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Ruparelia J, Gosal JS, Garg M, Jha DK, Kaur M, Kumari K. Mucous Extractor for Tumor Tissue Sampling in Neurosurgery. Asian J Neurosurg 2023; 18:88-90. [PMID: 37056902 PMCID: PMC10089749 DOI: 10.1055/s-0043-1761235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Objective Collection of sample for histopathological analysis is highly important during any surgical procedure. The histopathology report helps determine the diagnosis, prognosis further management, and follow-up plan. The use of a reliable sample collection technique is doubly important in neurosurgical procedures because lesions are often deep-seated and difficult to access.
Materials and Methods Conventional techniques of sample collection, such as use of tumor-grasping forceps and collection of material from the ultrasonic aspirator device suffer from limitations of access and unreliability. We propose a novel technique of sample collection using readily available mucous aspirator device.
Results This device is economical, sterile, and disposable. It can be used even in low-resource settings because it is easily available. It can also be connected to suction cannula and the negative pressure settings can be adjusted as required.
Conclusion The use of this device for neurosurgical procedures has been tried in the transcranial and transnasal neurosurgical procedures and found to be effective. The sample collected in the canister of the mucous aspirator can be directly sent to the laboratory for histopathological analysis.
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Mahmoud AT, Enayet A, Alselisly AMA. Surgical considerations for maximal safe resection of exophytic brainstem glioma in the pediatric age group. Surg Neurol Int 2021; 12:310. [PMID: 34345451 PMCID: PMC8326137 DOI: 10.25259/sni_318_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/28/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Brainstem glioma is the leading cause of morbidity and mortality among all central nervous system tumors, especially in childhood as it represents about 20% of all pediatric brain tumors. Therefore, this study aimed to present our experience in a tertiary center in a developing country with limited resources for the surgical management of exophytic brainstem gliomas. Methods: This retrospective study included pediatric patients with brainstem (midbrain, pontine, or medullary) focal or diffuse gliomas whether low or high grade that had dorsal, ventral, or lateral exophytic component who were presented to our hospitals from January 2019 to January 2021. The patients’ data were collected, such as age, sex, preoperative and postoperative clinical condition, radiological data, surgical approach, extent of tumor removal, histopathology, follow-up period, and adjuvant therapy. Results: A total of 23 patients were included in this study. The telovelar approach was used in 17 patients, the supracerebellar infratentorial approach in three patients, and the retrosigmoid, transcerebellar, and occipital transtentorial approach once for each patient. Twenty patients underwent near-total excision, and three underwent subtotal excision. Two-thirds of our cases (17 patients) were low-grade gliomas, with the remaining one-third comprising entirely of either anaplastic astrocytoma (five patients) or glioblastoma multiforme (one patient). The follow-up period of the patients extended from 3 months to 24 months. Conclusion: Exophytic brainstem glioma surgery can result in good outcomes with minimal complications when near-total excision is attempted through a properly chosen approach and adherence to some surgical techniques and considerations.
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Affiliation(s)
- Ayman Tarek Mahmoud
- Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Cairo University, Giza, Egypt
| | - Abdelrhman Enayet
- Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Children Cancer Hospital, Cairo, Egypt
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3
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Díaz-Bello S, Hernández-Hernández A, Guinto-Nishimura GY, Mondragón-Soto MG, Lem-Carrillo M, González-Aguilar A, Calleja-Castillo JM, Leyva-Rendón A, León-Ortiz P, Chávez-Piña CM, Pando-Tarín GA, Mejía-Pérez SI, Taboada-Barajas J, Zavala-Álvarez ED, Soto-Hernández JL, Cárdenas G, Gómez-Amador JL. Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center. Neurosurg Focus 2020; 49:E4. [PMID: 33260129 DOI: 10.3171/2020.9.focus20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications. METHODS The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: "Neurosurgery," "COVID-19/SARS-CoV-2," "reconversion/modification," "practice," "academy," and "teaching." Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel. RESULTS According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology. CONCLUSIONS The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.
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Affiliation(s)
- Sergio Díaz-Bello
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alan Hernández-Hernández
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Michel G Mondragón-Soto
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Monica Lem-Carrillo
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alberto González-Aguilar
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Juan M Calleja-Castillo
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Adolfo Leyva-Rendón
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Pablo León-Ortiz
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Carmen M Chávez-Piña
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Gustavo A Pando-Tarín
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Sonia I Mejía-Pérez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,5Medical Education
| | - Jesús Taboada-Barajas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,6Neuroradiology, and
| | - Elsa D Zavala-Álvarez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - José L Soto-Hernández
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Graciela Cárdenas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Juan L Gómez-Amador
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
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Iorio-Morin C, Hodaie M, Sarica C, Dea N, Westwick HJ, Christie SD, McDonald PJ, Labidi M, Farmer JP, Brisebois S, D'Aragon F, Carignan A, Fortin D. Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation. Neurosurgery 2020; 87:E178-E185. [PMID: 32335684 PMCID: PMC7188127 DOI: 10.1093/neuros/nyaa157] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery Department of Surgery Université de Sherbrooke Centre hospitalier universitaire de Sherbrooke Sherbrooke, Québec, Canada
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery Department of Surgery University of Toronto University Health Network - TWH Toronto, Ontario, Canada
| | - Nicolas Dea
- Division of Neurosurgery Department of Surgery University of British Columbia Blusson Spinal Cord Center Vancouver, British Columbia, Canada
| | - Harrison J Westwick
- CIUSSS du Nord de l'Ile de Montréal Hôpital de Sacré-Coeur de Montréal Montréal, Québec, Canada
| | - Sean D Christie
- Division of Neurosurgery Department of Surgery Dalhousie University Halifax, Nova Scotia, Canada
| | - Patrick J McDonald
- Division of Neurosurgery Department of Surgery University of British Columbia BC Children's Hospital Vancouver, British Columbia, Canada
| | - Moujahed Labidi
- Division of Neurosurgery Department of Surgery Centre hospitalier de l'Université de Montréal Montréal, Québec, Canada
| | - Jean-Pierre Farmer
- Division of Neurosurgery Department of Pediatric Surgery McGill University The Montreal Children's Hospital Montréal, Québec, Canada
| | - Simon Brisebois
- Division of Otolaryngology-Head & Neck Surgery Department of Surgery Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology Université de Sherbrooke Sherbrooke, Québec, Canada
| | - Alex Carignan
- Department of Microbiology and Infectious Diseases Université de Sherbrooke Sherbrooke, Québec, Canada
| | - David Fortin
- Division of Neurosurgery Department of Surgery Université de Sherbrooke Centre hospitalier universitaire de Sherbrooke Sherbrooke, Québec, Canada
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Olesrud IC, Schulz MK, Marcovic L, Kristensen BW, Pedersen CB, Kristiansen C, Poulsen FR. Early postoperative MRI after resection of brain metastases-complete tumour resection associated with prolonged survival. Acta Neurochir (Wien) 2019; 161:555-565. [PMID: 30756241 DOI: 10.1007/s00701-019-03829-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/31/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study aimed to investigate the incidence of residual tumour after resection of brain metastases using early postoperative magnetic resonance imaging (MRI) and the influence of residual tumour on overall patient survival. METHODS Data from 72 consecutive adult patients undergoing surgery for cerebral metastases over an 18-month study period were retrospectively collected. Early postoperative MRI was used to determine the presence of postoperative residual tumour. Patients were divided into three groups according to the presence of tumour remnant on early postoperative MRI: "no residual tumour", "non-measurable residual tumour" and "measurable residual tumour". Survival analysis (mean estimate survival time) was performed using the Kaplan-Meier and log-rank (mantel cox) tests and compared between groups. Surgical reports were evaluated with regard to the surgeon statement about intraoperative extent of resection (EOR) and compared with the presence of tumour remnant found on the early postoperative MRI. RESULTS Sixty-eight procedures were followed by early postoperative MRI. MRI verified the presence of "measurable residual tumour" following 15 procedures (22%). MRI confirmed complete resection in 57%. Gross total resection was described by the operating surgeon in 85% of the procedures. There was a significant difference in survival time after surgery between the group having no residual tumour on MRI and the group with measurable residual tumour (p = 0.025). This difference could not be explained by the differences in postoperative radiation therapy. The longest survival was found in patients with non-measurable and no residual tumour on early postoperative MRI, who also received postoperative radiotherapy. CONCLUSION Residual tumour was seen on MRI after 22% of the procedures. The intraoperative assessment of EOR performed by the surgeon diverged from the early postoperative MRI in 40% of procedures. Correct assessment of residual tumour thus requires early postoperative MRI. Measurable residual tumour on early postoperative MRI was associated with shorter overall survival independent on postoperative radiotherapy.
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Affiliation(s)
- Ida Christine Olesrud
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark.
| | - Mette Katrine Schulz
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Ljubo Marcovic
- Department of Neuroradiology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Bjarne Winther Kristensen
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Christian Bonde Pedersen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
| | - Charlotte Kristiansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense, Denmark
- Clinical Institute and BRIDGE - Brain Research - Inter-Disciplinary Guided Excellence, University of Southern Denmark, Odense, Denmark
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Ahn JH, Lee SH, Kim S, Joo J, Yoo H, Lee SH, Shin SH, Gwak HS. Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location with mode of resection. J Neurosurg 2012; 116:984-93. [DOI: 10.3171/2012.1.jns111560] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Surgical spillage has been one of the causative factors for the development of leptomeningeal seeding (LMS) after resection of brain metastases. In this paper, the authors' goal was to define the factors related to the development of LMS and to evaluate the difference according to tumor location.
Methods
The authors retrospectively analyzed 242 patients who had undergone resection for brain metastases. The factors investigated included tumor location with proximity to the CSF pathway (that is, contacting, involved with, or separated from the CSF pathway), the method of resection, and the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA).
Results
A total of 39 patients (16%) developed LMS at a median of 6.0 months (range 1–42 months) after resection. The risk of developing LMS was significantly higher in patients whose tumors were resected piecemeal than in those whose tumors were removed en bloc, with a hazard ratio (HR) of 4.08 (p < 0.01). The incidence of LMS was significantly higher in patients in whom the CUSA was used, and the HR was 2.64 (p < 0.01). The proximity of tumor to the CSF pathway in the involved group conferred an increased risk of LMS compared with the separated group (HR 11.36, p < 0.01). The risk of piecemeal resection for LMS was significant only in involved lesions (p < 0.01), and the use of the CUSA in both contact and involved lesions increased the incidence of LMS (p < 0.01 and p < 0.03, respectively).
Conclusions
The authors suggest that piecemeal resection using the CUSA should be limited because of the risk of postsurgical LMS, especially when the tumor is in contact with the CSF pathway.
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Affiliation(s)
- Jun Hyong Ahn
- 1Department of Neurosurgery, Seoul National University College of Medicine; and
| | | | | | | | - Heon Yoo
- 4Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
| | - Seung Hoon Lee
- 4Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- 4Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
| | - Ho-Shin Gwak
- 4Neuro-oncology Clinic, National Cancer Center, Goyang, Korea
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Forterre F, Dickomeit M, Senn D, Gorgas D, Spreng D. Microfenestration using the CUSA Excel ultrasonic aspiration system in chondrodystrophic dogs with thoracolumbar disk extrusion: a descriptive cadaveric and clinical study. Vet Surg 2010; 40:34-9. [PMID: 21175695 DOI: 10.1111/j.1532-950x.2010.00780.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe an ultrasonic surgical aspirator assisted disk fenestration technique in dogs. STUDY DESIGN Descriptive cadaveric and prospective clinical study. ANIMALS Fresh Beagle cadavers (n=5) and 10 chondrodystrophic dogs with thoracolumbar disk extrusion. METHODS Cadaveric study: Intervertebral disks T12-L2 were fenestrated with the CUSA Excel in 5 Beagle cadavers, and fenestration efficacy assessed by morphologic examination of the completeness of fenestration and size of annulotomy. Clinical study: the affected intervertebral disk was fenestrated in 10 chondrodystrophic dogs treated by hemilaminectomy for thoracolumbar disk disease. Efficacy of fenestration was evaluated. RESULTS Mean time necessary to perform CUSA assisted fenestration was 8 minutes (range, 5-10 minutes) for each disk in cadavers and patients. In cadaver spines, removal of the nucleus pulposus was complete in 11/15 disks. In 4 disks, remnants of nucleus pulposus material were observed on the contralateral side. Nuclear material was normal in 9/15 disks and showed evidence of chondroid degeneration on histopathologic examination in the 6 disks. Median annulotomy size was 3 mm. Clinically, no signs of early recurrence were observed and all dogs recovered uneventfully. CONCLUSIONS CUSA assisted fenestration is a safe and efficient method of fenestration for removal of most of the nucleus pulposus through a limited annulotomy.
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Affiliation(s)
- Franck Forterre
- Department of Surgery and Radiology, University of Berne, Switzerland.
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8
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Greco JJ, Aiken SA, Berg JM, Monette S, Bergman PJ. Evaluation of intracranial meningioma resection with a surgical aspirator in dogs: 17 cases (1996-2004). J Am Vet Med Assoc 2006; 229:394-400. [PMID: 16881832 DOI: 10.2460/javma.229.3.394] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine results of intracranial meningioma resection by use of a surgical aspirator and assess prognostic factors associated with intracranial meningiomas in dogs. DESIGN Retrospective case series. ANIMALS 17 dogs. PROCEDURES Medical records of dogs that underwent resection of an intracranial meningioma by use of a surgical aspirator were reviewed. Information pertaining to signalment, imaging findings, clinical signs, duration of clinical signs, preoperative treatment, location of the tumor, results of histologic assessment, outcome, and necropsy results was obtained from the medical record. Clients and referring veterinarians were contacted via telephone for information on recurrence of clinical signs and postoperative survival time. RESULTS 16 dogs were > 7 years of age, and all 17 dogs had seizures before surgery. The most commonly affected breed was the Golden Retriever, represented by 6 of the 17 dogs. Median survival time was 1,254 days. Of the data collected, only histologic subtype of the tumor was prognostic. Analysis of survival times according to histologic tumor subtypes indicated that the order from most brief to longest was as follows: anaplastic, 0 days; fibroblastic, 10 days; psammomatous, > 313 days; meningothelial, > 523 days; and transitional, 1,254 days. CONCLUSIONS AND CLINICAL RELEVANCE Use of a surgical aspirator to resect intracranial meningiomas in dogs was associated with longer survival times than those achieved with traditional surgery alone or traditional surgery combined with radiation therapy. Dogs with meningothelial, psammomatous, or transitional intracranial meningioma subtypes appeared to have a better prognosis than dogs with other subtypes of meningioma.
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Affiliation(s)
- Justin J Greco
- Department of Surgery, The Animal Medical Center, 510 E 62nd St, New York, NY 10021, USA
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9
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Galarza M, Sood S, Pomata HB. Use of ultrasonic aspiration for dural opening in cranial reoperations: technical note. Neurosurgery 2005; 57:E216; discussion E216. [PMID: 15987598 DOI: 10.1227/01.neu.0000163689.05620.2e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 09/20/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Dural detachment from the brain in cranial reoperations has been accomplished previously by selective coagulation and the cutting of brain-dural adhesions. The results of ultrasonic aspiration during tumor surgery or brain cutting procedures led the authors to speculate that the detachment of the dura mater from brain tumors by applying the Cavitron ultrasonic surgical aspirator (Valleylab, Boulder, CO [formerly Cavitron, Inc., Stamford, CT]) to the brain-dura mater interface could be used to reduce bleeding and facilitate dural opening during cranial reoperations. METHODS Ten patients underwent a second craniotomy for epilepsy surgery (five cases of extended temporal lobectomy and five cases of extended extratemporal lesionectomy). The use of ultrasonic aspiration and its effects on brain separation from the dura mater were examined. RESULTS Intraoperative use of the Cavitron ultrasonic surgical aspirator during dural opening produced immediate blanching of the dura mater and enhanced visualization of the cortical surface without distortion of the brain anatomy. CONCLUSION Incremental dural opening and brain visualization is achieved by careful application of ultrasonic aspiration directly into the brain-dura limit, producing immediate regional dural devascularization. Use of this technique reduces cortical and dural bleeding and enhances the ease and effectiveness of brain visualization.
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Affiliation(s)
- Marcelo Galarza
- Department of Neurosurgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, USA.
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10
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Hentschel SJ, Sawaya R. Optimizing outcomes with maximal surgical resection of malignant gliomas. Cancer Control 2003; 10:109-14. [PMID: 12712005 DOI: 10.1177/107327480301000202] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Aggressive surgical resection of malignant gliomas is a controversial issue in neurosurgery. Studies with rigorous methodology that fully address this issue have only recently become available. METHODS The controversy regarding the role of maximal surgical resection of malignant gliomas is reviewed. The authors discuss surgical techniques and adjunctive technologies that can be utilized to assist in resection of these lesions. RESULTS Using current microneurosurgical techniques, it is possible to resect malignant gliomas in gross total fashion. An aggressive approach in which 98% or more of the tumor mass is resected results in a statistically significant survival advantage. CONCLUSIONS An aggressive surgical procedure for malignant gliomas can result in increased survival duration for selected groups of patients.
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Affiliation(s)
- Stephen J Hentschel
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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