. We have found that a high-resolution CT scan with bone windows and MR imaging with gadolinium enhancement are complementary in providing complete preoperative information. Surgical Treatment A review of the literature revealed that total tumor removal was obtained in only 50% of the trigeminal schwannomas; 41, 56 however, a significant number of those were operated on before the era of microsurgery. 56 During the last 15 years, total or near-total removal was achieved in at least 70% of cases. 6, 31, 43, 48, 56 The major impediments to complete removal
Madjid Samii, Matteo M. Migliori, Marcos Tatagiba and Ramesh Babu
David G. Piepgras, Vini G. Khurana and Jack P. Whisnant
A lthough still controversial, 4, 5, 13, 14, 21, 30, 33 the advantages and benefits of early surgical treatment for patients admitted in good neurological condition with ruptured small aneurysms have been well documented. 34 No such information is available for giant aneurysms. The determination of the optimum time for surgical treatment of giant aneurysms is considerably more complicated, partly because the risks and patterns of rebleeding for giant aneurysms have not been described. This problem has been compounded by the fact that many giant aneurysms are
Philipp Dammann, Karsten Wrede, Ramazan Jabbarli, Salome Neuschulte, Katja Menzler, Yuan Zhu, Neriman Özkan, Oliver Müller, Michael Forsting, Felix Rosenow and Ulrich Sure
surgical treatment of CRE provides excellent seizure control, most authors recommend a conservative therapeutic approach after the initial diagnosis of CRE. 29 Subsequently, in cases of a first drug trial failure or the onset of drug-resistant CRE, presurgical evaluation and potential epilepsy surgery are commonly accepted. 4 , 29 However, besides the risk of epilepsy, patients with CCM carry the intrinsic risk of symptomatic hemorrhage. 4 , 11 , 20 , 25 , 31 Therefore, the management of CRE patients must respect the risks related both to epilepsy and to future CCM
Todd W. Vitaz, George H. Raque, Christopher B. Shields and Steven D. Glassman
they are advised to live with their pain. This is unfortunate, because although there are certain patients whose medical condition does preclude surgical intervention, the majority can undergo a major operation with acceptable levels of risk and a good outcome. 7, 24 The purpose of this study was to review our experience in the surgical treatment of elderly patients with this disorder and to show that surgery can be performed safely and with satisfactory results. Clinical Material and Methods Operative logs were reviewed to generate a list of patients older
D. Andrew Wilkinson, Kyle Johnson, Hugh J. L. Garton, Karin M. Muraszko and Cormac O. Maher
income and household net worth were lower than in the total insured population. The reason for this finding is unclear. Black or Hispanic race has been reported to be a predictor of medical complications after CMD in the pediatric population, but to our knowledge no study has examined race as a predictor of surgical treatment. 16 We are not aware of any studies that have examined income or net worth. Syringomyelia Using claims from all sources, including practitioner and outpatient claims, we found an overall spinal cord syrinx diagnosis rate of 42% in children
Gabriele Tedeschi, Francesco Paolo Bernini and Adolfo Cerillo
hemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2 : 221 – 226 , 1961 McKissock W, Richardson A, Taylor J: Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet 2: 221–226, 1961 8. Mitsuno T , Kanaya H , Shirakata S , et al : Surgical treatment of hypertensive intracerebral hemorrhage. J Neurosurg 24 : 70 – 76 , 1966 Mitsuno T, Kanaya H, Shirakata S, et al: Surgical
Thomas M. Kinfe, Hans-Holger Capelle and Joachim K. Krauss
ipsilateral. 2 , 31 If it involves the postdecussational course of the dentato-thalamic pathway, the tremor will be contralateral. 2 , 31 The marked compression effect resulting also in midbrain distortion therefore well explains the appearance of contra-lateral tremor in the patient in Case 6. Involvement of both predecussational and postdecussational segments can be responsible for bilateral tremor. It appears that tremor associated with extraaxial posterior fossa mass lesions occurs only when tumors reach a critical size. The effect of surgical treatment of such
Mitsuo Kaneko, Tomomi Koba and Tetsuo Yokoyama
deficit 4 can hold light object 5 can resist gravity 10 minimal movement 4 Discussion Several notable papers on the surgical treatment for intracerebral hematoma have advised against operating during the acute stage. 2, 3, 7, 9, 11, 12 However, we believe that it is in the acute stage, before the cerebral edema develops, that evacuation of the hematoma offers the best prognosis. Although several authors have recommended early operation, further experience is needed. 5, 8, 10 In operations in the acute phase we have noted
Evaluation of results by computerized tomography scanning
Joseph H. Galicich, Narayan Sundaresan and H. Tzvi Thaler
. Sem Oncol 5: 314–322, 1978 2. Galicich JH , Deck M : Surgical localization of small lesions demonstrated by the computerized tomographic (CT) scan. Neurosurgery 2 : 170 , 1978 (Abstract) Galicich JH, Deck M: Surgical localization of small lesions demonstrated by the computerized tomographic (CT) scan. Neurosurgery 2: 170, 1978 (Abstract) 3. Galicich JH , Sundaresan N , Arbit E , et al : Surgical treatment of single brain metastasis: factors associated with survival. Cancer 45
Yuri P. Zozulya, Eugene I. Slin'ko and Iyad I. Al-Qashqish
Spinal vascular malformations represent rare and insufficiently studied pathological entities characterized by considerable variation. Insufficient study of this disease is connected with the complexity of its diagnosis, which restricts the development of surgical treatments that are differentiated according to the type of malformation. Great difficulties are caused by the lack of a clear structural–hemodynamic classification of spinal arteriovenous malformations (AVMs). At present the classification created between 1991 and 1998 by the combined efforts of different authors is the most widely used one. According to this classification, four categories are distinguishable: Type I, dural arteriovenous fistulas (AVFs); Type II, intramedullary glomus AVMs; Type III, juvenile or combined AVMs; and Type IV, intradural perimedullary AVFs. Vascular tumors are also classified, as follows: hemangiomas, hemangioblastomas, angiosarcomas, hemangiopericytomas, angiofibromas, angiolipomas, and hemangioendotheliomas, as well as cavernous malformations.
In this study the authors analyze the diagnostic data and results of treatment in 91 patients with AVMs and AVFs who were treated at the Institute of Neurosurgery between 1995 and 2005. The patients' ages ranged from 9 to 83 years; the mean age was 42.9 years. For spinal vascular malformations we devised a classification that took into account the aforementioned features of AVMs: the anatomical characteristics of a malformation and its angiostructural and hemodynamic features. In all patients the neuroimaging modalities used in the investigation of their lesions included magnetic resonance (MR) imaging and selective spinal angiography. Three-dimensional computerized tomography angiography studies were obtained in 14 patients, and MR angiography was used in 17.
For successful surgical treatment of spinal AVMs it is necessary to obtain data about their localization, vascular structure, and hemodynamics that are as complete as possible. This information will promote the use of optimum surgical procedures and the latest methods of microsurgical and endovascular interventions, with treatments differentiated according to the type of malformation. One should try to use the least invasive endovascular approach in these cases,where possible, to occlude the AVM or reduce the intensity of blood flow by means of embolization. To perform an AVM resection or occlusion, one should use a direct approach to the malformation, blocking only the vessels supplying blood to the malformation and preserving the vessels feeding the spinal cord.