Outcome of surgical resection of subcortical metastatic tumors in the central and paracentral regions of the brain

The operative treatment of subcortical metastatic tumors within the central and paracentral area is still under discussion. Against the background of possible new postoperative neurological deficits and of evolving new radio oncological techniques, the indication for surgery is limited only to a subgroup of patients. To present the clinical results after operative treatment of metastases within the central and paracentral brain regions, with an emphasis on the short-term and midterm functional outcome. This study was carried out in the period between January 2007 and January 2011 in the neurosciences hospital in Baghdad, Iraq. The prerequisite inclusion criteria for the patients to be included in this study were: A contrast enhanced CT and/or MRI showing a secondary lesion in the central or paracentral regions of the brain. The patient has a known primary tumor source with a confirmed histopathological diagnosis. The postoperative histopathological result of the removed brain tumor correlates with the histopathology of the primary tumor. A stable extra cerebral tumors dissemination controlled by a systemic oncological therapy and an estimated life expectancy of more than 6 months. If the patient did not have, even one, of the above criteria he or she has not been included in this study. The Karnofsky Performance Status [KPS] was used to measure the patients' functional ability. The Functional Assessment of Cancer Therapy-Brain [FACT-Br] determines various quality of life [QOL] aspects in brain tumors patients. On a 54-item scale patients respond from 0 [not at all] to 4 [very much]. With the FACT-Br five major components of QOL are assessed: physical, social, emotional, functional well-being, patient-physician relationship and other activities of daily life [ADLs]. Tumor localization and its extension were defined on preoperative gadolinium-enhanced T1-weighted MRI-scans. Additional information was gained from T1-, and T2- scans, which were done in all patients. After updated MRI those patients were evaluated for surgery. Early postoperative control was done by MRI within the first 10 days. Follow-up took place in the outpatient department, assessing clinical criteria 2 and 6 weeks postoperatively, followed by clinical control and MRI-scans every 3 months. In all patients, surgery was performed under general anesthesia. 20 patients suffering from subcortical brain metastases within the primary sensori-motor area, with a median volume on MRI-scans of 8.18 cm. Patients were admitted to the hospital with a progressive hemiparesis [n - 11], focal seizures [n = 6] or other unspecific symptoms [n = 3] like headache, nausea, and neuropsychological disturbances, respectively. Surgery and the early postoperative course were uneventful in all cases. After a 6-month follow-up, two patients had died. The motor deficits improved in I seven patients and remained unchanged in four cases. One patient suffered from a new persistent hemiparesis. A temporary paresis occurred in two cases. In five patients there was no motor deficit pre- and postoperatively. The KPS improved in ten patients 6 months after surgery. Quality of life, measured by the FACT-Br score, improved in 12 patients and remained unchanged in one patient. Even preexistent deficits can improve with positive influence on the quality of life for oncological patients, being disabled by the symptoms caused by the cerebral lesion

Using steiner laser guide [Elekta] with the frame link4 [Medtronic] stereotactic biopsies of brain lesions for the first time in Iraq

In the majority of cases, the correct treatment of brain lesions is possible only when the histopathologrcal diagnosis is made. Several deep-seated lesions are not safely approached by the classical neurosurgical procedures. These patients can get benefit by a minimally invasive procedure. We present a series of 28 consecutive patients submitted to Stereotactic biopsies due to a great variety of brain lesions. Histological diagnosis found in this series Neoplasm was the most common diagnosis, representing [57.1%] of cases, [35.7%] of them were classified as glioma, [21.4%] of them as secondary metastases. [21.4%] of cases had their lesions classified as probable inflammatory or infection, [14.2%] of them diagnosed as tuberculomas and [7.1%] as non specific infection.[21.4%] ofpatient [=6 patients] had their lesions classified as others, 2 of them as reactional gliosis and 2 as necrosis and 2 as no abnormal histopathology

Two technical modifications for the Leksell stereotactic frame

Describing a newly designed frame holder applied to the head before pin fixation. The already available ear plugs facilitate the straight alignment of the frame by fixing it to the external auditory meatus, but they are quite painful for most of the patients and not prevent the anterior posterior rotation. The Leksell frame [Elekta, Sweden] is provided with a clamp that fits only with Mayfield head frame[SM, USA]. We performed certain modifications to make the frame fit to the Sugita head clamp [Mizuho, Japan]; the only sort of head frame we have in our hospital. The new modifications were used to fifteen patients in whom the application of the frame was indicated. A new designed net made of sewed ribbons applied to the head before pin fixation. It prevents slipping of the frame especially with the aid of the top plastic cup for its suction ability over a well shaved head. No pain recorded with its use. The other modification was to make few changes with the sugita head clamp middle piece to make it adaptable with that of the Leksell which was originally designed for the Mayfield head clamp. The newly designed net caused no pain to all the patients .Slipping was minimal. The time of the application of the frame shortened. With the use of the new adapter with the Leksell frame, we were able to perform surgical interventions even as long as 8 hours as in deep brain stimulation operations with no movement noticed between the frame and the operating table. These two technical modifications were useful to help in application of the frame over the patients head with minimal slipping movement and no pain. It permitted us to use the Leksell frame with the sugita head frame which is the only sort of head frame we have in our hospital

Response of C-reactive protein after lumber laminectomy, a prospective study

To assess the level of C-reactive protein [CRP] following lumber laminectomy to evaluate the physiological increase related to the surgical operation from that resulting to post operative infection. CRP was measured for 40 patients who underwent lumber laminectomy. CRP rapidly increased to reach a peak value [average 39] on the second post operative day. In 18 patients it reached it is maximum level in the third post operative day. From day 5 the level started to decline reaching to normal levels [mean 4.8] on day 9. There was no significant correlation between the CRP and Erythrocyte Sedimentation Rate [ESR], body temperature, white blood cell [WBC] count. CRP is effective and highly sensitive for evaluation of patients following lumber laminectomy. The rapid decline CRP will probably be interrupted by a second rise or persisting elevation [more than 5 days] if infection occurs