摘要:

A series of 54 posterior fossa meningiomas treated from January 1971 to December 1996 is reported. The patients were 42 women and 12 men ranging in age from 35 to 83 years (mean 55.6 years). Grouped by the site of tumor attachment, these tumors were divided into six categories: tentorial, petroclival, cerebellopontine angle, falcotentorial, cerebellar convexity, and foramen magnum meningiomas. Surgical approaches were selected on the basis of the tumor attachment and extension, the involvement of major cerebral arteries and the venous system, and the involvement of the cranium and brain stem on preoperative neuroimaging. Of 54 patients, 50 underwent operation. Total removal (Simpson I, 8 cases; Simpson II, 27 cases) was achieved in 35 patients (70%), subtotal removal (Simpson III) in 5 patients (10%), and partial removal (Simpson IV) in 10 patients. Eight patients had immediate surgical complications, and the morbidity rate was 16%. One patient died; thus, the mortality rate was 2%. All patients were followed over a mean of 8.1 years (range 3 months to 22 years) after surgery. Recurrence occurred in three patients, two with tentorial meningioma and one with petroclival meningioma. With advances in neuroradiology and micro-surgical techniques, the surgical outcome of meningiomas has markedly improved. The present surgical approach, including skull base operative techniques and intraoperative monitoring and navigation, has resulted in successful removal of posterior fossa meningiomas more safely with acceptable mortality and morbidity rates.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

As surgical approaches and internal fixation techniques in the cervical spine continue to evolve, a detailed knowledge of the anatomy of the cervical spine is required to avoid or minimize surgical complications. The purpose of this article is to review the current studies of the essential bony anatomy relative to surgical procedures and instrumentation in the cervical spine.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Rheumatoid arthritis and other bone-softening diseases such as Paget's disease, osteogenesis imperfecta, rickets, osteomalacia, and hyperparathyroidism have the potential to destabilize the upper cervical spine. In these disease settings, the relation between the occiput, axis, and atlas may be altered and destabilized. This paper reviews the anatomy, clinical presentation, and pathogenesis of the different diseases, as well as their medical and surgical management at the occipitocervical junction.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Choroid plexus papillomas (CPPs) are neuroectodermal neoplasms constituting 0.4% to 0.6% of all central nervous system tumors; 70% to 90% of all CPPs occur in the first 2 years of life. CPPs are usually slow-growing and cause symptoms related to increased intracranial pressure because of concomitant hydrocephalus or focal neurologic signs. Up to 10% of CPPs, however, behave in a clinically malignant fashion or display histologic features of malignancy or, regardless of the latter, feature cerebrospinal fluid dissemination. Elective treatment is radical surgical ablation; radiation therapy and chemotherapy have served only as adjuvants. The authors carried out a comprehensive review of the literature to assess the present state of knowledge with respect to the biology, pathologic diagnosis, modality of treatment, prognosis, and genetics of these neoplasms, with a view to helping the diagnostician and the therapist.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Rheumatoid disease affects the cervical spinal cord in the great majority of patients who have had the condition for 10 years or more. Damage to the neuraxis is produced either by direct compression or by repeated microinsults that occur during normal neck movements. Surgery is clearly indicated in patients with obvious and progressive myelopathy and C2 radiculopathy. The cervical spine should be imaged to assess both static and dynamic mechanisms of neuraxis damage. Therapeutic surgery generally involves direct decompression by means of anterior approaches to the neuraxis. If the compression can be reduced by extension of the cervical spine, fusion should be carried out in this position without the need for anterior decompression. An alternative school of thought recommends posterior decompression by laminectomy, a simple fusion technique, and halo jacket immobilization. It remains difficult to predict which patients will progress to myelopathy. The use of absolute bone measurements such as the posterior atlantodental interval may prove helpful and may be one of the keys in identifying patients who will benefit from prophylactic surgery.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Primary brain tumors arising during childhood continue to pose an immense challenge for neurosurgeons and other clinicians. These neoplasms are heterogeneous in their histologic composition, potential for metastasis, need for adjuvant therapy, and prognosis for survival. Collectively, children with brain tumors now have a 5-year overall survival rate approximating 60%. Advances in surgical approaches and techniques have contributed greatly to this effort, as reviewed previously here. Equally important to improved survival have been the trials conducted by two national pedi-atric consortiums sponsored by the National Cancer Institute's Clinical Trials Group Program. Clinical studies of brain tumors conducted over the last two decades by these consortiums—the Pediatric Oncology Group (POG) and the Children's Cancer Group (CCG)—are reviewed here, along with basic postsurgical management and standard adjuvant therapies. Past and current POG and CCG studies for medulloblastoma, ependymoma, brain stem glioma, low-grade gliomas, malignant gliomas, germ cell tumors, and infant brain tumors are summarized. Understanding these past and present efforts is of paramount importance to advance management and ultimately survival for childhood brain tumors.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Ludvig Puusepp (1875–1942) performed his first neurosurgical case in 1899, the same year he graduated from the St. Petersburg Military Medical Academy. His mentor was Vladimir Bekhterev, the founder of Russian neurology. Puusepp thought that the then-dismal state of brain surgery could be improved, and subsequently set out to prove his innovative ideas and established neurosurgery in St. Petersburg. There he became the world's first professor in neurosurgery in 1910 and worked on establishing neurosurgery as a subspecialty until 1920, when he left Russia for Estonia.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Spinal cord injury (SCI) continues to present a challenging spectrum of diseases. Pessimism about the prognosis and potential treatment for SCI has persisted until recently. Advances in the emergency, diagnostic, medical, and surgical care of these patients have prompted fresh enthusiasm for developing further treatment strategies. This progress for the most part is a direct result of advances made in the laboratory from basic science research, as well as innovative clinical studies. This article reviews the epidemiology and pathophysiology of SCI and details the evolution of therapies designed to enhance recovery that have arisen from the laboratory.

ISSN:1050-6438    

出版商:OVID    

年代:1998

数据来源: OVID