Acta neurochirurgica
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Acta neurochirurgica · Jan 1998
ReviewMeningioma surgery in the elderly: a case-control study assessing morbidity and mortality.
To assess the morbidity and mortality of meningioma surgery in patients over age 65 and compare our results with matched controls and with the present literature on meningioma surgery in the elderly. ⋯ Our lower morbidity and mortality rates after meningioma surgery in the elderly may be a result of patient selection, surgical technique, or excellent pre- and post-operative care by the resident staff, anesthesiologists, and nurses. It suggests, however, that elderly patients can have meningioma surgery safely.
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Acta neurochirurgica · Jan 1998
Wrapping of solitary ruptured intracranial aneurysms, outcome at five years.
Previous follow up studies of patients who have had ruptured intracranial aneurysms treated by a wrapping technique have largely been in the pre-microsurgical era. Our objective was to ascertain whether wrapping aneurysms with the aid of the operating microscope provides protection against rebleeding in the short and long term. The study involved retrospective analysis of patients with ruptured aneurysms treated by wrapping over a six-year period. ⋯ Of the 15 patients who had a solitary ruptured aneurysm wrapped, none had rebled at one year follow up. One patient died of a myocardial infarction at 4 years, the remaining 14 patients had no episodes of rebleeding with all patients achieving Glasgow outcome scores of four or five at 5 years follow-up. Although surgical clipping of intracranial aneurysms is the definitive method of treatment, our findings suggest that wrapping of ruptured intracranial aneurysms with the aid of the operating microscope confers good protection against both early and late rebleeding in those cases considered 'unclippable'.
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Acta neurochirurgica · Jan 1998
Comparative StudyA comparison between ventriculo-peritoneal and ventriculo-atrial cerebrospinal fluid shunts in relation to rate of revision and durability.
Results of 884 first-time shunts inserted in the time period from 1958 to 1989 are retrospectively evaluated, 1) to perform a durability analysis of a shunt based on Kaplan-Meyer method, 2) to compare the rate of revision for ventriculo-atrial (VA) and ventriculo-peritoneal (VP) shunts, 3) to compare the durability of a VA shunt with a VP shunt and 4) to do a stratified durability analysis comparing the VA and VP shunts in relation to the following background variables: shunt type, time period and age of the patient. Furthermore the specific complications related to VA and VP shunts are identified based on findings in the literature. Overall one-year shunt durability is 57% and five-year shunt durability is 37%. ⋯ Hence the apparent difference in revision rate between VA and VP shunts seems secondary to variations in follow-up time and variations in background variables. To supplement our statistical analysis we have performed a literature study to look at the specific complications associated with VA and VP shunts. It seems as if the specific complications in relation to the VA shunting method are more severe than in relation to the VP shunting method.
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Acta neurochirurgica · Jan 1998
Clinical analysis of internal carotid artery aneurysms with reference to classification and clipping techniques.
An intraoperative classification of intradural internal carotid artery (ICA) aneurysms not related to the arterial division but based on their operative presentation and clipping techniques is introduced. On the basis of the surgeon's view of the operative field via the pterional approach in 156 operated intradural ICA aneurysms in 143 patients, these aneurysms were classified according to their location in relation to the long axis of the ICA as either proximal, middle or distal in type and also according to their relation to the cross section of the ICA as either lateral, medial, ventral or dorsal in type. Numerically the largest in frequency is the middle type of aneurysm by axial location and the lateral type of aneurysms by cross sectional location. ⋯ Furthermore, the forward clipping was useful for proximal type aneurysms and the reversed clipping for distal type aneurysms. For the middle type aneurysms clipping was performed bidirectionally. This classification includes all types of the ICA aneurysms located at any points along its long axis and on its cross section, and is useful for planning safe and exact clipping of the ICA aneurysms.
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Although histologically benign, craniopharyngioma can regrow either from macroscopic remnants of the tumour left behind at operation, or even after an apparently gross total removal. Recurrence rates vary significantly in the literature, depending on the efficacy of surgical treatment and also on the growth potential of the tumour itself. The main factor influencing tumour regrowth is obviously the extent of surgical resection, as total removal carries a much lesser risk of recurrence compared to subtotal or partial resections (although in such cases radiation therapy can lower this risk significantly). ⋯ Four of the 5 survivors received radiation therapy. All the patients are presently alive and stable (mean follow-up: 5.6 yrs). The authors conclude that surgery should be the first therapeutic option in case of recurrent craniopharyngioma and that radiation therapy should also be considered but only as adjuvant therapy.