ABSTRACT
Objective To explore the optimal diagnosis and treatment strategy of tumors at the foramen magnum,the clinical characteristics were analyzed retrospectively.Methods The clinical data of 58 cases with foramen magnum tumors treated with microsurgery in our department were collected and analyzed retrospectively.And intraoperative neurophysiological monitoring was employed in later 21 cases.Results Gross total resection was achieved in 48 of the 58 cases ; Five of the 10 patients with VA encased by tumors were totally resected.Full resection was achieved in 43 of the last 48 cases.Forty-three of the 47 cases with intradural tumors got complete resection,and total resection was achieved in 3 and 2,respectively,in 9 intra-extradural communicated tumors and 2 extradural ones.Symptoms were significantly improved in 50 cases,worsened in 5 patients,and maintained stable in the last 3 patients.Post-operative symptoms were obviously improved in the later 21 cases with intraoperative neurophysiological monitoring employed and the therapeutic effect of the treatment was much better than the former cases.Three patients died postoperatively.Fifty cases got complete follow-up from 6 months to 3 years.Among them,forty-four patients had a KPS score of 80-100,but the other 6 patients less than 80.Conclusion Microsurgical treatment for foramen magnum tumors is effective.Optimal surgical approaches and precise micro-operative techniques are crucial for the tumor removing.It is quite difficult and risky to fully resect the intra-extradural communicated tumors and the ones encasing vertebral artery.Preoperative evaluation should be profound.The application of intra-operative electrophysiological monitoring and the timely management of post-operative complications can improve the prognosis obviously.
ABSTRACT
Objective To investigate the difference of clinical characteristics and treatment outcome between pituitary apoplexy with and without inducing factors. Methods The clinical characteristics and treatment outcome between 12 pituitary apoplexy with inducing factors and 30 pituitary apoplexy without ones. Results Compared with the patients of pituitary apoplexy without inducing factors, the patients of pituitary apoplexy with inducing factors more frequently occurred visual dysfunction(P=0.020) and visual field defection(P=0.046), and the diagnosis of pituitary apoplexy was also delayed in the latter (P=0.015). Conclusion Inducing factors of pituitary apoplexy often aggravated the apoplexy, delayed its diagnosis and treatment due to atypical clinical symptoms, and caused worse restoration of visual function. Headache patients with abrupt visual deterioration should be considered suffering from pituitary apoplexy.