摘要:

OBJECTIVE:The goal of this study was to evaluate the effect of postoperative residual tumor size on the outcomes for patients with incompletely resected benign meningiomas who underwent radiotherapy (RT).METHODS:Fifty-four patients with incompletely resected benign meningiomas received postoperative RT between 1984 and 1995. Surgery consisted of partial resection for 43 patients (80%) and biopsy for 11 (20%). All patients underwent postoperative imaging (using computed tomography and/or magnetic resonance imaging), and the median residual tumor size was 3.5 cm (in greatest dimension). Thirty-eight tumors (69%) were <5 cm, and 17 (31%) were ≥5 cm. The median RT dose was 54 Gy (range, 45-60 Gy), delivered in daily fractions of 1.8 to 2 Gy. The median follow-up period was 55 months.RESULTS:The 5-year actuarial progression-free survival (PFS) rate for the entire group was 76%. The only significant predictor of PFS rates was residual tumor size. Large residual tumors (≥5 cm) exhibited a worse 5-year PFS rate than did small tumors (<5 cm) (40 versus 93%,P< 0.0001). When analyzed as a continuous variable, residual tumor size remained a significant prognostic factor. Age, sex, tumor histological features, tumor location, timing of treatment (immediate versus delayed), extent of resection, and RT dose (<54 Gy versus ≥54 Gy) did not reach prognostic significance. The difference in PFS rates for small and large residual tumors translated into a significant difference in 5-year cause-specific survival rates (65 versus 97%,P= 0.01).CONCLUSION:For incompletely resected benign meningiomas treated with RT, residual tumor size is the most significant predictor of tumor control. Small residual tumors are well controlled with conventional RT doses and techniques. In contrast, more aggressive therapies should be considered for large tumors.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:This study was undertaken to establish whether measurement of ocular microtremor (OMT) activity could be used as a method to establish brain stem death. Presently, the diagnosis of brain stem death can be made using clinical criteria alone. OMT is a high-frequency, low-amplitude physiological tremor of the eye caused by impulses emanating from the brain stem. There have been a number of reports indicating that the recording of OMT may be useful in the assessment of comatose states and in establishing brain stem viability or death.METHODS:We obtained the OMT recordings of 32 patients suspected of having brain stem death using the piezoelectric strain gauge technique. This method involves mounting the piezoelectric probe in a headset and lowering the rubber-tipped end piece onto the anesthetized scleral surface of the subject. The signal produced is recorded on audiomagnetic tape and later played back and analyzed on an electrocardiographic tape analyzer.RESULTS:In 28 patients, initial clinical assessment confirmed the diagnosis of brain stem death and no OMT activity was recorded from these subjects. In three patients in whom initial clinical assessment demonstrated brain stem function, OMT activity was present; when brain stem death was subsequently diagnosed in these three patients, no OMT activity could be demonstrated. In the remaining patient, two of three OMT recordings demonstrated activity in spite of the absence of clinical evidence of brain stem function. A post mortem revealed bacterial cerebritis in this subject.CONCLUSION:The results suggest that OMT is a sensitive method of detecting brain stem life and that it could play an important role in the assessment of brain stem death.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:In the treatment of patients with cranial base tumors, unclippable aneurysms, or medically intractable ischemia, it may be necessary to use high-flow bypass grafts. The indications, surgical techniques and complications are discussed.METHODS:During a 10-year period, 99 saphenous vein grafts and 3 radial artery grafts were performed for 101 patients, i.e., 72 with neoplasms, 23 with aneurysms, and 6 with ischemia. Clinical follow-up monitoring of the patients was by direct examination or telephone interview, with a mean follow-up period of 41.2 months (range, 5-147 mo). Radiological follow-up monitoring was by magnetic resonance imaging, magnetic resonance angiography, or three-dimensional computed tomographic angiography, with a mean follow-up period of 32 months (range, 1-120 mo). During the follow-up period, there was one late graft occlusion and one graft stenosis.RESULTS:The use of intraoperative angiography improved the patency rate from 90 to 98% and reduced the incidence of perioperative stroke from 13 to 9.5%. Ninety-two percent of the patients were in excellent or good neurological condition at the time of discharge from the hospital, compared with 95% before surgery. The perioperative mortality rate was 2%. Other complications included three intracranial hematomas, rupture of a vein graft in a patient with Marfan's syndrome, and five tumor resection-related problems. The long-term survival rates for patients who received grafts were excellent for patients with benign tumors, fair to poor for patients with malignant tumors, good for patients with aneurysms, and excellent for patients with ischemia.CONCLUSION:The results of saphenous vein and radial artery grafting have been greatly improved by the use of intraoperative angiography, improvements in surgical techniques, and improved perioperative treatment.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVE:Fifteen basilar aneurysms approached via Kawase's anterior petrosectomy were analyzed to determine parameters that could reliably predict the applicability of this approach to specific basilar aneurysms on the basis of existing imaging.METHODS:Anatomic data were gathered by studying 40 dry skulls in which measurements were taken to define the limits of the surgical window. Clinical data were obtained from the review of charts and radiographic images of 15 patients surgically treated with the Kawase approach. The data were combined to categorize basilar aneurysms according to their position in relation to bony anatomy as seen on preoperative angiograms.RESULTS:Two relevant measurements were determined on lateral angiograms that were predictive of the applicability of operative approach. The K1 line determined the caudal extent of exposure of the Kawase approach to be 18 mm below the floor of the sella turcica and represented the distance to the floor of the internal auditory meatus. The K2 line determined the caudal extent of exposure of the posterior petrosectomy approach to be 24 mm below the floor of the sella turcica and represented the distance to the upper aspect of the jugular tubercle. Basilar aneurysms below the posterior clinoid process could be categorized in relationship to the regional bony anatomy in a manner that is predictive of the appropriate surgical approach as 1) retrosellar, 2) upper clival, 3) midclival, and 4) lower clival. Glasgow outcome data in 15 patients surgically treated with the Kawase approach demonstrated results comparable to those reported for ruptured basilar aneurysms.CONCLUSION:Individual basilar artery aneurysms can be categorized according to their relationship to bony anatomy on lateral view preoperative angiograms without bone subtraction. Anatomic parameters, the K1 and K2 lines, from these angiograms enable the neurosurgeon to predict the most appropriate approach for each type of basilar artery aneurysm.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID