Introduction: High grade gliomas (HGG) are a group of tumors with infiltrative nature in general. Surgery is the first step in their treatment. It can be beneficial in two aspects: firstly, in establishing normal intracranial pressure and, secondly, in reducing the tumour volume. The choice of method depends on the location of the lesion, the expected grade of malignancy, and the general condition of the patient. Despite constant development of neuro-oncology and microsurgical techniques, the 5-year survival rate in patients with HGG remains less than 10% and the median survival is still less than 2 years. Aim: At present, there is no final therapeutic “segment” to provide a better outcome than the complex treatment of HGG. Moreover, the treatment’s relative efficacy and recurrence of these tumours carry an additional problem. The aim of this study was to estimate the overall survival of patients with HGG operated in our clinic and compare it with literature data. Materials and methods: One hundred twenty-one cranial operations for HGG were reviewed (conducted between 2014 and 2019). Summary characteristics of the various parameters were presented in respect to the radical nature of the operative intervention using Kaplan-Meier analysis and chi square tests. All patients were followed up at regular check-ups. Results: HGGs were 103 or 85.12% of all gliomas operated for the 2014-2019 period. The most common cases were in the 51 to 60 age group. The cases in men were twice as common. The most common localization of the neoplasm is in the temporal region (36.36%) and the rarest was found in the occipital region (3.30%). It was estimated that our operated patients with HGG had 12.23 months over-all survival. Gross total resected patients had a median survival (OS) of 14.53 months, while subtotal resected patients had a median survival (OS) of 10.44 months. It is estimated 7.97 months free tumor survival period (time to relapse - FTS) for our operated patients with HGG. Gross total resected patients had a median FTS of 10.88 months, while subtotal resected patients had median FTS of 5.70 months. We noticed permanent new neurological deficit (NND) in 20 patients (19.45%) operated with GTR, and in 5 patients (4.85%) operated with STR. Conclusions: Median survival - OS, free tumor survival period - FTS and new neurological deficit - NND were statistically significant (p<0.05) with extent of resection – GTR or STR in our study. Maximal safe radical (total) or supratotal resection is preferred in treating HGG.
Summary Craniometric points are essential for orienting neurosurgeons in their practice. Understanding the correlations of these points help to manage any pathological lesion located on the cortical surface and subcortically. The brain sulci and gyri should be identified before craniotomy. It is difficult to identify these anatomical structures intraoperatively (after craniotomy) with precision. The main purpose of this study was to collect as much information as possible from the literature and our clinical practice in order to facilitate the placement of craniotomies without using modern neuronavigation systems. Operative reports from the last five years on cranial operations for cortical and subcortical lesions were reviewed. All the craniotomies had been planned, using four methods: detection of craniometric points, computed tomography (CT) scans/topograms, magnetic resonance imaging (MRI) scans/topograms, and intraoperative real-time ultrasonography (USG). Retrospectively, we analyzed 295 cranial operations. Our analysis showed that operating on for cortical lesions, we had frequently used the first and the second method mentioned above (118 patients), while in cases of subcortical lesions, we had used craniometric points, MRI scans/topograms and intraoperative real-time USG as methods of neuronavigation (177 patients). These results show that craniometric points are essential in both neurosurgical procedures.
Summary Unsatisfactory results from lumbar disc herniation (LDH) conservative treatment suggest referral of patients for neurosurgical treatment. The time required for such a decision is considered to be about 4-6 weeks. In most cases, surgery quickly relieves pain symptoms, all along with the restoration of patient functions. The optimal surgical technique for LDH is theoretically controversial. We consider two discectomy methods as quite effective in our clinic: standard open discectomy (SD) and microdiscectomy (MD). Many retrospective studies have demonstrated the superiority of one of these techniques. Most studies describe microdiscectomy as a golden standard for surgical treatment of symptomatic disc herniation. We focused on the clinical aspects and correlations in the surgical treatment of LDH, as presented in the literature. The patients we present were divided by type of surgical procedure (SD or MD), and other parameters: sex, age, duration of symptoms, blood loss, duration of the operation, reoperation rate, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). We used chi-square tests (ANOVA analysis) and directional measures to determine statistically significant data. Five hundred eighty-nine single-level lumbar discectomies were performed for five years (2012-2017), and all the patients presented with classical signs of the condition, i.e., vertebral and radicular syndromes. SD was performed on 498 patients, and MD – on 91 patients. Analyses of the parameters mean VAS values of lumbar and leg pain postoperatively, and within one month after surgery demonstrated statistically significant differences between standard and microdiscectomy (p<0.05). LDH surgical techniques have become more and more sophisticated over the last 40 years, but without substantial improvement in the functional and clinical results. Appropriate patient selection is a crucial factor for the postoperative outcome. Neurosurgeons should fully master the chosen technique for satisfactory postoperative results.
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