Management of Intracranial Meningiomas Using Keyhole Techniques

BACKGROUND: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas. METHODS: Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II. RESULTS: The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed. CONCLUSIONS: With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results

Predictive factors for beneficial application of high-frequency electromagnetics for tumour vaporization and coagulation in neurosurgery

<p>Abstract</p> <p>Objective</p> <p>To identify preoperative and intraoperative factors and conditions that predicts the beneficial application of a high-frequency electromagnetic field (EMF) system for tumor vaporization and coagulation.</p> <p>Methods</p> <p>One hundred three subsequent patients with brain tumors were microsurgically treated using the EMF system in addition to the standard neurosurgical instrumentarium. A multivariate analysis was performed regarding the usefulness (ineffective/useful/very helpful/essential) of the new technology for tumor vaporization and coagulation, with respect to tumor histology and location, tissue consistency and texture, patients' age and sex.</p> <p>Results</p> <p>The EMF system could be used effectively during tumor surgery in 83 cases with an essential contribution to the overall success in 14 cases. In the advanced category of effectiveness (very helpful/essential), there was a significant difference between hard and soft tissue consistency (50 of 66 cases vs. 3 of 37 cases). The coagulation function worked well (very helpful/essential) for surface (73 of 103 cases) and spot (46 of 103 cases) coagulation when vessels with a diameter of less than one millimeter were involved. The light-weight bayonet hand piece and long malleable electrodes made the system especially suited for the resection of deep-seated lesions (34 of 52 cases) compared to superficial tumors (19 of 50 cases).</p> <p>The EMF system was less effective than traditional electrosurgical devices in reducing soft glial tumors. Standard methods where also required for coagulation of larger vessels.</p> <p>Conclusion</p> <p>It is possible to identify factors and conditions that predict a beneficial application of high-frequency electromagnetics for tumor vaporization and coagulation. This allows focusing the use of this technology on selective indications.</p

Cauda equina entrapment in a pseudomeningocele after lumbar Schwannoma extirpation

Incidental or intentional durotomy causing cerebrospinal fluid (CSF) leakage, leading to the formation of a pseudomeningocele is a known complication in spinal surgery. Herniation of nerve roots into such a pseudomeningocele is very rare, but can occur up to years after initial durotomy and has been described to cause permanent neurologic deficit. However, cauda equina fiber herniation and entrapment into a pseudomeningocele has not been reported before. Here, we present a case of symptomatic transdural cauda equina herniation and incarceration into a pseudomeningocele, 3 months after extirpation of a lumbar Schwannoma. A 59-year-old man, who previously underwent intradural Schwannoma extirpation presented 3 months after surgery with back pain, sciatica and loss of bladder filling sensation caused by cauda equina fiber entrapment into a defect in the wall of a pseudomeningocele, diagnosed with magnetic resonance imaging. On re-operation, the pseudomeningocele was resected and the herniated and entrapped cauda fibers were released and replaced intradurally. The dura defect was closed and the patient recovered completely. In conclusion, CSF leakage can cause neurological deficit up to years after durotomy by transdural nerve root herniation and subsequent entrapment. Clinicians should be aware of the possibility of this potentially devastating complication. The present case also underlines the importance of meticulous dura closure in spinal surgery

Establishment of gene bank of inland water fish species

Genetic knowledge helps to protect biodiversity and optimal harvest resources by several ways. This knowledge can help to reduce the risk of extinction to those populations that have high genetic diversity or diminished by detected them. Also, studies of population genetics can present guidelines for improving the structure of the population and understanding the biology of species. One of the most important applications of DNA database is detecting species, fishing offense, diagnose of anemia and genetic classification of animals. DNA bank has helped to identify the species that are hunted and were discovered only parts of their meat and texture. Optimal Storage of aquatic genetic resources and the conservation of biological diversity, as the national capital by using biotechnology methods are the most important goals of gene bank and database reserves of the country creation. Collecting biological specimens of aquatic species, preparation and long-term maintenance of them, genetic registration of endangered and threatened species and the use of biotechnology techniques for the protection, conservation and management of aquatic genetic resources is one of the other functions of the gene bank. Gene bank of inland waters of Iran (Gorgan) is planned and implemented to identify, collect, maintain and protect species at the level of genes, cells, tissues and live fish research and commercial exploitation. Despite the predicted projected funding for this project, unfortunately funding sources have been considered, does not allocated. Therefore some parts of the aims of this project has been organized by Golestan province credits to build molecular laboratory and aquaculture pond in Alang farm and exploitation of potential Gharasou station and Sijoval center restocking and the conditions for the bulk of the project goals is provided. Some parts like tissue culture laboratory and bioinformatics as well as parts and equipment related to the freezing of sperm and embryo development are the items that should be considered in the development of the this bank