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Chen Z, Lin T, Liu D, Zeng Y, Zhang X, Deng B, Guo D, Shi T, Lu M. Comparison of Short-Term Surgery Outcomes and Clinical Characteristics Between Elderly and Non-Elderly Patients with Middle Third Parasagittal and Parafalcine Meningiomas. Neuropsychiatr Dis Treat 2023; 19:2331-2340. [PMID: 37928167 PMCID: PMC10624188 DOI: 10.2147/ndt.s428341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aims to compare the short-term surgery outcomes of the resection of meningiomas and clinical characteristics between elderly and non-elderly patients. Patients and Methods This retrospective study included patients who underwent a resection of middle third parasagittal and parafalcine meningiomas between January 2011 and December 2020. All lesions arise from the middle third of the parafalcine or infiltrate superior sagittal sinus (SSS). The clinical characteristics studied included neurological deficit, peritumoral brain edema (PTBE), SSS invasion, tumor size, and symptoms; perioperative complications, and short-term surgery outcomes including neurological deficit, operative blood loss, postoperative hospitalization duration, and WHO classification were compared. Results A total of 43 elderly patients and 63 non-elderly patients were included. Compared with non-elderly patients, elderly patients had larger lesions (P = 0.013) and presented with a larger PTBE (P = 0.019). SSS blockage was identified in 28.57% of elderly patients and 19.57% of non-elderly patients. Compared with non-elderly patients, elderly patients tended to suffer from more aggressive lesions (WHO II/III meningioma 6 vs 3, P = 0.154) and presented with longer postoperative hospital stays (17.25 ± 5.8 vs 13.50 ± 3.8, P = 0.009); conversely, while the non-elderly patients experienced more blood loss (P = 0.022) and had more perioperative reoperations (3 vs 1). No significant difference in neurological deficit was detected between the two groups (P = 0.97). After total tumor resection, patients with neurological deficits in both groups can recover during the follow-up period. Conclusion Among the 106 patients with middle third parasagittal and falx meningiomas in our hospital, elderly patients had larger lesions, presented with more severe PTBE, and had longer postoperative hospital stays than younger patients. Conversely, younger patients had more blood loss and serious complications than elderly patients. Postoperative neurological dysfunction in elderly patients was similar to that in middle-aged and young patients.
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Affiliation(s)
- Zhijie Chen
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Lin
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Da Liu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Yongqin Zeng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Xubiao Zhang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Bin Deng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Dongliang Guo
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Shi
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Ming Lu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
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Tosi U, Souweidane MM. The Future of Neuroendoscopy: Looking Ahead Through a Lens. World Neurosurg 2023; 178:311-316. [PMID: 37803687 DOI: 10.1016/j.wneu.2023.07.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
Neuroendoscopy has progressed remarkably in the past few decades. Ventriculoscopy, skull base endoscopy, and spinal endoscopy are now part of routine practice in the neurosurgical treatment of numerous pathologies. Like other developing fields, however, it faces numerous challenges and obstacles that must be overcome for the field to continue to evolve and expand. This brief review of new and exciting developments in neuroendoscopy describes some of the most interesting directions the field is starting to steer towards.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
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Tosi U, Guadix SW, Cohen AR, Souweidane MM. Neuroendoscopy: How We Got Here. World Neurosurg 2023; 178:298-304. [PMID: 37803685 DOI: 10.1016/j.wneu.2023.07.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
From its inception in ancient Egyptian rituals, neuroendoscopy always promised a minimally invasive route to the cerebrum. Early visionaries, however, hit the proverbial wall of technical development until the 20th century, when new technologies allowed for light to be transmitted across a tube for visualization of intracranial structures. Despite a hiccupping start, with surgical microscopy hampering initial excitement, the development and transformation of neuroendoscopy continued, and today it is a widespread and reliable surgical option for the treatment of numerous varied and complex pathologies.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Alan R Cohen
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
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Xie T, Wang Y, Zhang X, Shao N, Lu W, Yang Q, Qu C, Li C, Liu T, Liu S, Zhu W. Endoscopic Far-Lateral Supracerebellar Infratentorial Approach for Petroclival Region Meningioma: Surgical Technique and Clinical Experience. Oper Neurosurg (Hagerstown) 2022; 22:290-297. [PMID: 35315837 DOI: 10.1227/ons.0000000000000126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The management of petroclival region meningioma remains the ultimate achievement in neurosurgery, because of the formidable technical challenges involved. OBJECTIVE To describe the technique and feasibility of the purely endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA) for the treatment of petroclival region meningiomas. METHODS We reviewed the clinical data of 10 consecutive cases of petroclival region meningiomas treated with the EF-SCITA from August 2018 to August 2020. The clinical outcomes were analyzed. The patient was placed in the lateral position, and then, a "C" shaped incision and craniotomy with exposed sigmoid and transverse sinuses were performed. With the endoscopic holder, endoscopic procedures were performed using standard 2-hand microsurgical techniques. Whether the tentorium or Meckel cave was handled depended on the tumor extension. RESULTS The mean diameter was 45 × 25 mm. Dizziness and headache were the main symptoms. All 10 patients achieved gross total or subtotal resection (Petroclival Meningioma Grade I-III) with good neurological outcomes. The EF-SCITA provides satisfactory, direct exposure to the petroclival region. Cranial nerve deficits are the main postoperative complications. Two patients had a trochlear nerve injury, 3 patients had transient facial paralysis, and 2 patients had oculomotor paralysis (1 total and 1 incomplete), but both of them recovered during the follow-up period. One patient experienced an ipsilateral superior cerebellar artery infarction, and another patient had transient hemiparesis. CONCLUSION The EF-SCITA is effective for most petroclival region meningiomas, except for the cavernous sinus type. This approach simplifies craniotomy procedures, omits burdensome petrosectomy, and avoids crossing posterior neurovascular structures.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yushe Wang
- Department of Neurosurgery, Henan Provincial Peoples Hospital, Zhengzhou, Henan Province, China
| | - Xiaobiao Zhang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China.,Digital Medical Research Center, Fudan University, Shanghai, China
| | - Naiyuan Shao
- Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Weicheng Lu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Qiaoqiao Yang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chenghui Qu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tengfei Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shuang Liu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Zhu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Bai J, Li M, Shi J, Jing L, Zhai Y, Zhang S, Wang J, Zhao P, Li C, Gui S, Zhang Y. Mid-term follow-up surgical results in 284 cases of clival chordomas: the risk factors for outcome and tumor recurrence. Neurosurg Rev 2021; 45:1451-1462. [PMID: 34623525 PMCID: PMC8976789 DOI: 10.1007/s10143-021-01576-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/12/2021] [Accepted: 05/26/2021] [Indexed: 12/03/2022]
Abstract
Objective Skull base chordoma (SBC) is rare and one of the most challenging diseases to treat. We aimed to assess the optimal timing of adjuvant radiation therapy (RT) and to evaluate the factors that influence resection and long-term outcomes. Methods In total, 284 patients with 382 surgeries were enrolled in this retrospective study. Postsurgically, 64 patients underwent RT before recurrence (pre-recurrence RT), and 47 patients underwent RT after recurrence. During the first attempt to achieve gross-total resection (GTR), when the entire tumor was resected, 268 patients were treated with an endoscopic midline approach, and 16 patients were treated with microscopic lateral approaches. Factors associated with the success of GTR were identified using χ2 and logistic regression analyses. Risk factors associated with chordoma-specific survival (CSS) and progression-free survival (PFS) were evaluated with the Cox proportional hazards model. Results In total, 74.6% of tumors were marginally resected [GTR (40.1%), near-total resection (34.5%)]. History of surgery, large tumor volumes, and tumor locations in the lower clivus were associated with a lower GTR rate. The mean follow-up period was 43.9 months. At the last follow-up, 181 (63.7%) patients were alive. RT history, histologic subtype (dedifferentiated and sarcomatoid), non-GTR, no postsurgical RT, and the presence of metastasis were associated with poorer CSS. Patients with pre-recurrence RT had the longest PFS and CSS, while patients without postsurgical RT had the worst outcome. Conclusion GTR is the goal of initial surgical treatment. Pre-recurrence RT would improve outcome regardless of GTR. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-021-01576-4.
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Affiliation(s)
- Jiwei Bai
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mingxuan Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianxin Shi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Liwei Jing
- Department of Health Statistics, Shanxi Medical University, Taiyuan, China
| | - Yixuan Zhai
- Department of Neurosurgery, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Shuheng Zhang
- Department of Neurosurgery, Anshan Central Hospital, Anshan, China
| | - Junmei Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Peng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuzhong Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Songbai Gui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yazhuo Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. .,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Ni B, He M, Cao B, He J, Liu Y, Zhao Z. Status Quo and Research Trends of Neurosurgical Departments in China: Bibliometric and Scientometric Analyses (Preprint). J Med Internet Res 2020; 23:e25700. [PMID: 36260378 PMCID: PMC8406120 DOI: 10.2196/25700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bowen Ni
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Minyi He
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
- Clinical Medicine Education Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bei Cao
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
- Laboratories & Facilities Management Office, Southern Medical University, Guangzhou, China
| | - Jianmin He
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
- Institute of Scientific Research, Southern Medical University, Guangzhou, China
| | - Yawei Liu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
| | - Zhen Zhao
- Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Southern Medical University, Guangzhou, China
- Institute of Scientific Research, Southern Medical University, Guangzhou, China
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Development of Cerebral Endoscopy in Italy: Background, Narration, and Legacy. World Neurosurg 2020; 134:396-401. [DOI: 10.1016/j.wneu.2019.10.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/25/2019] [Accepted: 10/26/2019] [Indexed: 11/17/2022]
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Intracerebral hemorrhage cadaver model for training in hematoma evacuation under endoscopy. J Clin Neurosci 2019; 63:272-277. [DOI: 10.1016/j.jocn.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/25/2018] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
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