摘要:

&NA;Seventy‐five patients older than 60 years of age underwent surgical resection of intracranial meningiomas during a 10‐year period at a single institution. All patients had a computed tomographic scan preoperatively, and all were followed for at least 3 months postoperatively. There were 50 patients 61 to 70 years of age (Group A), and 25 patients older than 70 years (Group B). Sixteen patients (21%) were asymptomatic, and no patient was severely disabled preoperatively. Operative morbidity and mortality and outcome at 3 months were assessed and correlated with age, preoperative neurological status, and tumor size and location. Operative mortality was 6.6% (6% in Group A; 8% in Group B). Perioperative morbidity (including medical and surgical complications and worsening in neurological status) was 48% (46% in Group A; 52% in Group B). Neurological status 3 months after surgery was improved by at least one grade as compared to before surgery in 40% of patients (38% in Group A; 44% in Group B), unchanged in 29% (34% in Group A; 20% in Group B), and worsened in 31% (28% in Group A; 36% in Group B). While nearly half of the patients were asymptomatic 3 months after surgery, 11 patients (15%) had died or remained seriously disabled. Outcome at 3 months correlated significantly with low neurological grade preoperatively and with a tumor location over the cortical convexity. There was no significant correlation with age or tumor size. We conclude that resection of intracranial meningiomas is associated with significant morbidity and mortality in the elderly. Figures from large series of mostly younger patients with meningiomas do not reflect surgical outcome in the aged. The best outcome is seen in patients who do not have advanced neurological symptoms preoperatively and in patients with meningioma location in the cortical convexity. (Neurosurgery24:557‐560, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Forty‐three patients with intracranial, intradural dermoid (8) and epidermoid (35) tumors underwent radical surgical resection utilizing strict microneurosurgical technique. The average age was 37.3 years for the patients with epidermoid tumors and 36.2 years for the patients with dermoid tumors. The male to female ratio was 3:2 for the epidermoid group and 3:1 for the dermoid group. Common clinical presentations included cerebellar dysfunction, cranial nerve impairment, and seizures. Typically, computed tomography scans revealed the epidermoid tumors (30 cases studied) as nonhomogeneous hypodense lesions with irregular borders and without contrast enhancement. The dermoid tumors (7 cases studied) had a similar appearance, but with a wider range of attenuation values. Magnetic resonance imaging findings for the epidermoid tumors (6 cases studied) consisted of increased T1and increased T2relaxation times. Supratentorial tumors were excised by the pterional (frontosphenotemporal) approach, mesencephalic tumors by either a supratentorial posterior interhemispheric transtentorial approach or an infratentorial/supracerebellar method, and posterior fossa tumors by either a medially or laterally positioned suboccipital osteoplastic craniotomy. One epidermoid tumor and one dermoid tumor were considered to be subtotally resected because of dense adherences left attached to vital structures; the remaining 41 tumors were completely excised. The most frequent complications were aseptic/chemical meningitis and transient cranial nerve palsies. There were no perioperative deaths. Mean follow‐up was 5.2 years. Eighty‐six percent of patients reported good to excellent results. No patient had experienced symptomatic or radiographic evidence of recurrence. These results suggest that although dermoid and epidermoid tumors tend to cross anatomical boundaries via the subarachnoid system, in the majority of patients tumors can be resected in their entirety with relatively low morbidity by utilizing microneurosurgical techniques. (Neurosurgery24:561‐567, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Thirty‐three cases of intracranial epidermoid tumors treated during the past 25 years were analyzed with regard to clinical manifestations, recurrence rates related to the extent of surgery, and long‐term survival rates. Epidermoid tumors caused various symptoms, especially in the cerebellopontine angle (15 cases), of which a transient remission of symptoms was observed in 4 cases (23.5%). The average time from initial symptoms to surgery was much shorter in suprasellar region and third ventricular locations (average of 11 months) than in other locations (average of 7 years). In 28 patients (84.9%), the tumor was removed totally or subtotally. Most of the patients could lead an independent and useful life after operation (93.1%). Among the 29 patients in a long‐term follow‐up survey, seven tumors recurred after an average interval of 8 years and 10 months (from the first to second operation) and 12 years and 6 months (from the second to third operation). Patients with recurrent tumors were successfully treated, and excellent functional prognosis was observed even after the second or third operation. The 20‐year survival rate was 92.8% (Kaplan‐Meier method). (Neurosurgery24:568‐573, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Intracranial epidermoid and dermoid tumors are unusual benign lesions that are potentially curable. Subtotal removal carries a high incidence of recurrence, plus the rare possibility of carcinomatous degeneration of the remnants. Aseptic meningitis from spillage of cyst contents into the subarachnoid space is frequent after operation and has been reported to occur spontaneously. A case of a patient with a posterior fossa epidermoid cyst presenting with multiple bouts of aseptic meningitis in which squamous cell carcinoma arose in recurrent tumor 5 years after subtotal removal of the benign lesion is described. (Neurosurgery24:574‐578, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Two cases of a human chorionic gonadotropin‐producing germ cell tumor originating bilaterally in the basal ganglia and thalamus are reported. The biological behavior and clinical characteristics were similar to those of unilateral germinomas involving the basal ganglia and thalamus. Common clinical features were slowly progressive unilateral pyramidal signs and bilateral and/or unilateral extrapyramidal signs which occurred either concomitantly or sequentially. Bilateral symmetrical lesions were demonstrated by computed tomography and/or magnetic resonance imaging at an early stage of illness. Serum and cerebrospinal fluid human chorionic gonadotropin levels were elevated (116 and 141 mIU/ml, respectively) but decreased and remained within normal limits after radiation therapy alone. Radiosensitivity was confirmed by repeated computed tomographic scans and tumor marker measurements. Multiple concomitant germ cell tumors is a rare, but interesting lesion, especially considering its pathogenesis and oncogenesis. (Neurosurgery24:579‐583, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of neurinoma affecting the intracranial part of the hypoglossal nerve is reported. Symptoms and signs, radiological findings, and operative results of other cases are reviewed. The value of computerized tomography and magnetic resonance imaging in local diagnosis and the feasibility of a one‐stage operation for total removal of tumors with extracranial extension are discussed (Neurosurgery24:583‐587, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Meningiomas of the fourth ventricle are rare neoplasms. Only meningothelial and fibroblastic subtypes, purportedly arising from the tela choroidea, have been described. In this report we describe clinical, neuroradiological and pathological findings in a 52‐year‐old man with mild hydrocephalus produced by a large, calcified, osteoblastic meningioma of the fourth ventricle. (Neurosurgery24:587‐590, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;An exceptional case of intracranial plasma cell granuloma, located in the right frontoparietal convexity in a 16‐year‐old boy is reported. Reports of these rare inflammatory lesions locate them primarily in the lungs and in other regions of the body, and only exceptionally in the nervous system; indeed, only three intracranial cases and one other arising from the spinal meninges have been reported. The computed tomographic and surgical aspects suggested a falx meningioma in our case. The pathological diagnosis differentiating these from other intracranial lesions with a plasma cell component, including meningioma with plasma cell infiltration and plasmacytoma, is discussed. (Neurosurgery24:591‐595, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;Fractures of the vertebral limbus occur between the vertebral ring apophyses and the cartilaginous rim of the superior or inferior margins of the vertebral end plates. These fractures are typically seen in adolescents or young adults, since fusion in this area is not complete until the ages of 18 to 25. Of 85 cases reported, 24 occurred in adolescents. The authors present the clinical, neurodiagnostic, and surgical management of fractures of the vertebral limbus and coincident segmental spinal stenosis in a group of 5 adolescents and 5 adults. An additional category for fractures of the vertebral limbus is proposed, namely, a lesion that is not confined to the superior or inferior margins of the vertebral end plates, but that spans the full length of the vertebral body. (Neurosurgery24:595‐604, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

&NA;A case of infection of the superior sagittal sinus withPetriellidium boydiiis reported. This relatively common fungal pathogen rarely invades the central nervous system. Immunological compromise and poor personal hygiene seem to be common attributes shared by this patient and the 4 previous patients reported to have suffered invasion of the central nervous system by this organism. This report is unique in that it is the first demonstrating apparent hematogenous dissemination of this organism to the central nervous system. (Neurosurgery24:604‐607, 1989)

ISSN:0148-396X    

出版商:OVID    

年代:1989

数据来源: OVID