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>