4 research outputs found
Neurosurgical Options for Glioma
Glioma surgery has been the main component of glioma treatment for decades. The surgical approach changed over time, making it more complex and more challenging. With molecular knowledge and diagnostic improvement, this challenge became maximally safe resection of tumor, which resulted in prolonged overall survival, progression-free period, and a better quality of life. Today, the standard glioma treatment includes maximally safe resection, if feasible, administration of temozolomide, radiotherapy, and chemotherapy. Surgical resection is performed as subtotal resection, gross total resection, and supratotal resection. Subtotal resection is the resection where a part of tumor is left. Gross total resection is a complete removal of the magnetic resonance imaging (MRI) visible tumor tissue. Supratotal resection is performed as gross total resection with excising the MRI visible tumor tissue borders into the unaffected brain tissue. Before we make final decision on which type of resection should be performed, many factors have to be considered. The main question has to be answered: what the actual impact of resection on the progression of glioma is and what the functional risk of resection is
Clinical characteristics of poor-grade aneurysmal subarachnoid hemorrhage treatment
Background: The initial clinical status after aneurysm rupture, whether primary or secondary, determines the final outcome. The most common cause of patient deterioration is a high Hunt and Hess (HH) score, which correlates closely with a high mortality rate. Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is determined as an HH score 4 or 5. The aim of this study was to evaluate the clinical characteristics of poor graded aneurysmal SAH at our institution. Patients and Methods āDuring the 5-year period, 415 patients with intracranial aneurysm were admitted to our institution. Patients with poor-grade aneurysmal SAH accounted 31.08% ( n ā=ā132) of the total number of ruptured aneurysms. Interventional treatment was predominantly in the form of surgery, whereas conservative treatment included medication and external ventricular drainage. Final outcome was assessed with a modified Rankin score (mRs). Statistical analysis was performed using SPSS version 23.0 with a significance level set to 5% (Ī±ā=ā0.05). Results āThe majority of patients (57.6%) were in the age range from 51 to 69 years. Twenty-five patients (18.9%) had an HH score of 4, whereas 107 patients (81.1%) had an HH score of 5. Depending on the location, the majority of patients ( n ā=ā43) had an aneurysm on the medial cerebral artery (MCA). The final aneurysm occlusion was performed in 71 patients, of whom 94.36% were treated surgically. A positive outcome (mRs 0-4) was found in 49.25% of patients who underwent primarily surgical, treatment with a mortality of 42.3%. Although the outcome was better in patients with an HH score 4, both groups benefited from surgical treatment. Conclusion āPoor-grade aneurismal SAH is a condition of the middle and older age, with most patients with an HH 5 score and deep comatose state. There was better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients
Clinical and radiologic features in patients with the WHO grade I and II meningiomas
Introduction: Meningiomas are the most common benign tumor of the central nervous system, accounting for 53.3% and 37.6% of all central nervous system tumors (1). The World Health Organization (WHO) Grade I meningiomas account for 80.5% of all meningiomas and are considered benign meningiomas; the WHO Grade II meningiomas account for 17.7% of all meningiomas and exhibit more aggressive behavior.
Methods: In the period 2015-2022, a retrospective single-center study at the clinic of neurosurgery at the Clinical Center University of Sarajevo was conducted, which included patients with a pathohistological finding of WHO Grade I or II meningioma. Depending on the pathohistological grade of the tumor, patients were divided into two groups: Grade I and Grade II patients. Patients were examined clinically and radiologically. Clinical data collected included in the study: Gender, age, number of symptoms before surgery, whether patients were symptomatic or asymptomatic, pre-operative Eastern Cooperative Oncology Group,and Karnopsky performance scale. Pre-operative contrast magnetic resonance imaging of the head measured tumor volume, temporal muscle thickness (TMT), sagittal midline shift, and surrounding cerebral edema.
Results: A total of 80 patients were enrolled in the study, 68 with WHO Grade I and 12 with WHO Grade II meningiomas. We found that patients with Grade I meningioma were younger and that the mean thickness of the temporal muscle was statistically thicker than in patients with Grade II. Increasing TMT was significantly and positively associated with Grade I tumors and negatively associated with Grade II tumors (p = 0.032).
Conclusion: This study demonstrates that TMT can serve as a radiologic pre-operative indicator of meningioma grade and provide valuable guidance to neurosurgeons in surgical planning. Further studies are needed to validate these results
KliniÄke i kirurÅ”ke znaÄajke tumora stražnje lubanjske jame u odraslih - institucijsko iskustvo kirurÅ”kog lijeÄenja
In contrast to tumors in children, between 6% and 20% of all brain tumors in
adults arise solitary in the posterior cranial fossa. Given their rarity in adults, as well as the importance
and complexity of their treatment, this paper reviews and discusses the clinical and surgical characteristics
of such tumors. In a retrospective single-institution observational study, adult patients with
posterior fossa tumors treated surgically over a ten-year period were analyzed. The characteristics
observed were age and gender distribution, clinical symptoms, histopathologic tumor type, tumor size,
location and extent of surgical resection, tumor recurrence and postoperative complications, as well as
surgical outcome. Sixty-six patients who underwent surgical treatment were diagnosed with a tumor
in the posterior fossa. The mean age was 63 years, and patients were evenly distributed by gender.
The most common histopathologic type was metastatic tumor (59.1%), whereas meningioma was
the most common primary brain tumor (16.6%) recorded. Most patients presented with vegetative
and cerebellar symptoms in general and cranial nerve palsy, especially in the occurrence of vestibular
schwannoma. In conclusion, posterior fossa tumors grow in a confined space and therefore may directly
threaten vital centers in their immediate vicinity. Thus, it is crucial to schedule an appropriate
surgical intervention as soon as possible, as it can significantly improve treatment outcome and prognosis
of the disease. If possible, meticulous total tumor resection should be the treatment of choice. In
the case of hydrocephalus, a ventriculoperitoneal shunt should be considered as an alternative surgical
option after tumor resection.Za razliku od tumora u djece, samo 6% do 20% svih tumora mozga u odraslih nastaje u stražnjoj lubanjskoj jami. S obzirom
na njihovu rijetkost, ali i složenost i važnost lijeÄenja tumora stražnje lubanjske jame u odraslih, ovdje raspravljamo
i osvrÄemo se na kliniÄke i kirurÅ”ke znaÄajke takvih tumora. U opservacijskoj retrospektivnoj studiji analizirani su odrasli
bolesnici s tumorom stražnje jame koji su kirurÅ”ki lijeÄeni tijekom desetogodiÅ”njeg razdoblja. Ispitivane su znaÄajke bile
dob i spolna distribucija, histopatoloÅ”ki tip tumora te kliniÄki simptomi, veliÄina tumora, lokacija i opseg kirurÅ”ke resekcije,
recidiv tumora i poslijeoperacijske komplikacije te uspjeÅ”nost kirurÅ”kog lijeÄenja. Tumor stražnje jame dijagnosticiran je u 66
bolesnika koji su podvrgnuti kirurÅ”kom lijeÄenju. ProsjeÄna dob bila je 63 godine, a bolesnici su bili ravnomjerno rasporeÄeni
prema spolu. NajÄeÅ”Äi histopatoloÅ”ki tip bio je metastatski tumor (59,1%), dok je meningiom bio najÄeÅ”Äi primarni tumor
mozga (16,6%). VeÄina bolesnika imala je vegetativne i cerebelarne simptome te ispad vestibularnog živca u sluÄaju vestibularnog
Å”vanoma. U zakljuÄku, buduÄi da tumori stražnje jame rastu u ograniÄenom prostoru i stoga mogu izravno ugroziti
vitalne centre smjeÅ”tene u njihovoj neposrednoj blizini, kljuÄno je Å”to prije zapoÄeti s odgovarajuÄim kirurÅ”kim lijeÄenjem,
Å”to može znaÄajno poboljÅ”ati uspjeÅ”nost lijeÄenja i prognozu bolesti. Ako je moguÄe, precizna i potpuna resekcija tumora
treba biti metoda izbora u kirurÅ”kom lijeÄenju. U sluÄaju hidrocefalusa, ventrikuloperitonejska likvorska drenaža može biti
alternativa u nadopuni tumorske resekcije