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1.
Mansoura Medical Journal. 2004; 35 (1_2): 63-78
in English | IMEMR | ID: emr-207121

ABSTRACT

Objective: this study was designed to evaluate transnasal trans-sphenoidal endoscopic-controlled approach and compare it to the standard sublabial transnasal transseptal trans-sphenoidal microsurgical approach for sellar lesions


Design: prospective study


Materials and Methods: forty patients with sellar lesions were included in this work that was conducted between June 1997 and January 2002. Twenty patients were approached by the classic sublabial transnasal transseptal transsphenoidal microsurgical technique described by Hardy and another group of 20 patients were managed endoscopically Patients were allocated randomly to either group. All patients had clinical, radiological, ophthalmic and endocrine evaluation prior to surgery. Both techniques were compared as regard accessibility, visibility, duration of surgery, completion of lesion resection, morbidity including trauma to nasal skeleton and length of hospitalization and return to work


Results: lesions accessibility, visibility and completion of resection were better with the endoscopic-controlled technique. Mean [SD] operative times were significantly reduced in the endoscopic group vs. the sublabial group: 2.7 [0.7] hours vs. 3.4 [0.9] hours. Hospital stay ranged between 1-3 days for endoscopic group and 4-10 days for the sublabial microsurgical group. There was significant reduction in trauma to nasal skeleton in endoscopic group. There were no major complications in both techniques


Conclusion: the emerging endoscopic-controlled transnasal trans-sphenoidal approach for lesions in the sella is safe and effective alternative to the standard sublabial transnasal transseptal transsphenoidal microsurgical approach. It has the advantage of minimal invasiveness

2.
Tanta Medical Journal. 2001; 29 (1): 123-128
in English | IMEMR | ID: emr-58442

ABSTRACT

The results of two prospective randomized studies 1, 2 indicate survival advantages for patients with single brain metastases treated with surgery and radiotherapy compared with radiotherapy alone. Radiosurgery - a minimally invasive technique that uses multiple convergent beams to deliver a high dose of radiation to a small volume precisely localized stereotactically - can serve as a surgical alternative. The biological and physical characteristics of metastases [radiographically discrete, small, spherical, non- invasive] render them ideal targets for radiosurgery, with the potential advantages of reduced morbidity, short hospitalization and reduced health care costs. At Mansoura we treated [10] patients with brain metastases, [7] had single lesions and [3] had multiple lesions [up to 5]. The age ranged between 51 and 68ys. The primary lesion was known in [8] cases. Each received a dose of 20 Gy to the tumor edge and a supplementary whole brain dose of 2000 cGy divided over 10 fractions. All patients, except one, tolerated the treatment well and were discharged from hospital within 3 days on average. One case who had five lesions developed hydrocephalus that was shunted, he died a few days later. Nine Patients showed subsequent radiological evidence of tumor shrinkage and central tumor necrosis. The peritumoural edema subsequently subsided and most patients became steroid independent within 3 months of radiosurgery .We acknowledge the small number of cases and short period of follow up that negate any statistical significance. However our limited experience shows that stereotactic radiosurgery is a safe alternative to open surgery, particularly for lesions in deep location, near eloquent cortex and for multiple lesions. Surgical resection would be more advantageous for metastatic lesion of size greater than 35 mm in diameter with significant edema and mass effect, particularly if there is significant mass effect on fourth ventricle


Subject(s)
Humans , Male , Female , Brain Neoplasms/surgery , Radiosurgery , Neoplasm Metastasis , Stereotaxic Techniques , Length of Stay , Treatment Outcome , Follow-Up Studies
3.
Scientific Medical Journal. 1997; 9 (4): 183-191
in English | IMEMR | ID: emr-46976

ABSTRACT

Fifty patients with trigeminal neuralgia were operated upon in Suez Canal University hospital, Al-Sahel Teaching hospital, and Al Azhar University hospital. Micro vascular decompression [MVD] was used in 42 cases, MVD and Rhizotomy in 3 cases, and Rhizotomy only in 3 Cases. The most common etiological factor was arterial loop compression [29 cases]. The superior cerebellar artery was the compressing factor in 24 cases. Thirty five patients had excellent outcome after MVD, 6 good, and 4 had poor outcome. MVD has proved to be an effective method for treatment of Trigeminal neuralgia


Subject(s)
Humans , Male , Female , Decompression, Surgical , Rhizotomy , Treatment Outcome , Postoperative Complications
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