To evaluate the important role of Intraoperative Ultrasound (IOUS) in measurement of pre & postoperative resection volume of an intra-axial posterior fossa lesions and to compare these results with that measured in pre and postoperative MRI brain. Also, to assess the principal surgeon opinion regarding the ability of IOUS in localization and differentiating the borders of those lesions, and his comfortability during handling of this device. There are different methods, which are helpful to localize precisely and allow maximum tumor resection, such as neuro-navigation, intraoperative MRI, 5aminolevulinic acid, as well as IOUS. Every method has its pros & cons. Although Intraoperative MRI Provides real time updated images, however it's not available in most of neurosurgery centers in developing countries. So, with these financial and ergonomic limitations of the Intraoperative MRI, usage of Intraoperative Ultrasound could be considered as a potential competitor in developing world. This is a prospective study conducted at Ain Shams University hospital in the period from February 2016 to July 2018, we enrolled 23 patients presented with posterior fossa intra axial neoplasms that operated with Intra Operative Ultrasound (IOUS) assistance. IOUS was able to well localize the lesions in 96% of cases and it was able to differentiate solid and cystic parts in all the cases. IOUS was able to define well the lesion borders in 20/23 (87%) of cases. There was no difference between volumes calculated from preoperative MRI and the pre-resection IOUS, also there was no significant difference between the residual volume detected by the IOUS and the postoperative MRI brain. Principal surgeon reported overall great impression of the IOUS in 18/23 (78%) of cases. Mean total additional time of usage of the IOUS was 27min. IOUS was found to be valuable in localization of the lesions, differentiating solid and cystic parts and detection of the residual volume in the posterior fossa intra axial tumors.
Introduction Occult spinal dysraphism involves a wide range of congenital anomalies, e.g., lipoma, Lipomeningomyelocele, congenital dermal sinus, etc. Occult spinal dysraphism also may present with a wide spectrum of clinical manifestations and radiological findings, i.e., it ranges from asymptomatic patients that are accidentally discovered to low lying conus with neurological, skeletal and urological manifestations. Even though neurosurgeons are well-aware of neurological presentations that indicate surgical intervention in children with occult spinal dysraphism, urological symptoms may present some controversy in management. This review aims to discuss urological outcomes of detethering as regarding time of intervention, improvement of the urological symptoms after detethering, and the role of urodynamics preoperatively and during follow-up. Methodology An online search of the literature was done including studies in English language from 1990 to January 2022. Included studies were analytical with well conducted descriptive nature of acceptable quality (at least level 3 evidence). Patient characteristics included both male and female children and adolescents, up to 19 years old who presented with clinical and/or radiological evidence of tethering of the spinal cord. Most studies that were included had availability of urodynamics. A total of 15 studies were included involving 633 patients. Meningomyelocele (MMC) and other spina bifida operta cases are excluded. Results Results of all studies were collected and mean age of studies was gathered and plotted on a chart in relation to urological outcome and urodynamic improvement. Most results favored early detethering; however, many factors were found to affect the inverse proportion curve of age with clinical improvement or urodynamics. For example, studies that included secondary tethered cord showed poorer results than results that included primary tethered cord only, preoperative severity of urological symptoms (more severe symptoms were associated with irreversible poor outcomes), and preoperative urodynamic parameters. Conclusion The management of tethered cord syndrome and occult spinal dysraphism remains controversial. There is lack of class 1 evidence regarding tethered cord release surgery in occult spinal dysraphism. Heterogenicity of pathology, symptomatology and radiology make the randomization of such sample size difficult. The outcomes of surgical detethering are therefore multifactorial. A large sample of prospective randomized controlled studies addressing each factor, e.g., age, severity of symptoms, preoperative urodynamic parameters, is recommended in order to evaluate the impact of each factor on outcome.
Background: Cavernous angioma or cavernoma is a benign vascular malformation, which can be found at any region within the brain. Brain stem cavernous angioma is rare. Although the optimal management of intracranial cavernous angiomas is open resection, Gamma Knife radiosurgery (GKR) has played an important role in treating these deeply seated and high surgical risk malformations throughout the past 20 years.
Background The first line of treatment of Cushing’s disease (CD) is surgery. However, surgical resection is not amenable in all cases and the role of radiosurgical management of residual tumors or upfront treatment has been reported. Our study highlights the effectiveness and safety of Gamma Knife Radiosurgery for the treatment of Cushing’s disease. Methods This was an ambidirectional descriptive cohort study on 16 consecutive patients with a confirmed Cushing’s disease that underwent Gamma Knife Radiosurgery (GKR) before July 2014 and assessed for outcome during the study period between January 2014 and June 2016 (30 Months). We included patients with a minimum of two years follow up. The main outcomes were biochemical remission and tumor volume control. Secondary outcomes were visual field changes and morbidity. Results Sixteen cases with CD were included into the study. The Mean age ± SD was 34.81 ± 10.10 years. The male to female sex ratio was 1:3. Six cases (37.5%) were de novo. Normalization of hypersecretion at 2 years was achieved in 13 cases (81.3%).The median hormone normalization time was 23 months. Tumor volume control was achieved in all the cases, whereas tumor shrinkage was achieved in (10 cases) 62.5%. The median shrinkage time was 13 months. Of the 12 eyes with pre-Gamma Knife visual affection, 8 (75%) normalized, 4 (25%) improved, and none deteriorated. No patient developed new hypopituitarism after GK radiosurgery. One case developed diplopia at 24 months follow up from abducens palsy. No mortality occurred in our series. Conclusion Gamma Knife Stereotactic Radiosurgery is an effective and safe treatment option for Cushing’s disease. It can be used as a complementary therapeutic procedure to classic surgery or as a first line treatment in selected number of patients.
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