摘要:

OBJECTIVEThis article reviews and summarizes recent data on the diagnosis, prognosis, and treatment of oligodendroglial tumors.METHODSHistological criteria for optimized diagnosis and grading of oligodendroglial tumors are described and discussed. The therapeutic approaches are analyzed in light of the results of recent series.RESULTSOligodendroglial tumors may be more common than is generally thought. Perinuclear halo and “chicken-wire” pattern, although considered classic histological features of oligodendrogliomas, are unreliable as sole criteria for diagnosis. Nuclear regularity and roundness and an eccentric rim of eosinophilic cytoplasm lacking obvious cell processes are more constant features. Grading should be accomplished using a composite of radiological and histopathological relevant features. The allelic loss of chromosome arms 1p and 19q might be a marker for both chemosensitivity and longer survival after chemotherapy. Oligodendrogliomas are notably chemosensitive when compared with other gliomas. For aggressive lesions, chemotherapy should be used upfront, after surgery.CONCLUSIONOligodendrogliomas are underdiagnosed. One unfortunate implication is that a large number of patients may be receiving suboptimal care. A simplification in grading of oligodendroglioma to two grades would reduce the confusion surrounding the classification and better define prognosis and response to treatment modalities. A better definition of the so-called mixed tumor should also allow a better classification of these lesions in an intermediate prognostic class between astrocytic and oligodendroglial lesions. Loss of 1p and 19q could be used as a cytogenetic marker in assisting grading. New concepts emerging in the recent literature should help optimize the diagnosis of these lesions and reduce interobserver variability.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

OBJECTIVETo assess the quality of life (QOL) of a group of patients treated for intracranial germinoma with biopsy followed by prophylactic whole-neuraxis radiation therapy.METHODSThe Short-form-36 and Functional Assessment of Cancer Therapy QOL questionnaires were completed by 22 of 27 eligible adults treated with whole-neuraxis irradiation for biopsy-proven, marker-negative intracranial germinomas between 1976 and 1996. In addition, data were obtained regarding height and weight, medications, ability to work, and educational achievement.RESULTSThe patients’ QOL was generally good. All of the patients are in or have completed high school; nine are in or have completed college, and five have advanced degrees. Patients rated themselves lower on the physical composite scale of the Short-form-36 (average, 46 versus 54 in a normal population). On the mental composite scale, patients rated themselves more favorably than the normal population (average, 54 versus 49 in a normal population). Patients were normally proportioned for height and weight, but female patients tended to be short. Age at radiation did not correlate with QOL.CONCLUSIONThe QOL of adults treated for marker-negative germinoma with prophylactic whole-neuraxis irradiation is generally good. These data should serve as a benchmark for newer treatment protocols eliminating or reducing radiation.

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:

OBJECTIVEMicrosurgery and stereotactic radiosurgery (SRS) for vestibular schwannomas are associated with a relatively high incidence of sensorineural hearing loss. A prospective trial of fractionated SRS was undertaken in an attempt to preserve hearing and minimize incidental cranial nerve injury.METHODSThirty-three patients with vestibular schwannomas were treated with 2100 cGy in three fractions during a 24-hour period using conventional frame-based linear accelerator radiosurgery. The median tumor diameter was 20 mm (range, 7–42 mm). Baseline and follow-up evaluations included audiometry and contrast-enhanced magnetic resonance imaging. End points were tumor progression, preservation of serviceable hearing, and treatment-related complications.RESULTSThirty-one patients (32 tumors) were assessable for tumor progression and treatment-related complications and 21 patients for preservation of serviceable hearing, with a median follow-up interval of 2 years (range, 0.5–4.0 yr). Tumor regression or stabilization was documented in 30 patients (97%) and tumor progression in 1 (3%). The patient with tumor progression remains asymptomatic and has not required surgical intervention. Five patients (16%) developed trigeminal nerve injury at a median of 6 months (range, 4–12 mo) after SRS; two of these patients had preexisting trigeminal neuropathy. One patient (3%) developed facial nerve injury (House-Brackmann Class 3) 7 months after SRS. Preservation of useful hearing (Gardner-Robertson Class 1–2) was 77% at 2 years. All patients with pretreatment Gardner-Robertson Class 1 to 2 hearing maintained serviceable (Class 1–3) hearing as of their last follow-up examination.CONCLUSIONThree-fraction SRS with a conventional stereotactic frame is feasible and well tolerated in the treatment of acoustic neuroma. This study demonstrates a high rate of hearing preservation and few treatment-related complications among a relatively high-risk patient cohort (tumors >15 mm or neurofibromatosis Type 2). Longer follow-up will be required to assess the durability of tumor control.

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:

OBJECTIVECavernous hemangiomas located within the cavernous sinus are rare vascular tumors that are very difficult to remove because of severe intraoperative bleeding. The purpose of this study was to analyze the clinical, neuroimaging, and pathological features and the surgical treatment of these tumors.METHODSTen patients with cavernous hemangiomas in the cavernous sinus who were surgically treated from August 1985 to October 1997, in our hospital, were retrospectively studied.RESULTSAmong the 10 patients, total tumor removal was performed in four cases, partial removal in two cases, and tumor biopsies in four cases. The four patients who underwent total tumor removal experienced uneventful postoperative courses, with no postoperative neurological deficits for one patient, no new neurological deficits for two patients, and complete ophthalmoplegia and diminished sensation in the distribution of Cranial Nerve V1for one patient. The two patients who underwent partial removal developed complete ophthalmoplegia and diminished sensation in the distribution of Cranial Nerve V1after surgery, and one of them experienced contralateral paralysis. All four patients who underwent tumor biopsies experienced severe intraoperative tumor bleeding; one exhibited Cranial Nerve III, IV, and VI injuries after surgery.CONCLUSIONThe features of prominent hyperintensity in T2-weighted scans, with well-defined borders in enhancing magnetic resonance imaging scans, or marked enhancement in computed tomographic and magnetic resonance imaging scans, with no tumor blush in angiographic analyses, facilitate the diagnosis of these tumors. These tumors can be divided into two subgroups on the basis of intraoperative findings and pathological features. We do not recommend division and piecemeal removal of the tumor during surgery if the main supplies of the tumor have not been interrupted.

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:

OBJECTIVEComputed tomographic angiography (CTA) is a rapid and minimally invasive method of detecting intracranial aneurysms. We wished to determine whether CTA could replace digital subtraction angiography (DSA) in the diagnosis and operative planning of ruptured cerebral aneurysms.METHODSIn a prospective study, patients with subarachnoid hemorrhage diagnosed by plain computed tomography underwent CTA, DSA, or both. Computed tomographic scans and CTA studies were first reviewed by the treating surgeon, along with a neuroradiologist, and a decision to proceed to DSA or directly to surgery was made on the basis of the type and quality of information provided by CTA. All patients underwent postoperative DSA.RESULTSA total of 173 patients were studied. In 24 patients, both CTA and DSA were negative for a source of subarachnoid hemorrhage. Twelve patients underwent DSA without prior CTA because a technologist capable of performing CTA was not available when the patient was evaluated. Nine patients in poor neurological condition underwent CTA, and all tested positive for aneurysms but died without surgical intervention. Of the 126 patients who underwent CTA and surgery, 65 (52%) also required preoperative DSA. The decision to proceed to DSA after CTA was influenced by aneurysm location; posterior communicating artery (62%) and posterior circulation locations (67–75%) more commonly proceeded to DSA than middle cerebral artery aneurysms (34%; 0.025 >P> 0.01). The sensitivity and specificity of CTA for the detection of all aneurysms, ruptured and unruptured, in the group of patients who underwent both types of angiograms preoperatively were 84 and 100%, respectively. In the group of 61 patients in whom aneurysm surgery was performed on the basis of CTA results alone, the sensitivity and specificity for the detection of all aneurysms, as compared with postoperative DSA, were 90 and 100%, respectively. Missed aneurysms (n = 24) were always small (<4 mm) and were usually found in patients with multiple aneurysms in whom the larger, ruptured aneurysm was identified by CTA. In one patient, the aneurysm missed by preoperative CTA would have resulted in a different operation if detected preoperatively.CONCLUSIONIt is possible to proceed to ruptured aneurysm repair entirely on the basis of good-quality CTA studies that demonstrate an aneurysm consistent with the pattern of bleeding observed on plain computed tomography (48% of the patients in this series and most common middle cerebral artery aneurysms). However, detection of small unruptured aneurysms in patients with multiple lesions remains a problem.

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:

OBJECTIVEThe outcomes for patients with cerebellar hemorrhage are thought to be influenced by anatomic damage to the brainstem. In this study, we investigated the magnetic resonance imaging findings in the brainstem, to examine the relationship between the degree of brainstem damage and the outcomes for patients with spontaneous cerebellar hemorrhage who are in poor-grade condition.METHODSThe results for 31 patients with spontaneous cerebellar hemorrhage, with Glasgow Coma Scale scores of 8 or less at admission, who underwent magnetic resonance imaging examinations were reviewed. All patients underwent surgical intervention. The patients were divided into two groups according to their Glasgow Outcome Scale scores at the time of discharge, i.e., patients who experienced good recoveries or exhibited moderate disabilities (Group I, n = 8) and patients who exhibited severe disabilities, were in a persistent vegetative state, or had died (Group II, n = 23). We investigated obliteration of the fourth ventricle and the perimesencephalic cistern and the presence of hydrocephalus in initial computed tomographic scans and the presence of areas of high signal intensity in the brainstem in T2-weighted images.RESULTSEight patients experienced good outcomes, and 23 patients experienced poor outcomes. The overall mortality rate was 32.3%. There were no significant differences between groups with respect to computed tomographic findings such as hematoma size, but the incidence of high signal intensities in the pons and midbrain in T2-weighted images for Group II was significantly higher than that for Group I (P< 0.01).CONCLUSIONMagnetic resonance imaging clearly demonstrated brainstem damage, and high signal intensity in the brainstem was a significant prognostic factor for determining outcomes for patients with spontaneous cerebellar hemorrhage who were in poor-grade condition.

ISSN:0148-396X    

出版商:OVID    

年代:1999

数据来源: OVID