Journal of neurosurgery
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Journal of neurosurgery · Jun 1993
Randomized Controlled Trial Clinical TrialA randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group study.
Sixty adult patients with incompletely excised low-grade gliomas were randomly assigned to receive radiotherapy (55 Gy over a total of 6 1/2 to 7 weeks) either alone or with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU; 100 mg/sq m every 6 weeks). Pathological review showed that six patients were ineligible for the study. Evaluation of patient age, extent of surgery, tumor grade, and performance status showed no significant differences between the treatment arms. ⋯ For the group as a whole, patient age and performance status were the most important prognostic parameters. The majority of patients receiving chemotherapy experienced moderate hematological toxicity. This study demonstrates that CCNU chemotherapy does not improve the results of radiation therapy in the treatment of incompletely excised low-grade gliomas.
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Journal of neurosurgery · Jun 1993
Case ReportsIntraoperative electrocorticography during tumor resection: impact on seizure outcome in patients with gangliogliomas.
Gangliogliomas are indolent neoplasms that are often associated with long-standing intractable seizures. The seizure-free outcome following ganglioglioma resection alone (or "lesionectomy") has been generally favorable, ranging in most series from 50% to 65%. Thus, the value of resection of epileptogenic cortex in addition to tumor with regard to seizure outcome has been the subject of controversy. ⋯ In a subset of four patients, neuropsychological and cognitive function were evaluated pre- and postoperatively. In these four, a clear trend toward improvement was noted in most functions. Thus, resection of epileptogenic cortex along with tumor may improve seizure outcome in selected patients with tumor-associated epilepsy without engendering identifiable neurological or cognitive deficits attributable to the incremental resection.
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Journal of neurosurgery · Jun 1993
Case ReportsGiant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass. Case report.
Giant intracranial aneurysms often pose difficult management issues. Such aneurysms may not be amenable to direct surgical attack because of their size, location, or lack of a clear aneurysmal neck. In such cases, a combination of strategies may provide a means of proximal aneurysm occlusion and distal cerebral revascularization. ⋯ The aneurysm was managed in a two-stage procedure in which the MCA branches distal to the aneurysm were anastomosed first with branches of the left superficial temporal artery. After the bypass procedure, direct occlusion of the MCA was performed at the proximal base of the aneurysm at its site of dilatation. The patient had no intraoperative or postoperative complications and was intact neurologically 6 months following the procedures.