Journal of neurosurgery
-
Journal of neurosurgery · Apr 1998
Review Case ReportsExperience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature.
The authors aimed to develop management strategies for the treatment of herniated thoracic discs and to define indications for selection of surgical approaches. Symptomatic thoracic discs requiring surgery are rare. Between 1971 and 1995, 71 patients with 82 herniated thoracic discs were surgically treated by the authors. The treated group included 34 men and 37 women whose ages ranged from 19 to 75 years, with a mean age of 48 years. The most common sites of disc herniation requiring surgery were from T-8 to T-11. Evidence of antecedent trauma was present in 37% of the patients. Preoperative symptoms included pain (localized, axial, or radicular) in 54 (76%) of the 71 patients, evidence of myelopathy, that is, motor impairment in 43 (61%), hyperreflexia and spasticity in 41 (58%), sensory impairment in 43 (61%), and bladder dysfunction in 17 (24%). ⋯ Review of this series, with the attendant complications, together with evaluation of several contemporary thoracic disc series, has facilitated the authors' decision-making process when considering the comprehensive management of these patients, including the selection of a surgical approach.
-
Journal of neurosurgery · Apr 1998
Randomized Controlled Trial Clinical TrialSurvival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children's Cancer Group.
Ependymomas in children continue to generate controversy regarding their histological diagnosis and grading. optimal management, and possible prognostic factors. To increase our knowledge of these tumors the authors addressed these issues in a cohort of children with prospectively staged ependymomas treated with radiotherapy and chemotherapy. ⋯ Predictors of PFS duration included an estimate of the extent of resection made at surgery (total compared with less than total, p = 0.0001) and the amount of residual tumor on postoperative imaging as verified by centralized radiological review (< or = 1.5 cm2 compared with > 1.5 cm2, p < 0.0001). No other factors, including centrally reviewed tumor histopathological type, location, metastasis and tumor (M and T) stages, patient age, race, gender, or chemotherapy treatment regimen significantly correlated with PFS duration. The pattern of predominantly local relapse and the important influence of residual tumor or the extent of resection on PFS duration confirms a prevailing impression that local disease control is the major factor in the prediction of outcome of ependymoma. Survival rates were comparable with those reported by other investigators who have treated patients with similar doses of radiation and no chemotherapy.
-
Journal of neurosurgery · Apr 1998
Review Comparative StudyMicrosurgical treatment of arteriovenous malformations: analysis and comparison with stereotactic radiosurgery.
To compare microsurgical and stereotactic radiosurgical treatment of arteriovenous malformations (AVMs), the authors analyzed a prospective series of 72 consecutive patients who were treated microsurgically for cerebral AVMs by one neurosurgeon. The authors then compared the results of microsurgical treatment with published results of stereotactic radiosurgical treatment of small AVMs. ⋯ Based on this analysis, microsurgical treatment of Grades I to III AVMs is superior to stereotactic radiosurgery.
-
Journal of neurosurgery · Apr 1998
Review Case ReportsIntradural retroclival chordoma without bone involvement: no tumor regrowth 5 years after operation. Case report.
Chordomas are most commonly located in the extradural region. A 56-year-old man presented with a large chondroid chordoma located totally within the intradural retroclival region. The tumor was resected via the petrosal approach. ⋯ The patient was free of symptoms except for moderate, conductive hearing loss in his right ear. The position of the intradural tumor could be preoperatively diagnosed by neuroimaging and, thus, the petrosal approach was selected. Primary intradural extraosseous chordomas are very rare and difficult to differentiate from ecchordoses physaliphorae on the basis of histological and radiological features; however, MIB-1 staining may be useful.
-
Journal of neurosurgery · Apr 1998
ReviewVertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons.
The 847 active members of the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Section on Disorders of the Spine and Peripheral Nerves were surveyed to quantitate the risk of vertebral artery (VA) injury during C1-2 transarticular screw placement. ⋯ Including both known and suspected cases, the risk of VA injury was 4.1% per patient or 2.2% per screw inserted. The risk of neurological deficit from VA injury was 0.2% per patient or 0.1% per screw, and the mortality rate was 0.1%. The choice of management of intraoperative VA injuries was evenly divided between placing the patient under observation and initiating immediate postoperative angiography with possible balloon occlusion.