Surgical management of brain-stem gliomas: a retrospective analysis of 311 cases / 中国医学科学院学报

<p><b>OBJECTIVE</b>To further study the clinical features, diagnosis, and surgery outcome of brain-stem gliomas.</p><p><b>METHODS</b>Totally 311 patients with brain-stem gliomas received surgery operations in our hospital from 1980 to the end of 2001. The clinical data, neuroimages, growth patterns, and operative feasibility were analyzed.</p><p><b>RESULTS</b>Different brain-stem gliomas showed different growth patterns. In this series, total excision rate of the tumor was 40.5%, subtotal 29.9%, partial 29.6%, and operative mortality 1.3%. Among 311 patients, 72.4% patients had been improved and stable in their symptoms after operation, and 27.6% deteriorated or having transitory new signs. Five years survival rate is 67% in ependymoma patients, 42% in astrocytoma patients. None of brain-stem glioblastoma patients survived up to 5 years.</p><p><b>CONCLUSIONS</b>The histology and growth pattern of brainstem gliomas varies. The patients with well-differentiated gliomas of brain-stem may be cured by microsurgical removal. For malignant ones, partial removal may prolong survival and facilitate the following combined therapy.</p>

Gamma knife radiosurgery for cavernous malformations / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the efficacy of Gamma knife surgery (GKS) in treating cavernous malformation (CM).</p><p><b>METHODS</b>From 1994 to 2001, 92 patients with 114 CMs were treated by GKS and then followed up for 2-8 years (mean 4.1+/-1.9). We analyzed the MRI features of CMs bleeding, efficacy of GKS, and the complications of treatment. Six pathological specimens after radiosurgery (1 from our group, 5 from other centers) were also assayed.</p><p><b>RESULTS</b>Among 43 patients who were treated by GKS to control their epilepsy, epileptic paroxysm was alleviated in 36 patients (83.7%), including 12 (27.9%) seizure-free. Rebleeding was confirmed in 9 patients (9.8%) by neuroimage, one of whom died. Transient symptomatic radiation edema occurred in 7 cases (7.6%) within 6-12 months after radiosurgery, and one patient underwent open surgery for cerebral decompression. The main pathological changes of cavernoma were coagulation necrosis and the vessels obliterated gradually after radiosurgery.</p><p><b>CONCLUSIONS</b>It is feasible to treat small and surgically high risk CMs by radiosurgery. The treatment has to be prudent in an acute bleeding and symptomatic progression. Optimal treatment timing and dose planning are prerequisites to reduce radiation-related complications. GKS is safe and effective to control the epilepsy caused by CMs, and also to bring down the rebleeding rate after a latency interval of several years.</p>

Clinical application of minimally invasive neuroendoscopic techniques / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize and analyze the application of neuroendoscopic techniques in neurosurgery, and to discuss the role and significance of neuroendoscopic techniques in the diagnosis and treatment of neurosurgical diseases.</p><p><b>METHODS</b>We treated 1300 patients with different neurosurgical diseases by performing endoscopic neurosurgery (EN) and endoscopy-assisted microneurosurgery (EAM). Among 1300 paitents, 522 were treated with pure endoscopic neurosurgery, 260 with endoscopy-assisted microneurosurgery, 79 with endoscope-controlled bur hole trephination neurosurgery, 434 with endoscope transsphenoidial surgery, and 5 with other techniques through which an endoscope was used in conjunction with stereotactic guidance.</p><p><b>RESULTS</b>Totally 362 hydrocephalus patients were treated using EN. Among them, 190 were treated by third ventriculostomy, 30 by V-P shunt, and 142 patients with complicated hydrocephalus and unsymmetry hydrocephalus by endoscopy-controlled pathologic septum fenestration, septum pellucidum fenestration, and treatment of inventricula inflammation. Clinical symptomatic improvement was achieved in 341 of 362 patients (94.2%). Also 160 intracranial cyst patients were treated using EN for resection and partial resection. Eighty-two patients were performed through cyst-ventricula fenestration. Clinical symptomatic improvement was achieved in 76 of 82 patients (92.7%). Seventy patients treated with endoscopy-controlled bur hole neurosurgery and 8 cases with endoscopy-assisted microneurosurgery got better recovery after operation. Among 260 patients with brain tumors, 252 patients were operated with EAM (190 patients with epidermoid cyst), 8 patients with EN (all brain tumors with diameters < 2.5 cm in inventricular). Clinical symptomatic improvement was achieved in 228 of 260 patients (87.7%). Among 49 patients with inventricular and cistern cyst, 40 patients who were treated by EN and 9 patients by endoscopy-controlled bur hole neurosurgery were resected and their clinical symptoms were improved after operation. Among 434 patients with sellar region lesions, 387 patients with pituitary adenomas, 19 patients with repair for CSF leaks, 9 patients with chordoma, and 19 patients with other neurosurgical diseases were performed with endoscopy-controlled transsphenoidial surgery. Clinical symptoms in 88.9% (386/434) of these patients were improved. Another 5 patients were treated with endoscopy combined with navigation and stereotatic guidance with good results. The complications related to operation were found in only 2% of all the patients including hemorrhage, infection, and damage of important structure.</p><p><b>CONCLUSIONS</b>Clinical application of neuroendoscopic techniques can decrease the damage caused by pure open surgery operation. It is possible to resect lesions at the utmost and protect normal tissue from lesions for using EN and EAM or endoscopy-controlled microneurosurgery (ECM). It is also helpful to enhance surgical quality and, reduce the complications.</p>