Management of intracranial meningeal hemangiopericytomas: outcome and experience

Hemangiopericytomas represent rare intracranial tumors that have a tendency to recur locally and have the unique characteristic of giving extracranial metastases. Our current communication reviews a series of patients diagnosed with hemangiopericytoma who were treated in our facility. Eleven patients with a mean age of 51.2 years underwent follow-up for a mean time of 7.1 years. Their neuroimaging preoperative evaluation included plain skull X-rays, head CT scans, brain MRI, angiograms, and ¹HMRS. Preoperative embolization of the tumor was employed in 6/11 patients. All patients underwent craniotomy for tumor resection and postoperative radiation treatment was employed on all but one. Grade I resection was accomplished in 6/11 (54.5%), grade III in 4/11 (36.4%), and grade IV in 1/11 (9.1%). Local recurrence was detected in 3/11 (27.3%) at a mean period of 5 (range 2–7.5) years. Extracranial metastatic disease was documented in 4/11 (36.4%) patients at a mean of 4.9 (range 2.5–7) years after the initial diagnosis. The GOS score was: 7/11 (63.6%) scored 5, while 4/11 (36.4%) died at a mean time of 5.5 (range 3–8) years after the initial diagnosis. Intracranial hemangiopericytomas management requires aggressive surgical resection, postoperative radiation treatment, and extensive follow-up to rule out local recurrences and delayed extracranial metastases.     

经尿道前列腺切除术或非接触式激光治疗男性急性尿潴留的疗效比较:CLasP 随机试验

虽然据文献报告激光前列腺切除术有效且安全 ,但经尿道前列腺电切术仍是治疗急性尿潴留的标准术式。ＣＬａｓＰ意指前列腺的保守、激光及经尿道电切治疗。本文主要对经尿道电切术与Ｎｄ :ＹＡＧ非接触式可见激光前列腺切除术治疗急性尿潴留进行了比较。此项研究为多中心、随机对照试验 ,目的在于分析治疗效果。随机分组后平均 7.5个月时进行随访。治疗失败记为初步结果 ,观察指标包括ＩＰＳＳ评分及生活质量评分、剩余尿和尿流率。第二次结果包括并发症、留置尿管时间及住院时间。共 148例患者随机分为电切组和非接触式激光治疗组 ,各 74例…     

Classification methods for the differentiation of atypical meningiomas using diffusion and perfusion techniques at 3-T MRI

The purpose was to investigate the contribution of machine learning algorithms using diffusion and perfusion techniques in the differentiation of atypical meningiomas from glioblastomas and metastases.Apparent diffusion coefficient, fractional anisotropy, and relative cerebral blood volume were measured in different tumor regions. Naive Bayes, k-Nearest Neighbor, and Support Vector Machine classifiers were used in the classification procedure.The application of classification methods adds incremental differential diagnostic value. Differentiation is mainly achieved using diffusion metrics, while perfusion measurements may provide significant information for the peritumoral regions.     

The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery

Introduction

Aneurysmal subarachnoid hemorrhage constitutes a clinical entity associated with high mortality and morbidity. It is widely accepted that improper clip placement may have as a result of incomplete aneurysm occlusion and/or partial or complete obstruction of an adjacent vessel. Various modalities, including intraoperative or postoperative digital subtracting angiography, near-infrared indocyanine green angiography, micro-Doppler ultrasonography (MDU), and neurophysiological studies, have been utilized for verifying proper clip placement. The aim of our study was to review the role of MDU during aneurysmal surgery.

Methods

A literature search was performed using any possible combination of the following terms: “aneurysm,” “brain,” “cerebral,” “clip,” “clipping,” “clip malpositioning,” “clip repositioning,” “clip suboptimal positioning,” “Doppler,” “intracranial,” “microsurgery,” “micro-Doppler,” “residual neck,” “ultrasonography,” “ultrasound,” and “vessel occlusion”. Additionally, reference lists from the retrieved articles were reviewed for identifying any additional articles. Case reports and miniseries were excluded.

Results

A total of 19 series employing intraoperative MDU during aneurysmal microsurgery were retrieved. All studies demonstrated that MDU accuracy is extremely high. The highest reported false-positive rate of MDU was 2?%, while the false-negative rate was reported as high as 1.6?%. It has been demonstrated that the presence of subarachnoid hemorrhage, specific anatomic locations, and large size may predispose to improper clip placement. Intraoperative MDU’s technical limitations and weaknesses are adequately identified, in order to minimize the possibility of any misinterpretations.

Conclusion

Intraoperative MDU constitutes a safe, accurate, and low cost imaging modality for evaluating blood flow and for verifying proper clip placement during microsurgical clipping.     

Does intraoperative electromyographic monitoring in lumbar microdiscectomy correlate with postoperative pain?

OBJECTIVES: Our objective was to correlate the findings of intraoperative electromyographic (EMG) monitoring with immediate postoperative pain in patients undergoing lumbar microdiscectomy. METHODS: A total of 112 patients undergoing de novo lumbar microdiscectomy were prospectively randomized into a control group (n = 45) and a study group (n = 67) in which intraoperative EMG monitoring was used. Postoperative pain and postoperative narcotic consumption were recorded for each patient. RESULTS: The presence or absence of EMG monitoring did not influence the level of reported pain in any anatomic area. In the monitored group, the degree of recorded nerve root irritation did not correlate with reported pain or postoperative narcotic consumption. The level of back pain was found to be significantly higher than the level of hip and calf pain (P < 0.0001). CONCLUSIONS: In our study no correlation was found between intraoperative EMG findings and immediate postoperative pain.     

SURVEY OF CARDIAC ARRESTS AND CARDIAC ARREST TROLLEYS IN A DISTRICT GENERAL HOSPITAL

SUMMARY In a 12-month period there were 137 cardiac arrests in a district general hospital. Cardiopulmonary resuscitation was instituted within 3 minutes in 82%. Delay in 18% was due to equipment failure. Survival at 6 months was 12%. Of the 18% of inappropriate arrests, 42% had ‘do-not-resuscitate’ orders in the casenotes. Survival did not depend on age, sex, location, presence of an anaesthetist, experience of house officer, time of day or admission diagnosis. Survival was more likely in the presence of ventricular fibrillation and absence of intubation. Of the 32 arrest trolleys, 66% were geographically acceptable to the area they served and 9% had significant deficiencies (these were situated in patient waiting areas and were infrequently checked).