ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

WE REVIEW THE phenomenology, pathophysiology, pathological anatomy, and therapy of posttraumatic movement disorders with special emphasis on neurosurgical treatment options. We also explore possible links between craniocerebral trauma and parkinsonism. The cause-effect relationship between head injury and subsequent movement disorder is not fully appreciated. This may be related partially to the delayed appearance of the movement disorder. Movement disorders after severe head injury have been reported in 13 to 66% of patients. Although movement disorders after mild or moderate head injury are frequently transient and, in general, do not result in additional disability, kinetic tremors and dystonia may be a source of marked disability in survivors of severe head injury. Functional stereotactic surgery provides long-term symptomatic and functional benefits in the majority of patients. Thalamic radiofrequency lesioning, although beneficial in some patients, frequently is associated with side effects such as increased dysarthria or gait disturbance, particularly in patients with kinetic tremor secondary to diffuse axonal injury. Deep brain stimulation is used increasingly as an option in such patients. It remains unclear whether pallidal or thalamic targets are more beneficial for treatment of posttraumatic dystonia. Trauma to the central nervous system is an important causative factor in a variety of movement disorders. The mediation of the effects of trauma and the pathophysiology of the development of posttraumatic movement disorders require further study. Functional stereotactic surgery should be considered in patients with disabling movement disorders refractory to medical treatment.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo study the outcomes of patients with basal meningiomas treated by one primary surgeon with a philosophy of aggressive surgical management to establish an index of satisfaction and patient-evaluated outcome.METHODSWe collected prospective data for patients with basal meningiomas who were operated on by one primary surgeon (LNS) during a 7-year period from 1993 to 2000. The outcomes in 269 patients were ascertained through follow-up visits, mailed follow-up questionnaires, and telephone interviews by two other surgeons (RA and MN). The mean patient age was 50 ± 13.6 years. The mean estimated tumor diameter was 3.07 ± 1.24 cm. There were 62 males and 207 females. Mean follow-up was 49 ± 26 months. Twenty-seven percent of patients were Levine-Sekhar (LS) Grade 0, 43% were LS Grade I, 24% were LS Grade II, and 6% were LS Grade III. Gross total resection was achieved in 66% of patients. Extent of resection correlated (P< 0.05) with LS grade. Thirty-seven patients received adjuvant treatments, and six patients required reoperations. Perioperative mortality was 1.1%. Eighty percent of patients were discharged home, 17% were discharged to rehabilitation facilities, and 1.5% were discharged to nursing homes. Postoperative complications were observed in 30% of patients.RESULTSDuring the follow-up study, of a total of 269 patients, 30 patients could not be contacted, and 11 patients had died of unrelated causes. The mean follow-up Karnofsky Performance Scale score of the patients was 83 ± 10. Ninety-seven percent of patients were very satisfied/satisfied with their treatments (P< 0.001). Forty-three percent of patients were employed, and 83% of patients were employable. Their expectations of treatment were met in 90% of patients (P< 0.001), 95% thought surgery had been a good treatment choice (P< 0.001), and 95% would recommend the same treatment for a family member (P< 0.001).CONCLUSIONThese results demonstrate that patient satisfaction can remain high and satisfactory outcome can be achieved with surgical management in patients with these complex lesions.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEThe management of primary optic nerve sheath meningioma (ONSM) is controversial. Surgery often results in postoperative blindness in the affected eye and thus has been abandoned as a treatment option for most patients. When these tumors are left untreated, however, progressive visual impairment ensues, which also leads to blindness. Recently, radiation therapy has gained wider acceptance in the treatment of these lesions. Experience with stereotactic radiotherapy (SRT) in the treatment of ONSMs is limited because of the rare incidence of this tumor. We present a series of patients with ONSM who were treated with SRT.METHODSFive patients (three women, two men), ranging in age from 40 to 73 years, presented with progressive visual loss with decreased visual field, visual acuity, and color vision affecting six eyes (one patient had tumor involving both optic nerves). One patient also presented with proptosis and diplopia. Five eyes had functional residual vision (range, 20/20 to 20/40), and one eye was completely blind. All five patients were diagnosed clinically and radiographically to have an ONSM. Three were intraorbital, one was intracanalicular as well as intraorbital, and one was a left ONSM extending through the optic foramen into the intracranial space and involving the right optic nerve. The five functional eyes were treated with SRT by use of 1.8-Gy fractions to a cumulative dose of 45 to 54 Gy.RESULTSFollow-up ranged from 1 to 7 years, and serial magnetic resonance imaging revealed no changes in the size of the tumor in all five patients. Four patients experienced dramatic improvement in visual acuity, visual field, and color vision within 3 months after SRT. One patient remained stable without evidence of visual deterioration or disease progression. None had radiation-induced optic neuropathy.CONCLUSIONSRT may be a viable option for treatment of primary ONSM in patients with documented progressive visual deterioration, and it may be effective in improving or stabilizing remaining functional vision.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVETo evaluate the prognostic significance of presence, intensity, and extent of amino acid uptake in patients with suspected primary or recurrent brain tumors.METHODSWe retrospectively analyzed 181 consecutive studies of amino acid uptake using single-photon emission computed tomography and the amino acid l-[3-123I]iodo-&agr;-methyltyrosine (IMT). In a blinded analysis, all studies were evaluated for presence, maximal uptake (IMTmax), and extent (IMText) of focal tracer uptake.RESULTSThe most frequent tumors were 53 astrocytomas (World Health Organization Grade I–III), 41 glioblastomas, 16 metastases, 13 oligodendrogliomas (Grade II–III), and 10 medulloblastomas. The other patients exhibited various parenchymal tumors or nonneoplastic lesions. IMT uptake was present in 69% of the patients with IMTmaxranging from 1.4 to 6.2. IMTmaxand IMTextwere significant predictors of survival in the whole group. When the group was divided according to primary versus recurrent tumor, only the primary tumors achieved a high level of significance (P< 0.01). When patients without any IMT uptake were excluded from the analysis, statistical significance for both IMTmaxand IMTextwas lost. Multiple regression analysis, including IMTmax, IMText, age, and tumor grade, revealed only extent of IMT uptake as an independent predictor of prognosis.CONCLUSIONAbsence of IMT uptake is a significant predictor of long-term survival in patients with suspected primary or recurrent brain tumors. Only the extent of a given lesion provided minor supplementary prognostic information as compared with histopathology and age. These findings suggest caution in relating high amino acid uptake values to poor prognosis, despite the capability of amino acid imaging to help determine the presence and extent of gliomas.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVESurgery in the superior frontal gyrus partially involving the supplementary motor area (SMA) may be followed by contralateral transient weakness and aphasia initially indistinguishable from damage to the primary motor cortex. However, recovery is different, and SMA deficits may resolve completely within days to weeks. No study has assessed the distinct postoperative deficits after tumor resection in the SMA on a homogeneous patient group.METHODSTwenty-four patients with World Health Organization Grade II astrocytomas in the superior frontal gyrus consecutively treated by surgery were studied. Degree and duration of postoperative deficits were evaluated according to tumor location and boundaries via magnetic resonance imaging scans, intraoperative neuromonitoring results, and extent of tumor resection.RESULTSPostoperatively, motor deficits were evident in 21 of 24 and speech deficits in 9 of 12 patients. Motor function quickly recovered in 11 and speech function in 3 patients. None of the 12 patients in whom the posterior tumor resection line was at a distance of more than 0.5 cm from the precentral sulcus experienced persistent motor deficits. Eight of these patients developed typical SMA syndrome with transient initiation difficulties. Seven of 12 patients in whom the tumor extended to the precentral sulcus still had motor deficits at the 12-month follow-up assessment.CONCLUSIONSurgery for Grade II gliomas in the superior frontal gyrus is more likely to result in permanent morbidity when the resection is performed at a distance of less than 0.5 cm from the precentral gyrus or positive stimulation points. Therefore, cortical mapping of motor and speech function, in critical cases under local anesthesia with the patient as his or her own monitor, is recommended; resection should be tailored to obtain good functional outcome and maintain quality of life.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

OBJECTIVEResection of intracranial tumors in the posterior hippocampus and the parahippocampal gyrus can be associated with significant morbidity because of the parenchymal resection and the cortical retraction often required in gaining access to this infrequently explored region. With the use of image guidance, the occipitosubtemporal (OST) approach requires neither lateral cortical resection nor the placement of brain retractors to gain surgical access to the posterior hippocampus and the parahippocampal gyrus, and this approach is associated with a high rate of gross total tumor resection.METHODSThe computer-assisted volumetric stereotactic OST approach was used to resect 40 posterior hippocampus and parahippocampal gyrus tumors in 34 consecutive patients during an 8-year period. Patient, radiographic, and surgical outcome data were collected retrospectively.RESULTSThe series included operations in 25 men and 15 women, and the patients’ average age was 40.3 years (range, 15–69 yr). Twenty-five of the 40 procedures were performed to remove lesions in the dominant hemisphere, and previous craniotomies for resection had been performed in 12 of 40 cases. In 38 of 40 cases, histopathological analysis revealed a glial neoplasm, and 50% of these tumors were high-grade lesions. Preoperatively, 23 patients were neurologically intact before 40 procedures, whereas visual field deficits were noted in 7 patients, mild hemiparesis was documented in 4 patients, and other neurological deficits were present in 9 patients. An excellent outcome (Glasgow Outcome Scale Grade 5) was noted after 38 (95%) of the 40 computer-assisted volumetric stereotactic OST procedures. Permanent postoperative hemiparesis (Glasgow Outcome Scale Grade 4) occurred after one procedure, and a second patient, despite being neurologically unchanged postoperatively and despite having had an optimal tumor resection, died on postoperative Day 33 (Glasgow Outcome Scale Grade 1). Complete resection of the preoperatively defined tumor volume was noted on postoperative gadolinium-enhanced magnetic resonance imaging examinations after 39 (97.5%) of the 40 procedures. The average duration of clinical follow-up was 15.9 months (range, 0.5–67 mo).CONCLUSIONWe think that the OST approach is well suited to the resection of tumors in the posterior hippocampus and the parahippocampal gyrus. By allowing the neurosurgeon to avoid unnecessary brain resection and retraction, this approach reduces the risk of injury to important lateral temporal and occipital lobe cortex and tracts. In addition, the resection of a posterior hippocampus or parahippocampal gyrus mass with the OST approach relieves temporal horn entrapment. Computer-assisted volumetric stereotaxy helps the neurosurgeon to maintain precise spatial and anatomic orientation and accurately delineates the margin between the tumor and the surrounding neural tissue.

ISSN:0148-396X    

出版商:OVID    

年代:2002

数据来源: OVID