Subject(s)
Ataxia/diagnostic imaging , Cerebellar Nuclei/diagnostic imaging , Hemangioma, Cavernous, Central Nervous System/diagnostic imaging , Olivary Nucleus/diagnostic imaging , Pontine Tegmentum/diagnostic imaging , Ataxia/etiology , Female , Hemangioma, Cavernous, Central Nervous System/complications , Humans , Middle Aged , Neural Pathways/diagnostic imagingABSTRACT
BACKGROUND: The aim of this retrospective study was to investigate and compare the outcome after surgery in patients with a supratentorial solitary metastasis (SSM) and an infratentorial solitary metastasis (ISM). A worse prognosis has been reported in ISM. METHODS: Fifty-two patients with a newly diagnosed solitary brain metastasis on MRI were included to identify risk factors affecting the outcome. Key variables included tumor size, staging of the primary tumor, time span of presurgical work-up, and surgical technique. Outcome variables included postoperative complications, tumor recurrence, and mortality. Kaplan-Meier survival analysis was applied. RESULTS: Thirty patients with a SSM and 22 patients with an ISM underwent gross total resection. The tumor size did not have a statistical significant effect on survival. Presurgical work-up time was similar in SSM and ISM. Postoperative complications were more frequently encountered in ISM. Recurrence rate was comparable in SSM and ISM. Carcinomatous meningitis (CM) was more frequently seen in ISM, and CM was seen more often with the piecemeal resection technique. There was no statistical difference in overall survival between SSM and ISM. CONCLUSIONS: This study identified factors that play a role in the outcome after surgery in patients with ISM and SSM on MRI. Postoperative complications seemed to be higher in ISM and CM was more often seen in ISM, but the worse prognosis in patients with ISM compared with SSM could not be confirmed.
Subject(s)
Infratentorial Neoplasms/surgery , Neoplasm Recurrence, Local/epidemiology , Neurosurgical Procedures/adverse effects , Postoperative Complications/epidemiology , Supratentorial Neoplasms/surgery , Adult , Aged , Female , Humans , Infratentorial Neoplasms/epidemiology , Infratentorial Neoplasms/pathology , Male , Middle Aged , Mortality , Neoplasm Metastasis , Supratentorial Neoplasms/epidemiology , Supratentorial Neoplasms/pathology , Survival AnalysisABSTRACT
We present a patient who underwent urgent neurosurgery for acute onset paraplegia due to a spontaneous subdural spinal hematoma less than 5 hours after she had taken rivaroxaban. The Key Clinical Question was whether early high-risk surgery on a patient taking direct oral anticoagulants is feasible. Prothrombin complex concentrate (PCC) and tranexamic acid were administered and perioperative hemostasis was good. There is scant data on neurosurgical procedures performed within 12 hours after the intake of a direct oral anticoagulant. With the hemostatic support of high-dose PCC, early surgery after administration of rivaroxaban seems feasible in case of an emergency indication, but should only be considered when delaying surgery is esteemed hazardous to the patient. More experience is needed to allow balancing risks and benefits of urgent vs delayed intervention and on the optimal hemostatic support in the absence of a specific antidote.
