Acta neurochirurgica
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Acta neurochirurgica · Nov 2001
Virtual MRI endoscopy: detection of anomalies of the ventricular anatomy and its possible role as a presurgical planning tool for endoscopic third ventriculostomy.
Many anatomical anomalies have the potential to impair the efficacy of endoscopic third ventriculostomy (ETV) and increase the surgical morbidity. By virtual magnetic resonance imaging (MRI) endoscopy, the real endoscopic view into the ventricular system can be simulated. It was the objective of the present study to investigate if this simulation is sensitive enough to detect anatomical anomalies of the ventricular system. ⋯ The sensitivity of virtual MRI endoscopy for detection of anatomical variants of the ventricular system is low. Its potential usefulness as a presurgical planning tool inspite of this low sensitivity rate is discussed.
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Skull base meningiomas present a difficult surgical challenge because of the high potential morbidity of radical surgical extirpation and their low potential for incapacitating symptomatology. The focal character of meningiomas makes stereotactic radiosurgery an attractive adjuvant treatment modality to resection. The purpose of this study was to evaluate the local control rates and complications in 56 patients with base of skull meningiomas undergoing radiosurgery. ⋯ Median followup was five years. Nineteen patients (34%) were improved clinically at follow-up; 32 (57%) were unchanged; and 5 patients (9%) developed new or worsened neurologic deficits. Serial imaging studies after radiosurgery showed a reduction in tumor volume in 23 patients (41%); 30 (54%) showed stable disease; 3 patients (5%) had tumors which increased in size (2 being outside the radiosurgery treatment site). The actuarial freedom from progression rate (defined as further tumor growth) was thus 95%, with a median imaging follow-up of 26 months (range, 6-66 months). Although further follow-up is necessary, the results of this series clearly demonstrate that these lesions are feasible for treatment by modern radiosurgical techniques. Linac radiosurgery can stabilize skull base meningiomas, with decreased or unchanged tumor volumes on radiologic follow-up in approximately 95% of patients. Radiosurgery is a low-morbidity, effective technique as adjunct and sometimes primary treatment of small to moderate-sized meningiomas of the skull base.