摘要:

Tumors in the region of the brachial plexus comprise less than 5% of all tumors of the upper extremity. Due to their rarity and anatomical complexity, they present a neurosurgical challenge. This article is a review of brachial plexus tumors, beginning with their historical management and classification. The distribution of tumor pathology at the University of Pennsylvania Medical Center and at other institutions is discussed. The clinical presentation and preoperative assessment of patients with brachial plexus masses segue into a section describing the indications for surgery. The relevant anatomy, surgical techniques, and intraoperative adjuncts are reviewed next. Finally, the surgical outcome for both benign nerve sheath tumors and malignant tumors of the brachial plexus region is discussed. A thorough understanding of the management of brachial plexus tumors can optimize care of patients with these lesions and minimize neurologic deficit.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The surgical management issues of 73 cases of trigeminal neurinoma treated over a 12-year period were analyzed. The case records and radiologic material of 73 patients with trigeminal neurinoma operated on in the Neurosurgery Department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, between the year 1989 and 2001 were retrospectively analyzed. The appropriateness of the selected surgical route is studied. Apart from the other typical presenting features of trigeminal schwannoma, 9 patients presented with the rarely reported symptom of pathologic laughter. Three approaches were found appropriate to treat these tumors: the infratemporal fossa interdural approach, the lateral basal subtemporal approach, and the retrosigmoid approach. In 51 (69.9%) cases, total tumor excision was achieved. Two patients died during the postoperative period. During an average follow-up of 38 months, there has been a recurrence in 1 case and 71 patients are leading an independent and active life. Radical surgery is associated with an excellent clinical outcome and long-term tumor control. A majority of tumors, even those that are large and multicompartmental, can be removed in a single surgical stage and exposure.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In contrast to shunt implantation, the indication for endoscopic ventriculostomy in patients diagnosed for normal-pressure hydrocephalus (NPH) is not scientifically established. Between September 1997 and May 2002, NPH was diagnosed in 91 patients. The diagnosis was established by means of the clinical signs, the intrathecal lumbar or ventricular infusion test, the cerebrospinal fluid tap test, and magnetic resonance imaging (MRI) cerebrospinal fluid (CSF) flow studies preoperatively and postoperatively. In 70 of these patients (77%), a ventriculoperitoneal shunt with a Miethke dual-switch valve (MDSV) was implanted, and in 17 patients (19%), endoscopic-assisted ventriculostomy was performed. Four patients refused an operation and were excluded from this study. With our own created NPH recovery rate and use of the clinical grading system for NPH created by Kiefer and his colleagues, the operative results in an average time interval of 12 and 27 months were compared in both groups of patients. In the group of patients with a shunt operation, 10 surgical revisions (14%) were necessary because of 4 shunt infections (6%), 2 shunt obstructions (3%), 2 cases of overdrainage (3%), and 2 catheter dislocations (3%). In the ventriculostomy group, the complications were pneumatocephalus in 1 patient (6%) and a partial ischemic thalamus lesion with temporary clinical signs in another patient. Underdrainage was seen after both surgical procedures: after shunt operation in 3 patients (4%) and after ventriculostomy in 3 patients (18%). In these patients, we changed the valve and inserted one with a lower opening pressure or implanted an MDSV in 2 patients after the ventriculostomy. In another patient, we performed an additional ventriculostomy. In patients with a pathologically increased resistance to CSF outflow in the lumbar infusion test caused by NPH, shunt implantation is indicated. Patients whose outflow resistance is increased in the ventricular infusion test but who are suspected of having functional aqueduct stenosis as the result of a physiologic lumbar infusion test should be treated by means of endoscopic ventriculostomy, and they should be monitored with clinical and neuroradiologic long-term follow-up. In case of inadequate experience with ventriculostomy or in cases with an uncertain result of the intrathecal infusion test, the shunt operation with implantation of a hydrostatic valve is the method of first choice.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

In spite of the development of recent imaging technology, it is sometimes difficult to make a diagnosis of intramedullary spinal cord neoplasm. The purpose of this study is to investigate the differentiation of these lesions from nonneoplastic ones. Twelve patients with nonneoplastic intramedullary spinal cord lesions, excluding syringomyelia, who underwent surgery for either partial removal or biopsy were reviewed. Eight lesions were located in the cervical cord, 3 were in the thoracic cord, and 1 was in the thoracolumbar cord. Signs and symptoms were usually referable to the location of the cord lesions, which was not helpful in distinguishing them from intramedullary spinal cord neoplasms. On T1-weighted magnetic resonance imaging, most of signal intensities were iso- or low intense, whereas T2-weighted images showed high signal in all cases. The extent of enhancement with gadolinium (Gd)-DTPA varied from mildly homogeneous to irregular enhancement; however, all lesions showed an ill-defined boundary. Minimal or no spinal cord expansion in spite of the extent of the enhanced mass was the most consistent finding in most of the cases. The pathology of the surgical specimens demonstrated demyelinating lesions in 2 patients, granulomatous disease in 2 patients, vascular disease in 3 patients, inflammatory disease in 3 patients, and other conditions in 2 patients. Even with the advent of diagnostic techniques, it is still sometimes difficult to distinguish nonneoplastic intramedullary spinal cord lesions preoperatively from intramedullary spinal cord neoplasms.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Subdural empyema (SDE) is a rare form of intracranial sepsis that can rapidly lead to death. This fatal outcome is potentially preventable if the diagnosis is made at an early phase of the disease process and appropriate treatment measures are implemented in time. A case series of 6 patients is presented, illustrating the difficulties encountered in the diagnosis and treatment of SDE. The pathoanatomical basis of SDE is highlighted, and management challenges encountered in treating the condition, namely, difficulties hindering early diagnosis and controversies in optimal surgical approach, are addressed.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A broad array of tumors of the central nervous system may arise within the third ventricular region, including gliomas; subependymal giant cell astrocytomas; meningiomas; pineal region tumors; and cysts, including ependymal, arachnoid, epidermoid, and suprasellar tumors (i.e., macroadenomas, craniopharyngiomas, meningiomas, and optic gliomas). The clinical presentation varies with tumor location in and around the third ventricle. Tumors of the inferior portion of the anterior third ventricle can cause endocrine complaints, including diabetes insipidus and hypopituitarism as well as visual field impairment. Tumors of the superior portion of the anterior third ventricle result in obstructive hydrocephalus and cognitive memory deficits. Tumors of the posterior third often create outflow obstruction and hydrocephalus, and pineal region tumors are associated with Parinaud syndrome. Multiple surgical approaches may be considered in resecting tumors of the third ventricular region, including transcortical or interhemispheric transcallosal, interforniceal, transforaminal, orbitozygomatic subfrontal, or infratentorial supracerebellar. Each approach has strengths and weaknesses, and the choice is often made according to the surgeon’s experience and comfort level. The goals of surgery must be carefully considered so as to minimize neurologic morbidity or mortality. Finally, adjuvant chemotherapy and/or radiation therapy may play a significant role in treating tumor after tissue diagnosis.

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1050-6438    

出版商:OVID    

年代:2003

数据来源: OVID