OBJECT World Health Organization Grade 2 meningiomas are aggressive tumors associated with a high recurrence rate leading to repeated surgical procedures, which can seriously worsen a patient's neurological status. Although radiosurgery is an increasingly popular technique, its role in the management of Grade 2 meningiomas has yet to be defined. In this study the authors aimed to evaluate radiosurgery in achieving control of proven tumor progression occurring after resection of Grade 2 meningioma. METHODS This retrospective study included consecutive patients who, between 2000 and 2012, had undergone radiosurgery for radiologically proven progression of a previously surgically treated Grade 2 meningioma. RESULTS Twenty-seven patients were eligible for analysis. There were 9 men and 18 women with a mean age of 59 years. The mean radiation dose was 15.2 Gy (range 12–21 Gy), and the mean target volume was 5.4 cm3 (range 0.194–14.2 cm3). Thirty-four radiosurgical procedures were performed in the 27 patients. The mean progression-free survival after radiosurgery was 32.4 months among those with progression in a target irradiated volume and 26.4 months among those with progression in any intracranial meninges. With a mean follow-up of 56.4 months (range 12–108 months), the 12-, 24-, and 36-month actuarial local control rates for all patients were 75%, 52%, and 40%, respectively, and the regional control rates were 75%, 48%, and 33%. A single case of transient hemiparesis completely resolved without sequelae. CONCLUSIONS Radiosurgery appears to be a safe and effective treatment for the local control of delayed progression after resection of a Grade 2 meningioma. Higher radiation doses similar to those applied for malignant tumors should be recommended when possible.
Background In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment. Methods This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion-extension radiographs at 2 years. Results The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p \ 0.05). The mean kyphosis angle decreased from 17°to 2°at the last follow-up (p \ 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.Conclusion Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.
Adjuvant radiotherapy is an important therapeutic tool in the treatment of patients with grade 2 meningioma. It delays tumor progression and reduces the need for further surgery. Adjuvant radiotherapy must be considered as a treatment option in oncological multidisciplinary meetings, regardless of the quality of surgical resection.
Highlights In our department of neurosurgery, we noticed a higher rate of patients with ruptured aneurysm who had a deteriorated neurological presentation on admission during COVID-19 pandemic (2020 group, n = 26). A group control included 28 consecutive patients managed at the same institution for the same disease in 2019, during the same time frame (2019 group). Rates of poor neurological presentation and severe radiological presentation on hospital admission were higher during COVID-19 pandemic (p = 0.01 and p = 0.02, respectively). During COVID-19 pandemic (2020 group), the delayed hospital admission was longer (p = 0.005). Therefore, vasospasm’s rate on presentation was also higher (p = 0.04). In 2020, patients with only sudden headache may have feared immediate hospital admission because of potential COVID-19 contamination. In case of recurrent COVID-19 pandemic, educating the population concerning specific symptoms such as sudden headache, neurological deficit or even sudden chest pain should be emphasized.
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