Extradural Devascularization for Resection of a Lesser Sphenoid Wing Meningioma: 2-Dimensional Operative Video.

We describe the case of a 42-yr-old female patient with a 2-yr history of headache that has progressively worsened. Physical examination revealed no neurological deficit. Magnetic resonance imaging showed a large tumor of the left lesser sphenoid wing that enhanced with gadolinium and produced displacement of the midline and the Sylvian fissure. A thorough analysis of the origin of the tumor was done to establish the surgical strategy. With the patient positioned supine with the head slightly turned to the right side, fixed in a 3-pin head clamp, a pterional craniotomy was performed. Since the origin of the tumor is in the lesser wing an early extradural devascularization of the tumor was done with drilling out all the hyperostotic bone of the lesser sphenoid wing, including the lateral base of the anterior clinoid process. Intradural debulking and resection showed the effect of extradural devascularization with an important decrease in bleeding, allowing the total resection of the tumor. An immediate postop magnetic resonance showed a complete removal of the tumor. The patient presented a paresis of the oculomotor nerve that completely resolved in the 3-mo follow-up. In the following video illustration, we narrate this operative case and highlight the nuances of this approach.1 The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.

Clinical prognostic factors in adults with astrocytoma: Historic cohort.

OBJECTIVE: To explore the clinical prognostic factors for adults affected with astrocytoma. PATIENTS AND METHODS: Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated. RESULTS: The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy+radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years. CONCLUSION: In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n=14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.