Trans-sinusal frontal approach for olfactory groove meningiomas

Background We report on our experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas in the department of neurosurgery of Univesity Hospital Center of Annaba (Algeria). Methods Ten tumours were operated on by the trans-sinusal frontal approach; using a bicoronal incision; tree tumours developed on one side; and there were seven bilateral olfactosellar tumours. Our procedure : steotomy of the anterior wall of the frontal sinus was performed with an oscillating saw. The posterior wall of the sinus was resected and the tumour was removed through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was early controlled at the initial stages of the operation; allowing avascular tumour debulking. Tumour extensions toward the sella and the optic canals were removed without brain retraction. Results Seven patients made a good neurologic recovery. Two was dead in the 24 hours after intervention and one four days after. Olfactory nets were preserved on the contralateral side in unilateral tumours. Conclusions The trans-sinusal frontal approach represents an excellent way for tumours developed in the central anterior skull base; especially for olfactory groove meningiomas; whatever their size

Results in the Operative Treatment of Elderly Patients with Spinal Meningiomas

Objective : With the life expectancy in the industrial nations increasing over the last two decades; the number of patients older than 70 years with spinal tumors and; especially; meningiomas is rising. Our objective is to assess the outcome of surgically treated spinal meningiomas in patients in their eighth or ninth decade of life and to analyze the possible role of some prognostic factors. Patients and methods : Twenty seven consecutive patients over 70 years of age (mean age; 78.3 years) were operated on for spinal meningiomas between 1995 and 2005 in Bordeaux's Neurosurgery Departement. The preoperative neurologic status of the patients was graded with the Solero score; and the general health conditions were staged according to the American Society of Anesthesiology classification. Tumor were removed totally in 26 cases and subtotally removed in one. The follow-up period ranged from 12 to 81 months (mean; 27.1 months). Results: There was no operative mortality; and morbidity was not significant. Although not significant; neurologic outcome was better in patients with a low preoperative Solero score than those with a high one (P 0.01). Clinical outcome was not influenced by the preoperative general health conditions according to American Society of Anesthesiology classification (p0.07). Clinical outcome was influenced by the duration of symptoms before surgery (p0.05). No recurrence was observed during the follow-up period. Conclusion: Neurologic outcome following surgery was favorable in the vast majority of patients; with no mortality or significant morbidity. Surgery is the only treatment in elderly patients with symptomatic spinal meningiomas; even for those with a poor preoperative neurologic condition. Whenever there is an acceptable risk from an anesthesiological point of view

Intraoperative magnetic resonance imaging and meningioma surgery

Objective: To determine if intraoperative magnetic resonance imaging improves surgical resection and postoperative outcome of intracranial meningioma. Study design: Prospective; on-randomized; cohort study Method: Intraoperative Magnetic Resonance Imaging (iMRI) was used to evaluate patients with meningioma undergoing surgery. Images were obtained after induction of anaesthesia and at various stages of tumour resection. Extent of surgical resection was graded using Simpson grading system for meningioma. The images were reviewed together with histopathology and early outcome. Primary outcome measure was determined by finding unexpected tumur in interdissection images. Secondary outcome measures were determined by postoperative complications including infections and mortalities. Results: There were 39 procedures in 38 patients from January 1998 to December 2002. Surgical-planning images helped to optimize craniotomy placement. Interdissection images revealed unexpected residual tumour in only 1 patient. Complete resection (Simpson grades 1-3) was achieved in 33 procedures. The average follow up period was 16.4 months. Tumour recurrence has been observed in three patients. Two of these patients had anaplastic meningioma. There was no mortality in the 30-day postoperative period. Conclusion: Intraoperative MRI was beneficial in siting the craniotomy in addition to providing anatomical relationships between the tumour and adjacent structures in lesions located at the skull base though the full benefit of these is yet to be determined. The low morbidity and zero mortality recorded in the study may be related to all these factors

Morphological Pattern and Frequency of Intracranial Meningioma in Tanzania

Objective: The objective of the study was to study the histological pattern of intracranial meningiomas; provide a comprehensive data about its frequency in both adults and children and to correlate the site of the tumour with histological diagnosis. Design: A descriptive study. Place and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998 to October 2004). Patients and methods :The histopathological data of 54 intracranial meningiomas of adults and children was evaluated on H et E stained sections of paraffin embedded tissue. Results: The ages ranged from 6 to 87 years with mean of 36.6 years. The male to female ratio was 1:1. All histological subtypes of meningiomas were in WHO grade I category and meningotheliomatous type comprised the largest subtype (37). Others were transitional (25.9); fibroblastic (22.2); angiomatous (7.4); psamommatous (5.6) and microcystic (1.9). Out of 54 meningiomas; 43 (79.6) were supratentorial and 11 (20.4) were infratentorial in location. Meningotheliomatous meningioma was the commonest histological subtype in supratentorial region (41.9) while in infratentorial region fibroblastic and transitional subtypes were the commonest (36.4each). Conclusion: All meningioma were in WHO grade I category and meningotheliomatous was the commonest overall and also the most predominant in the supratentorial region while in infratentorial location transitional and fibroblastic subtypes were the commonest with equal frequency. Meningioma gave an equal gender ratio in our study

Morphological Pattern and Frequency of Intacranial Tumours in Adults and Children in Tanzania

Objective: The objective of the present study was to study the histopathological pattern of intracranial tumours and to provide a comprehensive data about their frequency in adults and children less than 16 years and to correlate the site with histological diagnosis.Design: A descriptive studyPlace and duration of study: The study was carried out at the departments of Histopathology and Morbid Anatomy; Muhimbili National Hospital and Neurosurgery; Muhimbili Orthopaedic Institute in Tanzania; over a period of seven years (1998- October 2004).Patients and Methods: The histopathological data of 104 brain tumours of all adults and children less than 16 years histopathologically evaluated was performed on H et E stained sections of paraffin embedded tissue. Special stains were performed whenever indicated.Results: The ages ranged from 2 to 90 years with an overall mean of 34.4 years while that of children below 16 years was 9.5 years and in adults was 41.9 years. The male to female ratio was 1.2:1. Meningiomas comprised the largest category (51.9) and Glial tumours ranked the second (21.4) of primary brain tumours and among all gliomas astrocytomas were the commonest comprising of 16.4 of all intracranial neoplasms. Out of 104 brain tumours; 83(79.8) were supratentorial and 21(20.2) were infratentorial in location while in adults 72(84.7) were in supratentorial region and 13(15.3) were in infratentorial region. In children below 16 years; 11(57.9) and 8(42.1) were in supratentorial and infratentorial in location respectively. The most common tumour overall in both supratentorial and infratentiorial regions were meningiomas (53) and all were in WHO grade I. When age was taken in consideration; meningiomas remained the commonest supratentorial tumours in adult (56.9) while in children below 16 years; cranioparyngioma was the commonest supratentorial neoplasm (45.4). In children less than 16 years medulloblastoma and pilocytic astrocytoma were the commonest neoplasms in the infratentorial region (37.5 of each).Conclusion: Meningioma was the commonest intracranial tumour overall in both supratentorial and infratentorial locations. However medulloblastoma and pilocytic astrocytoma were the most common tumours in the infratentorial region in children below 16 years of age