摘要:

Summary:Approximately one‐third of newly diagnosed primary glial tumors in adults are low‐grade astrocytomas. With the development of more sensitive radiological techniques, these tumors are being detected earlier in their history, and thus the patients often have minimal or no neurological impairment. Lowgrade astrocytomas are thought to have a good prognosis. However, their clinical behavior is variable and they often dedifferentiate to a more aggressive, high‐grade glioma. Because of the lack of prospective, randomized studies, the role of surgery and radiation in the management of these lesions is controversial. We review the pathology, history, and clinical and radiological characteristics of low‐grade astrocytomas and the clinical studies that examine the role of surgery and radiation therapy. Based on this review, the following recommendations are made: (1) treatment should be based on the histological type (astrocytoma, pilocytic astrocytoma, and gemistocytic astrocytoma); (2) magnetic resonance imaging is the modality of choice for diagnosis and surgical planning; (3) radical total resection should be attempted whenever safely possible; (4) multiple biopsies should be examined pathologically to avoid sampling errors; (5) patients with the astrocytoma histologic type who have a total resection can be followed clinically and with frequent magnetic resonance imaging scans, whereas those who have a subtotal resection should receive adjuvant radiation therapy in a conventional fractionated schedule with a dose of 4,500 to 5,500 rad to a limited volume of brain; (6) complete resections of pilocytic astrocytomas may be curative; (7) the benefit of radiation in patients with subtotally resected pilocytic astrocytomas is not well defined; (8) patients with gemistocytic astrocytomas should receive adjuvant radiation therapy regardless of the extent of resection, because of the high incidence of dedifferentiation to a high‐grade glioma in these patients; and (9) lesions discovered as incidental findings can be managed conservatively by serial radiological observations.

ISSN:1050-6438    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Summary:We present an overview of the surgical management of intracerebral arteriovenous malformations (AVM), including grading, patient evaluation, and preoperative as well as postoperative screening procedures with CT, MRI, and MR‐angiography. In addition, surgical techniques are described in detail, with special consideration given to large AVM, paraventricular AVM, and functional area AVM. In terms of surgical results, we present data on relative outcomes, morbidity, and mortality as reported in major historical series. Although direct surgical excision is recommended for most cases, consideration should be given to embolization and radiosurgery; and we emphasize that the surgical decision‐making process employ current grading systems to determine the relative risk‐benefits of various treatment modalities.

ISSN:1050-6438    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Summary:We have reviewed the literature regarding intracranial arteriovenous malformations (AVMs) diagnosed in childhood. Although these lesions seem to be of the same structure and distribution as AVMs first diagnosed in adult life, they have a more malignant course. As many as 87% of patients initially present with hemorrhage; many of these patients progress to coma. Mortality related to the initial bleed is reported to be 25%. The risk of repeat bleed may also exceed the 2‐4% per annum figure usually quoted. However, children who survive the intracranial hemorrhage and receive definitive treatment can do well, despite presenting to the emergency room in extremis. In this article, we review the clinical presentation, natural history, and treatment outcome of arteriovenous malformations presenting before 18 years of age.

ISSN:1050-6438    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Summary:Psychological considerations in the complaint of chronic pain are increasingly recognized to be important. A review of 1,541 consecutive patients evaluated in a multidisciplinary pain treatment group and a subset of 1,032 of these patients with pain of spinal origin were reviewed with regard to psychiatric, psychological, and psychosocial factors. Of these patients, 258 were found to have normal premorbid psychological profiles and an acceptable diagnosable physical cause for the complaint of pain. In 52 patients, no psychological or physical problems could be identified to explain the abnormality. In 103 patients a definitive psychiatric diagnosis was made. In 619 patients, a diagnosis of personality disorder or personality dysfunction was made. An unusually prolonged adjustment disorder was identified in 304 patients, and 203 were thought to have a long‐standing dysfunction present before the disabling pain‐producing event. Of this group, 112 were diagnosed as true personality disorder. Reactive depression was present in 908 patients and 825 exhibited chronic anxiety state. When first seen, 928 patients were using narcotics and 825 were using a psychotropic drug. Only 10% were taking no drugs. The presence of a psychiatric diagnosis or personality dysfunction correlated with poor outcome from interventional procedures. Depression, anxiety, and previous drug use did not relate to outcome.

ISSN:1050-6438    

出版商:OVID    

年代:1991

数据来源: OVID