in treated chordomas. The patient's survival was despite negative prognosticators, such as advanced age of the patient and high sacral location above S2. [ABSTRACT FROM AUTHOR]

Abstract: Background: It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns. Methods: We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors. Results: A total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4–C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%). Conclusions: We propose that all CS fracture patterns warrant screening for BCVI. [Copyright &y& Elsevier]