Neurological Outcome Following Surgical Treatment of Spinal Metastases.

BACKGROUND: Spinal metastases lead to bony instability and spinal cord compression resulting in intractable pain and neurological deficits which affect ambulatory function and quality of life. The most appropriate treatment for spinal metastasis is still debated. OBJECTIVE: The aim of this study is to evaluate clinical outcome, quality of life, complications, and survival after surgical treatment of spinal metastases. METHODS: Retrospective review of patients with spinal metastases surgically treated at our facility between March 2008 and March 2013 was performed. Evaluations include hospital charts, initial and interval imaging studies, neurological outcome, and surgical complications. Follow-up examinations were performed every 3 months after surgery. RESULTS: Seventy patients underwent surgical intervention for treatment of spinal metastasis in our institution. There were 27 women and 43 men. The preoperative pain was reported in 65 patients (93%), whereas postoperative complete pain relief was reported in 16 patients (24%), and pain levels decreased in 38 patients (58%). Preoperative 39 patients were ambulant and 31 patients were nonambulant. Postoperative 52 patients were ambulant and 18 patients were nonambulant. Postoperative complications were experienced in 10 (14.2%) patients, and the patient survival rate was 71% (50 patients) at 3 months, 49% (34 patients) at 1 year. The postoperative 30-day mortality rate was 4.2%. CONCLUSION: Surgical decompression for a metastatic spinal tumor can improve the quality of life in a substantially high percentage of patients with acceptable complications rate.

Validity of the Lateral Supraorbital Approach as a Minimally Invasive Corridor for Orbital Lesions.

BACKGROUND: Many approaches were recommended for surgical treatment of orbital lesions via either transorbital or transcranial routes. The frontolateral craniotomy through eyebrow skin incision (lateral supraorbital approach) is a combined cranio-orbital approach that could be used in different orbital lesions. OBJECTIVES: To evaluate the efficacy and safety of the lateral supraorbital approach for resection of orbital lesions. PATIENTS AND METHODS: Ten patients with different orbital lesions were treated by this minimally invasive technique. The technique is described in details. The postoperative outcome was evaluated with casting light on the specific parameters related to this approach. RESULTS: This study included 6 females and 4 males, ranging in age from 2 years to 65 years with mean age of 37.3 years. Proptosis was the most common presenting complaint. Six patients were operated on via the right supraorbital approach, and 4 patients via the left supraorbital approach. Various pathological lesions were treated. The excision was total in 7 patients, subtotal in 1 patient, and partial in 2 patients. Two patients suffered transient supraorbital hypothesia, 1 patient showed temporary superficial wound infection with CSF leak and 1 patient died within 6 months. CONCLUSION: The lateral supraorbital approach is a minimally invasive approach that provides excellent exposure of the superior, lateral, and medial orbit, as well as the orbital apex.

Clinical and angiographic outcome in patients with completely occluded intracranial aneurysms by endovascular coiling: our experience.

OBJECTIVE: There are limited data about the rate of recanalization following complete coil occlusion. Long term clinical and angiographic outcome of completely occluded intracranial aneurysms (IAs) by the endovascular approach are presented. METHODS: Over the course of 4 years, patients with IAs which were completely occluded by coiling at our institution were reviewed. Clinical and angiographic data were analyzed. The patients were clinically assessed using the Glasgow Outcome Scale (GOS). Follow-up angiographic findings were categorized as: stable aneurysm with no recanalization, recanalization with a neck remnant and recanalization with a body remnant. RESULTS: 83 aneurysms were identified in 74 patients (15 men and 59 women, average age 52.4 years) with complete occlusion post intervention. Treatment by coiling only was used in 73 aneurysms while stent assisted coiling was used in 10 cases. At the last angiographic follow-up (mean 16.3 months), 20 of the 83 aneurysms demonstrated various degrees of recanalization of which five had neck remnants and 15 had body remnants. The recanalization rate was significantly higher in large aneurysms (57%) compared with small aneurysms (14%). Clinically, 65 of the 74 patients showed good recovery (GOS score 5), eight had moderate disability (GOS score 4) and one was severely disabled (GOS score 3). CONCLUSION: Complete endovascular occlusion of IA is certainly effective in preventing aneurysmal bleeding. However, recanalization rate, despite being lower when compared with subtotal occlusion, remains an issue. Longer follow-up is required.