World Neurosurg
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To examine the efficacy of spheno-orbital meningioma (SOM) resection aimed at symptomatic improvement, rather than gross total resection, followed by radiation therapy for recurrence. ⋯ Among this cohort, surgery provided a lasting improvement in proptosis and improved or stabilized visual deficits. Surgery followed by radiation at recurrence provided excellent tumor control and lends credence to the growing body of literature demonstrating effective control of subtotally resected skull base meningiomas.
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We report surgical results and complications of endoscopic endonasal skull base surgery for giant pituitary adenomas. ⋯ Endoscopic endonasal skull base surgery enables less invasive and safer removal of various extension types of giant pituitary adenomas. Preservation of visual function is essential. Two-stage surgery or partial resection with additional treatments is possible without complications if a sufficient amount of resection is performed. In cases in which insufficient resection may be expected, alternative treatment, including combined-simultaneous resection, should be considered.
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Endoscopic third ventriculostomy (ETV) is a safe and less-invasive treatment strategy for patients with obstructive hydrocephalus and provides excellent outcome. Nevertheless, repeat ETV in cases of ETV failure is a controversial issue. ⋯ Repeat ETV in cases of late ETV failures represents an excellent option for cerebrospinal fluid circulation restoration up to 14 years of follow-up. Repeat ETV in early ETV failure in contrast is not favored by the performing surgeons; and factors of ETV failure should be analyzed very carefully before a decision for repeat ETV is made.
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Somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) are frequently used to monitor neurologic function during spinal deformity surgery. The sensitivity and specificity of intraoperative neurophysiologic monitoring (IONM) in patients undergoing posterior spinal fusion (PSF) is debatable. ⋯ SSEP and MEP changes occurred in 3.3% of patients undergoing PSF, with the highest incidence at the cervicothoracic level. Twenty-three out of 26 patients with intraoperative neuromonitoring changes had improvements in IONM signals after interventions during surgery. Further studies using larger patient numbers may be useful in establishing the utility of neuromonitoring in PSF.
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Even with great advances in surgery and improved clinical outcome, morbidity and mortality are still high for large-volume intracranial meningiomas (MNGs). Recently, Gamma Knife radiosurgery (GKS) has proven to be a safe and effective treatment for many patients with intracranial MNGs. However, single-session GKS may increase the risk of radiation-induced toxicity for large MNGs. Recently, fractionated GKS (FGKS) has been performed for an increasing number of patients with surgically high-risk and large intracranial tumors. In this study, we report our results on the efficacy and safety of FGKS for large MNGs. ⋯ When the large-volume (>10 cm3) intracranial MNGs are expected to have high morbidity after microsurgery and for patients that have a poor medical status for surgery, FGKS can be considered an alternative with good tumor control and lower complications rates compared with single-session GKS (P = 0.017).