Survival after reoperation for recurrent glioblastoma multiforme: A prospective study.

PURPOSE: Glioblastoma multiforme (GBM) is the most common malignant brain tumor. Moreover, GBM recurs in nearly all patients. Although a standard STUPP protocol has been widely used for newly diagnosed GBM, no standard regimen has been established for recurrent patients. Here we evaluated the clinical value of recurrent GBM reoperation by comparing overall survival and quality of life (QoL) in patients with recurrent GBM undergoing repeat surgery or conservative treatment. METHODS: This was a prospective study of 165 patients with GBM receiving first operations for their disease between 2011 and 2013 at two tertiary neurosurgery centers in Poland. Thirty-five eligible patients were re-operated for recurrence (the study group), and 35 patients were selected as the control group using propensity score matching. A model was created to determine advantageous prognostic factors for longer survival of patients qualifying for reoperation using stepwise linear regression. RESULTS: The mean overall survival of patients undergoing repeat surgery was 528 days compared to 297 days in patients who did not undergo repeat surgery. Reoperation did not result in a significant deterioration in performance status as measured by the Karnofsky Performance Scale. Older age, the presence of symptoms of increased intracranial pressure, and a shorter period between initial operation and reoperation were independent predictors of a worse outcome. CONCLUSION: In selected patients, reoperation for recurrent GBM prolongs survival with no significant deteriorations in performance status.

Application of intraoperative computed tomography in a neurosurgical operating theatre.

BACKGROUND AND PURPOSE: The authors describe their own experience in use of intraoperative computed tomography (CT) with the Siemens SOMATOM Sensation in 125 cases. MATERIAL AND METHODS: Intraoperative CT of the head was most often used in functional neurosurgery for stereotactic planning in 32 cases and for control of deep brain stimulation electrode placement in 18 cases. In spine surgery, CT was used most often in spine stabilization to control the placement of implants. RESULTS: The implant had to be corrected in 7 cases (17% of 41 procedures), and in those cases the need for a revision procedure was therefore avoided. Intraoperative CT was also widely used in emergency procedures and perioperative complications in 13 cases, for control of intraventricular catheter or Rickham port placement in 8 cases, for evaluation of extent of tumour resection in 4 cases, for verification of electrode placement during percutaneous trigeminal rhizotomy in 3 cases, for evaluation of decompression after cervical corpectomy and thoracic discopathy in 3 cases, in complex fractures in 2 cases and as angio-CT after aneurysm clipping in 1 case. There was no significant prolongation of procedure duration. Intraoperative CT proved to be safe for a patient and for personnel. During the three-year evaluation period, the increasing use and indications for intraoperative CT were noted. Integration of CT with navigation is planned in the near future. CONCLUSIONS: Intraoperative CT is a very useful tool in spine surgery as well as in functional neurosurgery and neurooncology.

Strategy in the diagnostics and therapy of tumours of the spine.

The authors present the diagnostic methods and basic surgical procedures used in treatment of spinal neoplasms. Both metastatic and primary spinal tumours lead to instability and loss of the protective function. Spinal cord can be damaged by compression or increased mobility of the vertebral column. Pain is reported as common symptom. Investigations include: plain X-ray films, myelography, radioisotope bone scan, CT, MRI and needle biopsy. The goal of surgery is to improve the quality of life with preservation of neurological function, reduction of pain and assured spinal stability. Indications for surgery are related with patient's general condition, grade of neoplasmatic disease, neurological symptoms and spinal involvement. Curative surgery include total removal of the tumour with affected vertebral body, followed by spinal stabilization. Palliative surgery as partial tumour removal, partial removal of the vertebral body or laminectomy are performed for spinal decompression. In the majority of cases surgery is combined with radiotheraphy, chemiotheraphy and treatment of pain.
Main goal of surgery in the treatment of spinal metastatic lesions are: tumor removal (cytoreduction), protection of the spinal cord and spinal stabilization. The choice of surgical treatment depends on spinal involvement and neurological status.

[Atlanto-occipital instability due to the transverse atlas ligament rupture. Report of a case with symptoms persisting for 21 years]. / Niestabilnosc szczytowo-obrotowa jako skutek przerwania wiezadla poprzecznego kregu szczytowego. Prezentacja przypadku o wieloletnim przebiegu.

The authors describe a case of a judo sportsman with a cervical spine injury sustained 21 years earlier. The injury initiated characteristic sensations of severe generalized pain with paraesthesias recurring whenever he was hit on the top of the head. In February 2001 the patient fell on his head, which resulted in tetraplegia with a complete sensory loss. The symptoms disappeared after ten minutes. Plain radiography, CT and MRI performed after this episode revealed occipitalization of the atlas and C1-C2 instability due to a rupture of the transverse atlas ligament. The patient underwent surgery by the posterior approach: decompression of the foramen magnum, fixation of the occiput and C-2 (with wiring and a bone graft). At one-year follow-up after the surgery the patient had limited movements of the neck without neurological symptoms. Plain radiograms confirmed stability of the occipitocervical fusion. There was no recurrence of the preoperative symptoms.