Pre- and postoperative headache in patients with meningioma

Background Meningiomas are generally slowly growing intracranial tumors. They are often incidentally diagnosed, given that symptoms may be absent even in cases of an enormous tumor size. Headache is a frequent but not consistent symptom. Therefore, we examined the association between structural, biochemical and histochemical tumor parameters with preoperative as well as postoperative occurrence of headache. Methods In our study, we prospectively investigated 69 consecutive patients enrolled for meningioma neurosurgery. Anatomical, histological and biochemical parameters were acquired, and headache parameters were registered from the clinical report and from a questionnaire filled by the patients before neurosurgery. The headache was re-evaluated one year after neurosurgery. The study was designed to exploratively investigate whether there is an association of acquired clinical and biological parameters with the occurrence of preoperative and postoperative headache. Results Edema diameter and the proliferation marker MIB-1 were negatively associated with the incidence and intensity of preoperative headache, while the content of prostaglandin E2 in the tumor tissue was positively associated with preoperative headache intensity. Headache was more prevalent when the meningioma was located in the area supplied by the ophthalmic trigeminal branch. Compared to preoperative headache levels, an overall reduction was observed one year postoperative, and patients with a larger tumor had a higher headache remission. In parietal and occipital meningiomas and in those with a larger edema, the percentage of the headache remission rate was higher compared to other locations or smaller edema. Multivariable analyses showed an involvement of substance P and prostaglandin E2 in preoperative headache. Conclusions The study demonstrates new associations between meningiomas and headache. The postoperative headache outcome in the presented patient sample is encouraging for the performed neurosurgical intervention. These results should be tested in a prospective study that incorporates all patients with meningiomas

Evaluation der intraoperativen Computertomographie bei transsphenoidalen endoskopischen Hypophysenoperationen

Trotz moderner Operationstechniken gelingt selbst erfahrenen Chirurgen eine vollständige Resektion von Hypophysenadenomen bei transsphenoidalen Operationen nur in 50 – 60%. (13) In der Vergangenheit wurde daher versucht mit Hilfe von bildgebenden Verfahren die Radikalität zu verbessern. Im Rahmen der Implementierung eines intraoperativen Computertomographen in der Neurochirurgischen Klinik der Medizinischen Universität Innsbruck sollte erstmals ein OP-Protokoll zur intraoperativen Resektionskontrolle bei raumfordernden Prozeßen im Sellabereich angewendet werden. In dieser Arbeit wird zunächst die Etablierung der Operationsmethode der transsphenoidalen Operation im Computertomographen beschrieben. Anschließend sollten 26 Patienten im CT operiert werden, wobei die Operation an Hand der virtuellen Endoskopie unmittelbar vor dem Eingriff geplant werden konnte. Die Bildbefunde wurden nach folgenden Kriterien ausgewertet: Bildqualität, Artefakte und Ausmaß der Resektion. Wir konnten in 26 Fällen eine intraoperative Resektionskontrolle durch-führen. In keinem Fall kam es zu Komplikationen durch die intraoperative CT-Bildgebung. Die Qualität der CT-Bildgebung war in 61,5 % ausreichend zu Beurteilung eines Resttumors. Die mittlere Operationsdauer betrug 231 Minuten und war damit um 40 Minuten (prä- und postoperatives intraoperatives CT) länger als die konventionell durchgeführte transsphenoidale OP in Innsbruck. Der Vergleich der intraoperativen CT-Bildgebung mit den postoperativ durchgeführten MRT- Kontrollen zeigte, dass nur in 34,2 % ein übereinstimmendes Ergebnis des Tumor- Restvolumens bestand. Zusammenfassend stellen wir fest, dass die intraoperative Computertomographie bei der Resektion von Hypophysenadenomen keine überzeugenden Vorteile gegenüber anderen Verfahren bietet. Als Referenzstandard wird weiterhin die intraoperative MRT-Kontrolle bestehen bleiben.Despite modern operation techniques even experienced surgeons achieve complete resection via transsphenoidal approach only in at least 50 – 60% of adenomas of the pituitary gland (13). In the past there have been different attempts to improve extent of resection by aid of several imaging methods. Within the implementation of an intraoperative CT- scanner at the Department of Neurosurgery of Medical University Inns-bruck a protocol for intraoperative resection- control for tumors in the sella- region was set up for the first time. The first part of this study de-scribes the establishment of transsphenoidal surgery guided by in-traoperative computertomography. In the following clinical study 26 pa-tients were included. All patients were to be operated by use of intra- operative computertomography with treatment planning by help of virtual endoscopy. The images were analyzed after the following criteria: Image quality, artifacts and extent of resection. In 26 cases we could perform intraoperative resection control. No com-plications caused by intraoperative CT- imaging occured. The quality of the images was sufficient to depict residual tumour in 61,5%. Average duration of the operations was 231 minutes. The operations needed 40 minutes longer (pre- and postoperative intraoperative CT- imaging) than conventional transsphenoidal operations in Innsbruck. Comparison of intraoperative CT- imaging with postoperative MRI- scans illustrated that there was an according result of residual tumour- volume just in 34,2 %. We conclude that intraoperative computertomography does not have a convincing advantage over other imaging methods on adenomectomies. Intraoperative MRI- resection control will remain reference standard