Is surgery useful in very old patients with intracranial meningioma?
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Age Factors↗
Biomedical subjects
R Delfini
Publications and source records attributed to R Delfini.
Malignant cerebellar astrocytomas in childhood. Experience with four cases.
The most frequent type of cerebellar astrocytoma in children is the pilocytic variety, for which the treatment of choice and prognosis are now well established. In contrast, an anaplastic lesion in this site is extremely rare. The authors present four cases of high-grade astrocytoma in a cerebellar site. They discuss the best type of treatment for this pathology, with particular reference to postoperative radiotherapy and chemotherapy, in the light of their results.
Adolescent↗
Sarcoma metastatic to the brain: a series of 15 cases.
METHODS: We report on 15 patients surgically treated for intraparenchymal brain metastases from sarcoma, including six osteosarcomas, five leiomyosarcomas, two malignant fibrous histiocytomas, and two alveolar soft-part sarcomas (ASPS). RESULT: Median survival after craniotomy was 9.3 months. Patients with a preoperative Karnofsky performance score of > 70 survived for 12.8 versus 5.3 months for those with a Karnofsky performance score < 70 (p=0.03). Patients with evidence of only lung metastases at the time of surgery (nine cases) survived 8.6 months, which was similar to the 10.4-month survival for patients with disease limited to the brain (p=0.1). The two patients with alveolar soft-part sarcomas are alive at 15 and 20 months after surgery. CONCLUSION: We conclude that surgery is effective in treating selected patients with sarcoma metastatic to the brain and that patients with metastasis from ASPS may have a relatively good prognosis if they are surgically treated. The complete removal of all brain metastases and a Karnofsky performance score > 70 are associated with a favorable prognosis; the presence of concurrent lung metastases is not a contraindication to surgery.
Adolescent↗
Chronic subdural haematoma: a possible relationship with tamoxifen.
Five patients operated on between 6 months and 7 years earlier for breast cancer were surgically treated for chronic subdural haematoma. This unusual association may be explained on the basis of known factors such as coagulative impairment subsequent to chemotherapy, a degree of cerebral atrophy or mild trauma. On the other hand, since four of the patients were taking antioestrogen therapy to control the disease, it is speculated that the oestrogenic properties of tamoxifen may have contributed to subdural bleeding.
Aged↗
Acute posttraumatic subdural hematomas: "intradural" computed tomographic appearance as a favorable prognostic factor.
OBJECTIVE: Posttraumatic acute subdural hematoma carries a high postoperative mortality rate. Preservation of subarachnoid spaces in preoperative computed tomographic (CT) scans may be interpreted as a favorable prognostic factor. METHODS: Thirty-one cases of posttraumatic acute subdural hematoma operated on consecutively, with an interval from trauma to surgery of less than 4 hours and a Glasgow Coma Scale score of less than 8, were reviewed. The immediate and long-term results were evaluated with reference to preoperative CT images, distinguishing cases with preserved subarachnoid spaces from the others. RESULTS: In 5 of the 31 cases, preoperative CT scans showed intact subarachnoid spaces and the absence of blood in the cerebrospinal fluid. These cases presented a much better postoperative course than did the others. CONCLUSION: The presence of intact subarachnoid spaces in CT scans for patients with acute subdural hematomas may be interpreted as an extremely favorable prognostic factor; this may be attributed to the protective effect of the integral visceral membrane of the hematoma, which prevents the diffusion of neurotoxic and vasoactive substances into the subarachnoid spaces. This group of hematomas was classified as "intradural," with reference to the concept of the "subdural compartment" described in studies conducted using an electron microscope.
Adult↗
Metastatic spinal cord compression. Clinical remarks.
BACKGROUND: Metastatic compression of the spinal cord is a frequent occurrence throughout the evolution of neoplastic disease. Possible clinical-diagnostic strategies and therapeutic management of this pathology are discussed in terms of survival and quality of life. METHODS: The study includes 59 patients (40 males and 19 females, with an average age of 48.4 years) with metastatic spinal compression treated surgically in our centre (in some cases with stabilization of the spinal segment involved). RESULTS: In 40 cases the localization of the primary tumor was known when the patient was admitted. The segment involved was the dorsal one in 41 cases. The most frequent type of tumor was pulmonary carcinoma in males and breast carcinoma in females. Average survival was 5.3 months. Treatment integrated by stabilization improved the quality of life in comparison to laminectomy alone. Survival was also influenced by the histological type and site of the primary tumor. CONCLUSIONS: Surgical treatment not only prolongs survival but, above-all, guarantees a satisfactory quality of life.
Adult↗
Solitary cerebral metastasis from tumor of the testis: some observations about treatment in two cases.
The authors describe two cases of solitary cerebral metastasis from non-seminatous germ cell tumors of the testis: in the first case, the histology was teratocarcinoma; in the second, it was embryonal carcinoma. Both patients underwent surgery, whole-brain radiotherapy and chemotherapy, and are still alive and disease-free after respectively 42 and 72 months. Although systemic metastasis from tumors of the testis are relatively common, they rarely involve the nervous system. A review of our cases and those reported in the literature shows that the outcome in these patients can be improved by the combined surgical, radiological and chemotherapeutic treatment of the metastasis.
Adult↗
Primary spinal epidural non-Hodgkin's lymphomas in childhood: a review of 6 cases.
We report a retrospective study regarding 6 children with primary epidural non-Hodgkin's lymphomas and analyse the factors influencing prognosis with emphasis on treatment. Four patients were females and 2 males. The neurological condition of patients was assessed pre- and postoperatively according to Shaw's classification for neurological disability. All patients were submitted to surgery, radiotherapy and chemotherapy. Histologically, the tumour proved to be a high-grade non-Hodgkin's lymphoma in all cases. At follow-up, all patients are alive after a median interval of 52 months (range 24-72 months). This study showed that the outcome of patients depends on the gravity of pre-operative deficits whereas the survival is influenced by the type of treatment.
Adolescent↗
Malignant supratentorial astrocytomas of late childhood. Our experience with 25 cases.
The authors present 25 patients ranging in age from 8 to 16 years who had malignant supratentorial astrocytomas. This type of lesion represents one of the most important and statistically significant causes of morbidity and mortality in late childhood. Compared to adult malignant supratentorial astrocytomas, these lesions seem to show a better survival rate. The reason is unknown. The authors present their experience regarding the importance of radical removal and histology for a better prognosis.
Adolescent↗
High-dose radiation-induced meningiomas.
BACKGROUND: Numerous neoplasms within the CNS have been reported as radiogenic in origin; radiation-induced meningiomas are at least five times more numerous than gliomas or sarcomas in the world literature. METHODS: The authors review 10 cases of cerebral meningiomas following high-dose radiotherapy in patients operated for neoplasm of the nervous system. The pathologic and clinical aspects of this unusual complication are analyzed in all cases in the world literature. RESULTS: There is a female predominance (F-M ratio: 3:2) and the patients are young (mean age: 33.1 years; median: 29 years). The average latency period is 14.4 years (range: 9-21 years). The first disease is acute lymphocytic leukemia (ALL) in 40% of cases. Radiation induced meningiomas are atypical in four cases. Recurrence was observed in one case without malignant transformation. CONCLUSION: High-dose radiation-induced meningiomas have the following characteristics: (1) children appear particularly sensitive to the development of this tumor; (2) there is a female predominance, otherwise than is observed in low-dose meningioma; (3) these tumors present a peak frequency in the third decade of life; and (4) frequently, these tumors are atypical and recur. Finally, it is essential that every new case be reported to throw light on this particular pathologic correlation with its many grey areas.
Adolescent↗
Cavernoma of the cavernous sinus: case report.
BACKGROUND: The authors report a case of extra-axial cerebral cavernoma localized at the level of the cavernous sinus. This pathology is extremely rare, therefore, differential diagnosis with tumors such as meningioma is often difficult. During recent years, surgical indications for these lesions, congenital and rarely hereditary, have become more definite due to the considerable progress made in neuroradiologic and microsurgic techniques as well as better anatomic knowledge of this region. METHODS: This 49-year-old man was admitted with a 1-year history of diplopia. Cranial computed tomography (CT) scan with contrast medium, performed prior to admission, showed an expansive lesion at the level of the right cavernous sinus. Preoperative neuroradiologic diagnosis, after cerebral magnetic resonance imaging (MRI) with gadolinium enhancement and cerebral panangiography, was probable cavernoma. The lesion was totally removed via a fronto-orbito-temporo-zygomatic craniotomy. RESULTS: Postoperatively, the patient had a right oculomotor nerve palsy. This spontaneously resolved 8 months after surgery; diplopia also completely disappeared. Early postoperative control MRI scans with gadolinium on the 2nd postoperative day and 3 months after operation confirmed total removal of the lesion. CONCLUSIONS: The clinical onset and neuroradiologic aspect of these lesions and the fact that they rarely involve the cavernous sinus, may sometimes make preoperative diagnosis of cavernous sinus cavernoma difficult. Nevertheless, given the routine use of microsurgical techniques and improved anatomic knowledge of this delicate region, the treatment of choice is surgery. However, when doubts exist regarding achievement of total removal, radiosurgery is still a valid therapeutic tool.
Brain Neoplasms↗
Prognostic factors in intramedullary astrocytomas.
This report presents a retrospective prognostic study of 65 patients with intramedullary astrocytoma surgically treated between 1953 and 1990. Median survival and statistical survival at 5 years were assessed in relation to clinical, histological and therapeutic factors for each patient. Results showed that factors positively influencing the prognosis are low histological grade of the tumour and good pre- and post-operative general conditions. Among the grade II astrocytomas, the fibrillary and protoplasmatic types presented longer survival times regardless of the type of removal performed. In anaplastic astrocytomas the simultaneous presence of certain morphological features indicative of higher malignancy negatively influenced survival. The degree of resection did not influence average survival within each histological grade.
Adolescent↗
Three-dimensional computed tomographic imaging in the diagnosis of vertebral column trauma: experience based on 21 patients and review of the literature.
OBJECTIVE: To compare standard x-ray films, two-dimensional computed tomographic reconstructions and three-dimensional (3-D) computed tomographic reconstructions for assessing the grade, extent, and severity of vertebral fracture. PATIENTS AND METHODS: 3-D images were created from standard computed tomographic scans obtained using a General Electric PACE scanner. In 21 patients (17 men and four women) these images were obtained during both the acute phase and at long-term follow-up; there were six cervical, four dorsal, five dorso-lumbar, and six lumbar fractures. RESULTS: The 3-D images supplied useful information in complex traumas with rotation and/or dislocation of the vertebral body and in cases with loss of spinal alignment. The 3-D images also proved to be useful as an adjunctive imaging method for evaluation of bone fusion integrity. CONCLUSION: 3-D images produced by recently available software provide a 3-D understanding much more readily than do multiple two-dimensional images. Because it would be very difficult to standardize this method of imaging, it seems best that the specialist (orthopedic surgeon, neurosurgeon, neuroradiologist) be present during the investigation to decide the viewing angles. An important limitation to this method is the presence of degenerative disease or osteoporosis, mainly in elderly patients.
Adolescent↗
Role of transient-evoked otoacoustic emissions for hearing preservation in acoustic neuroma surgery.
OBJECTIVE: This study aimed to assess whether transient-evoked otoacoustic emissions (TEOAEs), which are known to be expressions of an intact cochlear function, could be useful for the rationale of hearing preservation in acoustic neuroma (AN) surgery. STUDY DESIGN: The TEOAEs were measured before, during, and after surgery in a consecutive series of patients affected by cerebellopontine angle tumors. SETTING: The study was performed at the Department of Otolaryngology, University "La Sapienza" of Rome. PATIENTS: Five patients with AN and one with a meningioma totally involving the Cochlear (VIII) nerve. INTERVENTION: Retrosigmoid approach on the ground of the limited AN size (within 20 mm) and the 30/70 rule, as proposed by the American Academy of Otolaryngology-Head and Neck Surgery nomogram. Two patients also were selected despite a poor hearing level and the absence of TEOAEs. MAIN OUTCOME MEASURES: Preoperative and postoperative pure tone audiometry compared with TEOAEs. Intraoperative TEOAEs were compared with electrocochleographic findings. RESULTS: The TEOAEs were found to be present also in patients with AN with poor pure-tone average (PTA) threshold (i.e., > 75 dB). Intraoperatively, TEOAEs recording showed to be markedly affected by the environmental noise as well as by specific intraoperative maneuvers, such as drilling of the internal auditory canal or tumor removal or both. In the three patients in whom hearing successfully was preserved. TEOAEs were present in the first postoperative days, despite a temporary deterioration of the PTA threshold. CONCLUSIONS: The intraoperative use of TEOAEs showed to be scarcely reliable, whereas their presence in the preoperative assessment of patients with AN could lead to an extended number of patients to be selected for hearing-preservation surgery. Finally, an early postoperative identification of TEOAEs may be considered a favorable prognostic sign for foreseeing a delayed pure-tone hearing threshold recovery.
Acoustic Stimulation↗
Spontaneous movement of metallic foreign bodies. Case report.
We report a case of missile injury to the brain with an unusual complication. The bullet migrated by its mere weight to a distant location through the brain parenchyma after initially lodged in a superficial site. Movement of the bullet was first detected on CT scan and the significance and treatment of this finding is emphasized.
Adult↗
Solitary brain metastases from non-oat cell lung cancer: clinical and prognostic features.
The authors report 91 cases of solitary brain metastasis from non-oat cell lung cancer, 66 patients were males and 25 females; average age was 57 years (range 40-72 years). Surgical removal was total in 80 cases and partial in 11. All patients received postoperative radiotherapy and 40 chemotherapy. Histologically, the tumor was an adenocarcinoma in 51 cases (56%), a squamous cell carcinoma in 22 (24%), an undifferentiated carcinoma in 18 (20%). Median survival was 16 months and the main cause of death was progression of the primary cancer (59% of cases). Survival was influenced by staging of the primary tumor, while no prognostic significance was found regarding the type of clinical tumor onset, type of radiotherapy and the histotype of the lesion. Use of the "no internal touch" technique and brain radiotherapy reduced local brain relapse.
Adenocarcinoma↗
High-dose radiation-induced meningiomas in elderly.
The authors report 2 cases of cerebral meningiomas following high-dose radiotherapy in elderly patients treated for skull basaloma. These two are the first cases over 65 years old cases reported in the literature. The pathological and clinical characteristics of high-dose radio-induced meningiomas are the following: 1) children appear particularly sensitive to the development of this tumor; 2) there is a female patient predominance, in contrast to the male dominance observed in low-dose meningioma, 3) these tumors present a peak frequency in third decade of life; 4) frequently, these tumors are atypical and recur.
Aged↗
Choroid plexus papillomas: consideration of a surgical series of 33 cases.
With the aim of understanding better the behaviour of an uncommon lesion such as the choroid plexus papilloma, we have analysed a surgical series of 33 cases operated on at the Neurosurgical Department, University of Rome "La Sapienza", between 1955 and 1992 and have reviewed the relevant literature. Our results support the view that a radical resection of these lesions, which if removed entirely, carry a very good prognosis. The hydrocephalus should be treated only if persistent. Adjuvant treatment such as radiotherapy and chemotherapy should be reserved for specific cases.
Adolescent↗