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Gamma knife surgery of meningiomas involving the cavernous sinus: long-term follow-up of 100 patients.

https://arctichealth.org/en/permalink/ahliterature97633
Source
Neurosurgery. 2010 Apr;66(4):661-8; discussion 668-9
Publication Type
Article
Date
Apr-2010
Author
Bente Sandvei Skeie
P O Enger
G O Skeie
F. Thorsen
P-H Pedersen
Author Affiliation
Department of Neurosurgery, Haukeland University Hospital, N-5021 Bergen, Norway. bsai@helse-bergen.no
Source
Neurosurgery. 2010 Apr;66(4):661-8; discussion 668-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cavernous Sinus - surgery
Female
Humans
Longitudinal Studies
Male
Meningeal Neoplasms - pathology - surgery
Meningioma - pathology - surgery
Middle Aged
Radiosurgery - methods
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Abstract
OBJECTIVE: Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. METHODS: 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0-243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients. RESULTS: Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6-20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives. CONCLUSION: GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.
PubMed ID
20305491 View in PubMed
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Intraoperative confocal microscopy for brain tumors: a feasibility analysis in humans.

https://arctichealth.org/en/permalink/ahliterature136867
Source
Neurosurgery. 2011 Jun;68(2 Suppl Operative):282-90; discussion 290
Publication Type
Article
Date
Jun-2011
Author
Nader Sanai
Jennifer Eschbacher
Guido Hattendorf
Stephen W Coons
Mark C Preul
Kris A Smith
Peter Nakaji
Robert F Spetzler
Author Affiliation
Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
Source
Neurosurgery. 2011 Jun;68(2 Suppl Operative):282-90; discussion 290
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Biopsy
Brain Neoplasms - pathology - surgery
Feasibility Studies
Female
Glioma - pathology - surgery
Humans
Image Processing, Computer-Assisted
Intraoperative Period
Male
Meningeal Neoplasms - pathology - surgery
Meningioma - pathology - surgery
Microscopy, Confocal - methods
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Abstract
The ability to diagnose brain tumors intraoperatively and identify tumor margins during resection could maximize resection and minimize morbidity. Advances in optical imaging enabled production of a handheld intraoperative confocal microscope.
To present a feasibility analysis of the intraoperative confocal microscope for brain tumor resection.
Thirty-three patients with brain tumor treated at Barrow Neurological Institute were examined. All patients received an intravenous bolus of sodium fluorescein before confocal imaging with the Optiscan FIVE 1 system probe. Optical biopsies were obtained within each tumor and along the tumor-brain interfaces. Corresponding pathologic specimens were then excised and processed. These data was compared by a neuropathologist to identify the concordance for tumor histology, grade, and margins.
Thirty-one of 33 lesions were tumors (93.9%) and 2 cases were identified as radiation necrosis (6.1%). Of the former, 25 (80.6%) were intra-axial and 6 (19.4%) were extra-axial. Intra-axial tumors were most commonly gliomas and metastases, while all extra-axial tumors were meningiomas. Among high-grade gliomas, vascular neoproliferation, as well as tumor margins, were identifiable using confocal imaging. Meningothelial and fibrous meningiomas were distinct on confocal microscopy--the latter featured spindle-shaped cells distinguishable from adjacent parenchyma. Other tumor histologies correlated well with standard neuropathology tissue preparations.
Intraoperative confocal microscopy is a practicable technology for the resection of human brain tumors. Preliminary analysis demonstrates reliability for a variety of lesions in identifying tumor cells and the tumor-brain interface. Further refinement of this technology depends upon the approval of tumor-specific fluorescent contrast agents for human use.
Notes
Comment In: Neurosurgery. 2011 Nov;69(5):E1182; author reply E118221778920
Comment In: Neurosurgery. 2012 Aug;71(2):E514-722596039
PubMed ID
21336204 View in PubMed
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