Caracterización clínica epidemiológica de pacientes operados de tumores raquimedulares / Clinical epidemiological characterization of patients operated on spinal cord tumors

Introducción: Los tumores raquimedulares son la mayor causa de morbilidad y mortalidad entre pacientes con afecciones oncológicas y representan aproximadamente del 10 al 15 por ciento de todos los tumores del sistema nervioso central. Objetivo: Identificar aspectos clínicos y epidemiológicos en pacientes operados de tumores raquimedulares. Métodos: Se realizó un estudio observacional descriptivo, de serie de casos, en 31 pacientes de más de 19 años, operados/as de tumores intrarraquídeos, en el servicio de Neurocirugía del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba, durante el período comprendido desde enero del 2008 a diciembre del 2013. Resultados: En los casos estudiados (n= 31) la edad tuvo un recorrido entre 19 y 76 años, predominó el sexo femenino (54,8 por ciento), las lesiones benignas (64,5 por ciento), así como mayor localización dorsal y extradural en el eje espinal. Conclusiones: Las principales características clínicas y epidemiológicas fueron: edad de presentación más frecuente en la sexta década de la vida, sintomatología con compromiso neurológico variable, dolor del raquis en todos los casos y predominio de lesiones benignas(AU)

Introduction: Spinal cord tumors are the leading cause of morbidity and mortality among patients with oncological conditions and it represents approximately 10 percent to 15 percent of all tumors of the central nervous system. Objective: To identify clinical and epidemiological aspects of patients operated on spinal cord tumors, from 2008 to 2013. Methods: We conducted an observational, descriptive study of a series of cases in 31 patients older than 19 years at the Neurosurgery Service of Saturnino Lora Provincial Teaching Hospital in Santiago de Cuba from January 2008 to December 2013. The subjects had diagnosis of intratracheal tumors. Results: In the cases studied (n = 31) age ranged 19 to 76 years. Female patients (54.8percent) and benign lesions (64.5 percent) were the majority. The most frequent localization was dorsal and extradural in the spinal axis. Conclusions: The main clinical and epidemiological characteristics were age of more frequent presentation of tumor lesions, that is 60 years of age; symptomatology with variable neurological involvement, spinal pain in all cases, and predominance of benign lesions(AU)

Facial Nerve Monitoring in Patients Under The Low Level Of Neuromuscular Blockade During Resection Of acoustic Neurinomas / 中国神经精神疾病杂志

Objective To perform facial nerve monitoring in patients under the low level of neuromuscular blockade during resection of acoustic neurinomas.Methods Twenty-eight patients with large,or medium acoustic neuroma underwent the surgery of acoustic neurinomas resection. During the operation,TOF and EEG monitoring were performed in order to detect the degree of muscle relaxation and the depth of anesthesia. Neuromuscular relaxation was maintained at T_4/T_1=25%～50% by adjusting doses of muscle relaxant and aneasthetic. Free-run EMG and Triggered EMG of orbicularis oris, orbicularis oculi, masseter and trapezius were recordered to monitor the function of the facial, trigeminal and accessory nerves, respectively. The function of the facial nerve was evaluated at first week and half year postoperatively according to House-brackmann classification.Results The facial never was successfully identified and mapped by neurominitoring in all 28 patients. successfully, tThe electrical stimulation was 0.1 mA-0.3 mA and no any involuntary body movement was observed in all patients ne of patients have moved during operation. The preservation of the facial nerve function following surgery was good. Five patients had a HB grade I, 13 a HB grade II, 8 a grade III and 2 a HB grade IV The facial nerve function was HB Grade Ⅰin 5 of 28 patients, HB GradeⅡ in 13, HB Grade Ⅲ in 8 and HB Grade Ⅳ in 2 immediately after operation. Six months after surgery, 10 casespatents showed demonstrated a HB GradeⅠof facial never function, 12 cases exhibited a slight palsy (HB Grade II) , and 5 cases exhibited a HB Grade III palsy and . Another 1 cases a exhibited severe palsy (HB Grade IV).Conclusions Facial nerve monitoring in patients under the low level of neuromuscular blockade can ensure the surgical safety and preserve the facial never function.

Neurofibromatosis tipo 1 y tumores raquídeos del contenido / Type 1 neurofibromatosis and spinal tumors of the content

Objetivos: evaluar la prevalencia, pronóstico y posibilidades terapéuticas de los pacientes con Neurofibromatosis tipo 1 (NF 1) y tumores raquídeos. Método: se realizó una revisión retrospectiva de las historias clínicas y estudios disponibles de todos los pacientes con NF1 admitidos a nuestros hospitales entre los años 1993 y 2002. Se evaluó a la admisión y al seguimiento aquellos casos con tumores raquídeos estadificados con el Sistema de Weinstein-Boriani- Bacci, y las escalas Visual Analógica [VAS](para el dolor), de Frankel (status neurológico) de Hoffer y de la OMS, así como el Indice de Karnofsky para el estado funcional. Resultados: se encontraron 12 pacientes (9 varones, 3 mujeres) con NF 1 y tumores raquídeos. La edad promedio al diagnóstico fue de 25.2 años, siendo 9 benignos y 3 malignos (uno con metástasis a distancia). El seguimiento promedio fue de: 2.8 años. Se realizaron 14 procedimientos quirúrgicos de ablación asociados o no a reconstrucción en 11 pacientes. Hubo 11 complicaciones en total (92%) pero solo en 6 pacientes (50%), de los cuales 2 eran portadores de tumores malignos. El 25% con tumores benignos operados presentó una recidiva (promedio: 3.3 años de postoperatorio). Sin embargo, todas las variables funcionales (Frankel, VAS, Hoffer, OMS y Karnofsky) mejoraron. Los dos últimos ítems (OMS, Karnofsky) mostraron mejoría de la calidad de vida, incluso en los casos de óbito Conclusión: 1) La existencia de tumores raquídeos sintomáticos debe tenerse presente en pacientes portadores de NF 1. 2) La agresividad de los tumores benignos sintomáticos en estos pareció mayor a los de la población general. 3) A pesar de las dificultades, la mejoría funcional y de la calidad de vida justificaron el abordaje quirúrgico en estos pacientes.

Objetive: To assess prevalence, prognosis and therapeutic possibilities of patients with type 1 neurofibromatosis (NF-1) and spinal tumors. Method: All patients with NF-1admitted to our Hospital settlings since January 1993 to December 2002 were analized, the clinical records and image studies of those with spinal tumors as a cause of admission were retrospectively reviewed. Karnofsky scale, Functional World Health Organization (WHO) scale, Frankel grade and Visual Analogical Scale (VAS) for pain were used at hospital admission, postoperatively and at follow-up. Surgical staging was reviewed with the Weinstein Boriani Bacci system. Results: In this 10 years period we admitted 44 patients who fully satisfied NIH criteria for NF-1. Twelve of them (27.3%) presented symptomatic spinal tumors: 9 males and 3 females, in average 25.2 years old. Spinal tumors were 9 benign (all neurofibromas) and 3 malign. Mean follow up was 2.8 years. Fourteen surgical procedures were performed in 11 patients. Eleven complications occurred in 6 operated cases (50% of patients), but 2 of 3 (67%) malignant spinal tumors cases had complications. Two of 8 benign tumors operated (25%) recurred an average of 3.3 years after surgery. All cases showed improved postoperative functional score at follow-up (Frankel, VAS, WHO and Karnofsky), including those cases who finally died. Conclusion: 1) Symptomatic spinal tumors should be taken into account in the general population patients with NF-1. 2) Benign tumors in this series were more aggressive than those arising in patients without NF. 3) Postoperative improvement of the functional status and the quality of life, supports the surgical approach among patients with NF-1 and symptomatic spinal tumors, despite the technical difficulties.

Linear Accelerator-Based Stereotactic Radiosurgery for Acoustic Neurinomas / 대한암학회지

No abstract available

Trigeminal Neurinomas: Report of 8 Cases with Special Reference to Operative Approach

The authors have treated eight cases of trigeminal neurinomas for the past thirteen years. We have been treating these tumors in accordance with the principle of radical resection through one-staged operation. Three were male and five were female. The age ranged from 25 to 56 years with the mean age of 41.5 years. One was a case of von Recklinghausen's disease. Topographically, the tumors were mainly located within the middle fossa in two cases, within the posterior fossa in two, and extended both supra- and infratentorially in four cases. Facial pain and hearing disturbance were the main symptoms and various other symptoms such as focal seizure, hemiparesis, gait disturbance, symptoms of increased intracranial pressure and visual disturbance were also noted. Surgical operations were performed in all cases. As a surgical approach, either transpetrosal-transtentorial or orbitozygomatic-infratemporal route was employed. The choice of the better approach depends on the topography of the tumor. Total removal was performed in all cases. Only one case, which was an early one in this series required second operation to remove the tumor completely. In one case, the tumor recurred five years after the operation. There has been no operative mortality, but the injury or permanent damage to the trigeminal branches was inevitable in many cases. Surgical results were excellent in three, good in four, and fair in one case.