Recent advances in neurosurgical treatment for the elderly

Intramedullary spinal cord tumors in patients older than 50 years of age: management and outcome analysis

OBJECT

Intramedullary spinal cord tumors (IMSCTs) in the older-age adult population pose complex management issues regarding the extent of resection and functional outcome, especially in terms of quality of life. Historically, IMSCTs in the older adult population were treated with irradiation alone because it was assumed that functional recovery would be poor. The authors examined their IMSCT database and report the first large series of IMSCTs in patients older than 50 years of age.

METHODS

In this retrospective clinical and chart review there were 30 cases meeting inclusion criteria drawn from databases at three different institutions. A modified McCormick Scale was used to assess functional levels in all 30 patients pre- and postoperatively. The mean age of patients in this cohort was 59.8 years (range 50-78 years), and the mean follow-up period was 10.6 years (range 2-16 years). Ependymoma was the most common tumor (83%), and 55% were located in the thoracic spine. The most common presenting symptom was sensory dysesthesia, with rare motor loss. The prodromal period to treatment was 19.4 months. Based on the McCormick Scale score at last follow-up examination 67% of patients were clinically functionally the same, 9% were worse, and 24% were improved after surgery. There were two deaths due tumor progression (both malignant tumors) and one recurrence (anaplastic astrocytoma). All three patients in whom malignant astrocytomas were diagnosed underwent postoperative radiation therapy.

CONCLUSIONS

In the population of patients older than age 50 years, thoracic ependymomas are the most common IMSCTs that present characteristically with sensory symptoms. The longer prodromal period in the older adult population may reflect the fact that their diagnosis and workup is inadequate. There was no significant increase in the length of stay in the neurosurgical ward. The authors recommend motor evoked potential-guided aggressive microsurgical resection, because the long-term outcome of benign lesions is excellent (good functional recovery and no tumor recurrence).

The carbon dioxide surgical laser in neurological surgery, decubitus ulcers, and burns

Laser surgery has become an established part of general and specialty surgical techniques. Of all the lasers available today, the carbon dioxide laser possesses the physical and biological-surgical properties of most value to the surgeon. The CO2 laser puts out a spatially and temporally coherent beam of high intensity, infrared radiation at 10.6 micrometers, a wavelength nearly 100% absorbed by tissue. Its action is dependent on heat, and it has the ability to vaporize, cut, and excise all tissue hemostatically, sterilizing as it proceeds. Experimental work in animal patients and man has laid the groundwork for clinical application. The CO2 laser's value as a surgical tool has been clearly shown in the treatment of cancers and other neoplasms in brain, thoracic, and abdominal viscera; larynx; pharynx; nasal and sinus cavities; rectum; vulva, vagina; and uterus, for palliation and, at times, cure. It has been found of undoubted value in the debridement of decubitus ulcers and burns and has great potential for orthopedic surgery and breast surgery. The surgical laser is safe for patient and operating personnel, relatively simple to use, rapid in its action and without untoward impact on tissue locally or at a distance.

Laser applications in medicine and biology: a bibliography

This bibliography covers the period from 1963 through 1974; 916 references are classified under 23 subject headings. The references are arranged chronologically.

Neurosurgery in the older patient

The outcome of brain and spinal surgery has been assessed in 141 patients who were over the age of 65 at the time of operation. Patients tolerated investigation and surgery remarkably well and good results were obtained for benign lesions. Survival times and the contribution of surgery to reducing disability in malignant disease were disappointing.