Computer-assisted stereotactic resection of posterior fossa lesions

A method for computer-assisted stereotactic laser resection of posterior fossa lesions is described. This procedure has been used successfully to treat 10 patients having a variety of lesions deep in the cerebellar hemisphere, vermis, and brainstem with satisfactory postoperative neurologic results.     

Short-term tumor control and acute toxicity after stereotactic radiosurgery for glomus jugulare tumors.

OBJECTIVE: Glomus jugulare tumors (GJT) have traditionally been treated by surgery or fractionated external beam radiation therapy (XRT). This study evaluates acute toxicity and short-term efficacy of single-fraction stereotactic radiosurgery (SRS) for the treatment of GJT. STUDY DESIGN AND SETTING: Eight patients (age range 28-74) with GJT underwent SRS (Brainlab linear accelerator) as primary treatment. A nominal dose of 15-16 Gy was prescribed. RESULTS: After undergoing SRS, 7 of 8 patients (87.5%) reported complete resolution of presenting symptoms. Follow-up MRIs showed tumor stabilization in 100% of patients. Transient vertigo occurred in one patient. One patient suffered acute GI upset and transient lower cranial neuropathy. CONCLUSION: Stereotactic radiosurgery is an effective alternative for patients with GJT in achieving tumor control and resolution of symptoms. EBM rating: C-4.     

Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa. Case report and review of the literature

The problem of radiation-induced necrosis of normal brain surrounding the target area has been a major catalyst for the development of stereotactically focused radiation therapy. According to current opinion, the effects of stereotactic irradiation are confined to the region targeted. The authors present a case in which the administration of a conventional dose of stereotactically focused irradiation for treatment of a pilocytic astrocytoma produced fulminant necrosis that necessitated a combination of intensive surgical and medical management, after which the patient improved over the course of 1 year. Concomitant with his improvement, the initially remarkable findings on magnetic resonance imaging gradually resolved. In this presentation the authors emphasize the need to evaluate alternatives carefully before a decision is made to administer therapeutic irradiation. Furthermore, they explore the roles that target, host, and dosage factors play in hypersensitivity to radiation injury, the detection of these factors before treatment, and the administration of radioprotective agents. With the growing use of stereotactically focused irradiation as a primary treatment modality for a variety of neurosurgical conditions, it is important to be cognizant of its uncommon but potentially lethal side effects. A cooperative multicenter database in which the outcomes and morbidity following stereotactic irradiation are recorded is essential to the detection of relatively uncommon but severe complications such as those observed in this case.     

Secondary tumor formation after stereotactic biopsy for intracerebral metastatic disease

BACKGROUND: There are only a few published cases of iatrogenic tumor seeding and distant neoplastic growth along the path of the cannula after stereotactic biopsy. CASE DESCRIPTION: We report the case of a female patient with a solitary lung cancer metastasis in the left parietal brain lobe. The tumor was stereotactically biopsied and treated by radiosurgery. One month after the initial biopsy, a smaller de novo tumor mass located along the track of the stereotactic cannula was detected by contrast-enhanced MRI. The spatial location of this neoplastic nodule and the short time before development of a macroscopic lesion seemed to confirm iatrogenic tumor cell spread due to the stereotactic procedure. CONCLUSION: Our findings and the reviewed literature suggest that this complication is rare. Nevertheless, neurosurgeons should be aware of the potential risk and, if necessary, should be able to modify the technical procedure and the adjuvant treatment.     

颅后窝实体性血管网织细胞瘤显微外科治疗

目的 为了提高颅后实体性血管网织细胞瘤的显微外科治疗效果。方法 回顾总结３４例颅后窝实体性血管网织细胞瘤煌诊断方式及显微外科手术治疗效果。结果 ３４例肿瘤全切除２９例,次全切除５例。手术后神经功能改善２４全理６例,手术后死亡４例,死亡的病例均死于继发性脑干损伤。结论 采用显微外科手术治疗颅后窝实体性血管网织细胞瘤是提高疗效的重要方法。     

Recurrence after strictureplasty or resection for Crohn's disease

This study attempts to define whether there is an increased need for reoperation in patients with small bowel Crohn's disease treated by strictureplasty compared with those treated by small bowel resection. Previous studies of the rate of reoperation for small bowel Crohn's disease do not distinguish between reoperation performed because of a lesion at the original operation site and that undertaken because of a lesion at a distant site. This study analyses the need for reoperation only at the original site of operation and measures operation-free intervals. The site specific operation-free intervals in 41 patients with small bowel Crohn's disease treated by strictureplasty were not significantly different from the similar intervals in 41 patients treated by a small bowel resection.