[Result of retrosigmoid sub-occipital craniectomy in patients with acoustic neurinoma in Shohada hospital [1998-2006]]

Acoustic neurinoma is a benign neoplasm of Schwann cell source that mainly originate from vestibular branch of 8th cranial nerve. In this study we evaluated the result of suboccipital retrosigmoid surgery in patients operated in Shohada hospital from 1998 to 2006. This retrospective study was carried out using the hospital records of patient with suboccipital retrosigmoid operated in Shohada hospital between 1998-2006. The clinical information and outcome of surgery were extracted and then analyzed. A total of 80 patients [42men and 38 women] with mean age 45 +/- 7 years evaluated. The most common clinical presentation was hearing loss. In 93% of patients, the tumor size was greater than 3 cm. The location of the tumor was left side in 25 patients and right side in 50 patients, whereas in 5 patients it was bilateral. All of the patients had been operated with retrosigmoid craniectomy approach and tumor was totally resected in 87% of cases. Regardless of the tumor size, the facial nerve had anatiomically been saved in 76.2% of patients. 6 patients [7%] died and temporary morbidity occured in 34% of patients which has been recovered by medical treatment. 59 patients were had accurately followed up. After 1 year of surgery, the functional condition of facial nerve was: Excellent 73/5%, good 22/5%, fair 6%. We demonstrated that facial nerve was considerably preserved in patients with acoustic neurinoma after operation. In this study, tumors were mainly large. Therefore, it is better to use CT scan and MRI in patients in order to achieve the earlier diagnosis and appropriate treatment

[Trans-sphenoidal surgery in 95 acromegalic patients: clinical and radiological findings]

Acromegaly, a multisystem disease, produced by growth hormone [GH] secreting pituitary adenomas, has devastating effects shortening life expectancy; thus control of the disease is vital. Surgical removal of adenomas is the primary and standard treatment in these patients. In this study, results of trans-sphenoidal surgery in 95 patients admitted consecutively to the Shohada-e Tadjrish Hospital, over 9 years beginning 1996, were analyzed. Data were collected retrospectively from files of all patients admitted to our hospital, over 9 years, and operated using a trans-sphenoidal approach. Clinical and radiological evaluations were reviewed and intra-operative findings, postoperative complications, immediate hormonal assay results and long term follow ups were analyzed. Forty eight patients were female and 47 male [1/1 ratio] with mean age of 39.2 +/- 12 years. Acromegalic features were present in almost every patient with a mean duration of 46 +/- 43 months. Macroadenomas were discovered in 70 patients and microadenomas in the other 25; there was no mortality. Postoperative complications were as follows: Temporary Dl in 80, CSF rhinorrhea in 11 and meningitis in 4 [all were managed conservatively with only one case of permanent Dl]; 79 patients had follow up [mean 13 +/- 12 months]; 64% of patients [76% of microadenomas and 62% of macroadenomas] had remission [post-operative GH < 5 ng/mL], but with remission criteria of GH < 2.5 ng/mL there was 51% remission rate [65% of microadenomas and 44% of macroadenomas]. In five patients, following initial surgery, there was recurrence after 1 to 4 years, which was controlled in 4 of with a second trans-sphenoidal surgery, with the remaining one case being referred for radiotherapy