V estibular schwannomas (VSs; also known as acoustic neuromas) are benign tumors that represent approximately 10% of intracranial primary brain tumors. 12 Although they may be asymptomatic, they often present with unilateral hearing loss, tinnitus, imbalance, or vertigo. When they are discovered, VSs are managed in 3 ways: observation (the “wait and scan” approach); Gamma Knife surgery (GKS); or microsurgery. There is a significant body of literature (including many single- and multi-institution studies, as well as meta-analyses) regarding which
Corinna C. Zygourakis, Taemin Oh, Matthew Z. Sun, Igor Barani, James G. Kahn and Andrew T. Parsa
Andrei F. Joaquim, Wellington K. Hsu and Alpesh A. Patel
physical demands that may put his spine at risk for new injury. The spines of high-performance athletes are under unique forces of compression and repetitive and intensive shear, increasing the prevalence of spondylosis. 1 , 8 , 9 Additionally, spine problems may affect the athlete's psychological state, which may lead to early retirement. 8 , 9 Considering the unique aspects involved in the management spinal diseases of professional athletes, we performed a systematic review of papers reporting the outcomes of cervical spine surgery in high-level athletes
Gregory W. Poorman, Peter G. Passias, Samantha R. Horn, Nicholas J. Frangella, Alan H. Daniels, D. Kojo Hamilton, Hanjo Kim, Daniel Sciubba, Bassel G. Diebo, Cole A. Bortz, Frank A. Segreto, Michael P. Kelly, Justin S. Smith, Brian J. Neuman, Christopher I. Shaffrey, Virginie LaFage, Renaud LaFage, Christopher P. Ames, Robert Hart, Gregory M. Mundis Jr. and Robert Eastlack
strong negative impact on postsurgery pain and outcome. 14 , 18 Specifically, patients with anxiety and depression have reported higher levels of postsurgery pain and worse long-term outcomes. 11 , 13 Currently there is no protocol for helping patients with depression and anxiety as they undergo cervical spine deformity surgery, whereas attempts at establishing protocols in the lumbar spine surgery population have been better developed. 31 Similar recommendations for the cervical spine were summarized in a review published in the Journal of Orthopedic and Sports
Michael E. Sughrue, Tyson Sheean, Phillip A. Bonney, Adrian J. Maurer and Charles Teo
R ecurrence in glioblastoma (GBM) is inevitable. Given that GBMs typically recur focally, 8 and in many cases, resection of all or most of the enhancing portion of the tumor is possible in experienced hands, 5 , 6 repeat resection is often a feasible management strategy. However, there is a paucity of literature to inform decision making for resectable focally recurrent tumor and help clinicians and surgeons decide when surgery is worth the risk. That our opinions and actions inherently change the overall survival (OS) independent of the intervention
Björn Sommer, Peter Grummich, Roland Coras, Burkhard Sebastian Kasper, Ingmar Blumcke, Hajo Martinus Hamer, Hermann Stefan, Michael Buchfelder and Karl Roessler
E xtratemporal epilepsy is one of the most challenging entities in the field of epilepsy surgery. Compared with temporal lobe epilepsy, where a good clinical outcome in terms of significant seizure reduction and improvement in quality of life after resection has been reported to be between 58% and greater than 80%, 4 , 11 , 47 , 50 extratemporal seizures are more difficult to treat surgically, with reported seizure freedom rates of only 10%–54%. 9 , 16 , 24 , 27 , 52 With the advent of iMRI, an intraoperative quality control was introduced to document
Ciaran J. Powers and Allan H. Friedman
✓The authors present a brief and selective history of surgery for peripheral nerve tumors to illustrate how the current understanding of the nature of disease influences the choice of surgical intervention. There was very little understanding of the anatomy and function of peripheral nerves in ancient times; consequently, surgical treatments for peripheral nerve tumors were based on the writings of authorities. The confusion between traumatic neuromas and genuine nerve sheath tumors coupled with the belief that manipulation of a peripheral nerve might be lethal to the patient stifled the development of surgical techniques for the management of nerve tumors in the 18th and 19th centuries. It was not until the 20th century, with an increased understanding of the microscopic anatomy of nerve sheath tumors, that efficacious surgical treatments for these diseases were developed. Continued advances in the understanding of the biology of these tumors will continue to impact their surgical management.
David Bellut, Jan-Karl Burkhardt, Anne F. Mannion and François Porchet
modified McCormick Scale 13 is considered the standard outcome tool. It is completed by the treating physician and assesses global functional impairment in terms of neurological function and walking ability. Over the last 2 decades, there has been increasing emphasis on the use of patient-rated outcome measures for assessing the outcome of spine surgery. However, most of the focus has been on degenerative spine surgery, using outcome instruments that address pain, function, and quality of life such as the Oswestry Disability Index, Neck Disability Index, 12-item Short
Sherman C. Stein
The neurosurgical profession has taken a circuitous route to attain its current knowledge about timing for aneurysm surgery. While addressing the timing issue, neurosurgeons were beset by many pressures simultaneously. They were forced to justify not only optimal surgical techniques but the need for surgery at all in the treatment of ruptured aneurysms. The beliefs of surgeons with strong personalities, in addition to intuitive guesses, often served to guide surgery in the absence of scientific evidence. That any progress could be made against a background of desperately ill patients and frustrating early results is remarkable. The author briefly outlines the controversies and misdirection that accompanied this progress toward understanding surgical timing in the treatment of ruptured aneurysms.
Michael Y. Wang
Adult spinal deformities (ASD) pose a challenge for the spinal surgeon. Because the spine is often rigid, mobilization of the segments is critical for effective correction, particularly in the sagittal plane. While minimally invasive surgery (MIS) has many favorable attributes that would be of great benefit for the ASD population, improvements in lordosis and sagittal balance have remained problematic using MIS approaches, including MIS lateral methods. This video illustrates one method for achieving improvement of coronal and sagittal correction without the extensive exposure and soft tissue envelope disruption needed in open surgery, particularly for less severe deformities. By using multi-level TLIFs through a mini-open surgery, curves of less than 60° can be managed with minimal blood loss and within a reasonable surgical timeframe. While feasibility will have to be proven with larger series and improved surgical methods, this technique holds promise as a means of reducing the significant morbidity associated with surgery in the ASD population.
The video can be found here: http://youtu.be/I0rkDSAVas0.
Oren N. Gottfried, James K. Liu and William T. Couldwell
The optimal management of glomus jugulare tumors remains controversial. Available treatments were once associated with poor outcomes and significant complication rates. Advances in skull base surgery and the delivery of radiation therapy by stereotactic radiosurgery have improved the results obtained using these treatment options. The authors summarize and compare the contemporary outcomes and complications for these therapies.
Papers published between 1994 and 2004 that detailed the use of radiosurgery or surgery to treat glomus jugulare tumors were reviewed. Eight radiosurgery series including 142 patients and seven surgical studies including 374 patients were evaluated for neurological outcome, change in tumor size (radiosurgery) or percent of total resection (surgery), recurrences, tumor control, need for further treatment, and complications.
The mean age at treatment for patients who underwent surgery and radiosurgery was 47.3 and 56.7 years, respectively. The mean follow-up duration was 49.2 and 39.4 months, respectively. The surgical control rate was 92.1%, with 88.2% of tumors totally resected in the initial surgery. A cerebrospinal fluid leak occurred in 8.3% of patients who underwent surgery and recurrences were found in 3.1%; the mortality rate was 1.3%. Among patients who underwent radiosurgery, tumors diminished in 36.5%, whereas 61.3% had no change in tumor size, and subjective or objective improvements occurred in 39%. Despite the presence of residual tumor in 100% of radiosurgically treated patients, recurrences were found in only 2.1%, the morbidity rate was 8.5%, and there were no deaths.
Death and recurrences after these treatments are infrequent, and therefore both treatments are considered to be safe and efficacious. Although surgery is associated with higher morbidity rates, it immediately and totally eliminates the tumor. The radiosurgery results are very promising, although the incidence of late recurrence (after 10–20 years) is unknown.