RESUMO
AIMS: To study the nature of the tumours managed in the Irish population. METHODS: This audit research was completed via a retrospective medical review on 200 patients with CNS tumours managed in a tertiary care centre between 2008 and 2009. RESULTS: The mean age was 53 years. The male:female ratio was 2:1. The majority were glioblastomas and astrocytomas. Grade IV tumours were predominant (65.5 %). Headaches (37 %), motor weakness (32 %) and seizures (25.5 %) were the highest presentations. The commonest sites affected were the left parietal and left temporal lobes. There were 17.5 % operative morbidities with motor weakness (22.9 %), seizure (14.3 %) and thrombo-embolism (14.3 %) dominating and significant association to surgical radicality (p = 0.041). 3.5 % operative mortalities were reported. 52.5 and 62.5 % of patients received adjuvant chemotherapy and radiotherapy, respectively. CONCLUSIONS: Patients with CNS tumours typically had multiple presentations. More extensive surgical resection was associated with higher postoperative morbidities (p = 0.041). The 30-day postoperative morbidity (17.5 %) and mortality (3.5 %) were concordant with the currently available literature.
Assuntos
Astrocitoma/cirurgia , Neoplasias do Sistema Nervoso Central/cirurgia , Glioblastoma/cirurgia , Procedimentos Neurocirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Astrocitoma/complicações , Astrocitoma/mortalidade , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/mortalidade , Quimioterapia Adjuvante , Criança , Pré-Escolar , Feminino , Glioblastoma/complicações , Glioblastoma/mortalidade , Cefaleia/etiologia , Humanos , Lactente , Irlanda , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Doença dos Neurônios Motores/etiologia , Gradação de Tumores , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/mortalidade , Radioterapia Adjuvante , Estudos Retrospectivos , Convulsões/etiologia , Centros de Atenção Terciária , Tromboembolia/etiologia , Resultado do Tratamento , Adulto JovemRESUMO
To ensure continuing patient care in a cost effective and efficient manner and to determine the importance of routine pre-op bloods in patients undergoing spine surgery, a retrospective audit of 170 patients was carried out in the Neurosurgery Department at Cork University Hospital. There were 94 males and 76 females. No test had less than 87.4% normal results. There were 17 (10.7%) abnormal haemoglobin levels, 13 (8.2%) abnormal white cell count levels, 14 (8.9%) abnormal creatinine levels and of sodium and potassium levels, 5 (3.2%) and 3 (2%) were abnormal respectively. Of the abnormal results, the majority fell close to reference range. 95% of the total cost incurred in performing the procedure was attributed to normal blood results. Abnormal blood results in this cohort of patients did not alter management. We conclude that routine blood tests, including coagulation screen, may not be necessary in healthy individuals undergoing elective spine surgery.
Assuntos
Testes Hematológicos , Cuidados Pré-Operatórios , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Testes Hematológicos/economia , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/economia , Estudos Retrospectivos , Procedimentos Desnecessários/economiaRESUMO
Symptomatic granular cell tumours of the neurohypophysis are rare sellar lesions. Preoperative prediction of the diagnosis on the basis of radiological appearance is useful as these tumours carry specific surgical difficulties. This is possible when the tumour arises from the pituitary stalk, rostral to a normal pituitary gland. This has not been emphasized previously.
Assuntos
Tumor de Células Granulares/diagnóstico , Neuro-Hipófise , Neoplasias Hipofisárias/diagnóstico , Tumor de Células Granulares/patologia , Tumor de Células Granulares/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neuro-Hipófise/patologia , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Resultado do Tratamento , Acuidade VisualRESUMO
A retrospective review was performed of the age profile and clinical features at presentation of 79 children with posterior fossa tumours. The mean age at presentation in this series (6.6 years) is consistent with a decreasing trend over the past 70 years. Headaches, ataxia and torticollis emerge as significant symptoms worthy of further investigation whilst abdominal pain and constipation might herald the presence of a posterior fossa tumour on rare occasions.
Assuntos
Neoplasias da Base do Crânio/diagnóstico , Neoplasias da Base do Crânio/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Fossa Craniana Posterior , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Irlanda/epidemiologia , Masculino , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/mortalidade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Neoplasias da Base do Crânio/cirurgia , Taxa de SobrevidaRESUMO
Metastatic carcinoma of the prostate is a common cause of spinal cord compression. In this review of 37 men who underwent laminectomy for this condition this was the first presentation of previously undiagnosed cancer in 11 (29%). One year after decompression 17 (50%) were alive. Twenty patients (59%) could walk after laminectomy. All but 8 were relieved of pain and bladder function was improved in 13 (38%). Those ambulant before laminectomy (7) and those with occult prostate cancer did particularly well. Poor results were associated with a rapid onset of paraparesis and pre-operative progression to paraplegia. A delay in diagnosis was detrimental to outcome. A high index of suspicion in patients with carcinoma of the prostate is essential so that early diagnosis can be made before paraplegia is established. Carcinoma of the prostate must always be excluded in men with cord compression of unknown aetiology.
