ObjectThe appropriate dose during stereotactic radiosurgery (SRS) of cerebral arteriovenous malformations (AVMs) remains a matter of debate. In the present study, the authors retrospectively evaluated the association of using a prescribed dose calculated utilizing the K index with the obliteration rate of cerebral AVMs after SRS.MethodsThe authors performed a retrospective analysis of the Cleveland Clinic SRS database. All patients undergoing Gamma Knife radiosurgery for cerebral AVMs from 1997 to 2010 were selected. Regression techniques and Kaplan-Meier analyses were used to investigate the effect of divergence from the optimal K index dose on the rate of AVM obliteration.ResultsIn the study period 152 patients (mean age 43.6 years; 53.9% of treatments were performed in females) underwent 165 Gamma Knife radiosurgery treatments for AVMs. In a univariate analysis Spetzler-Martin grade (OR 0.63 [95% CI 0.42–0.93]), higher AVM score (OR 0.43 [95% CI 0.27–0.70]), larger AVM volume (OR 0.88 [95% CI 0.82–0.94]), and higher maximum diameter (OR 0.56 [95% CI 0.41–0.77]) were associated with a lower rate of AVM obliteration. Higher margin dose (OR 1.16 [95% CI 1.08–1.24]) and higher maximum dose (OR 1.08 [95% CI 1.04–1.13]) were associated with a higher obliteration rate. To further examine the effect of prescribed dose divergence from the calculated K index dose, cases were classified to groups depending on the AVM volume and dose variance from the ideal K index dose. Contingency tables and Kaplan-Meier curves were then created, and no significant differences in rates of obliteration were noted among the different groups.ConclusionsGamma Knife radiosurgery for cerebral AVMs remains an effective and safe treatment modality. Smaller AVMs may receive doses less than the calculated K index dose without an apparent effect on obliteration rates.
Objective:To report our experience with the minipterional (MPT) craniotomy approach for anterior circulation aneurysms and to discuss the clinical outcomes as well as to evaluate the advantages of this unique approach.Materials and Methods:Single-center retrospective review of 57 cases involving anterior circulation aneurysms both ruptured and unruptured aneurysms treated with the MPT. We analyzed the clinical and patient demographic data, aneurysm characteristics, surgical outcomes, and complications in these individuals.Results:Between July 2008 and March 2014, of the 57 patients reviewed: 45 had middle cerebral artery (MCA), 6 had internal carotid artery terminus, and 7 had posterior communicating artery aneurysms. 20 of the 57 patients presented with a ruptured aneurysm. The average aneurysm size was 5.8 mm. The length of hospitalization for unruptured aneurysm cases ranged between 3 and 5 days. The average follow-up for all cases was 21.5 months. Successful clipping of the aneurysms was obtained in all patients. None of the cases required additional skin incisions or craniotomy extensions. The overall surgical outcomes were favorable. There was no postoperative facial nerve damage, temporalis muscle wasting, or symptoms of paresthesias around the incision line. Two patients developed a postoperative stroke manifested as symptoms of unilateral arm and facial weakness, receptive aphasia, and dysarthria.Conclusion:The MPT provides a reliable and less invasive alternative to the standard pterional craniotomy. Furthermore, ruptured and unruptured anterior circulation aneurysms can safely and effectively be treated with limited bone removal which provides better cosmetic outcomes and excellent postoperative temporalis muscle function.
Objective?To establish a consistent surface bony landmark for a middle fossa approach (MFA) lateral craniotomy represented by the squamosal suture (SS).
Methods?In 60 dried skulls, we assessed the relation between the SS and the external auditory canal (EAC). The lateral portion of the middle cranial fossa floor was also assessed for a possible relation with the anteroposterior diameter (APD) of the squama temporalis (ST). Clinically, we applied our findings on the SS in MFA for different lesions.
Results?A vertical line at the EAC divided the ST into the anterior part constituting 61% of the APD (i.e., two thirds) and the posterior part forming 39% (i.e., one third). The average ST height was 35.92 mm. The SS posterior limit at the supramastoid crest was located just anterior to the external projection of the petrous ridge in 35 skulls (58%) and exactly corresponded to it in 25 skulls (42%). The APD of the ST equals on average 97% of the APD of the lateral middle cranial fossa. Optimum exposure of the middle fossa was obtained without any further craniotomy extension.
Conclusion?The SS serves as a consistent natural surface bony landmark for MFA. Optimum craniotomy, two thirds anterior to the EAC and one third posterior, is obtained following SS as a landmark.
Introduction
Spinal ependymom as are rare tumors and present mainly around 40 years of age. Total resection is claimed to be the best option for the treatment, but it carries some risk and it needs good evaluation and may be some proper facilities to get satisfactory results.
Aim
The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths and locations. We present our surgical experience in Al-Zahraa University Hospital (Al-Azhar University) for managing spinal cord ependymomas.
Patients and methods
We report the results of eight patients over a 2-year period (2016–2018). All cases were managed in Al-Zahraa University Hospital. Surgery was recommended for all patients who have symptoms. Preoperative and postoperative clinical assessments were done for all cases.
Results
There were six men and two women. The mean age was 36.4 years (range, 24–60 years). The follow-up period ranged from 1 month to 2 years. Gross total resection was done in six (75%) cases. Near-total resection was done in one case, and partial resection was done in one cervical case. The overall postoperative complications rate was 12%. Seven of the eight cases improved clinically. Pain improved in seven (87.5%) cases. All three cases with weakness improved within the first week of surgery or during the first 6 months (postoperative follow-up period). Sphincters improved in three out four cases that had been presented with sphincters.
Conclusion
Most spinal ependymomas can be managed by gross total resection without significant morbidity. Neurological deficit occurred more in tumors that extend more than two spinal levels. Some cases have early postoperative neurological functions declination, but these cases improved during follow-up. It is better to use neurophysiological monitoring, but it is not essential for achieving good outcome.
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