Neurosurgical treatment and outcome patterns in patients with meningioma in South Moravian region-a population-based study

INTRODUCTION

Meningiomas are usually slow-growing tumours, constituting about one third of all primary intracranial tumours. They occur more frequently in women. Clinical manifestation of meningiomas depends on their location, tumour size and growth rate. In most cases, surgical treatment is the procedure of choice. The success of this treatment is, however, associated with the radicality of the resection. Radiotherapy represents an additional or alternative treatment modality. Gamma knife surgery is another notable treatment method, especially in small and/or slow-growing tumours in eloquent areas or in elderly patients.

MATERIAL AND METHODS

Authors describe their experience with the diagnosis, treatment and outcome of the patients with meningioma (n = 857). Furthermore, they also assess the postoperative morbidity/mortality and recurrence rate.

RESULTS AND CONCLUSIONS

In view of the benign histology of meningiomas, the success of the treatment largely depends (besides the tumour grading) on the radicality of the resection. The emphasis is also put on appropriate follow-up of the patients. In certain patients, the watch and wait strategy should be also considered as a suitable treatment method.

Probably the oldest patient with the diagnosis of medullar conus teratoma

BACKGROUND

Authors present a case report of a 60 year old patient suffering from several movement and sensitivity disorders lasting for several months. On magnetic resonance scans a huge extramedular intradural structure was described. Patient underwent three operations and the same number of histological investigations. Furthermore we have performed bacteriological investigations because of the presence of suspicious pus during the surgery.

RESULTS

Even after the third investigation the evidence of mature teratoma has been established. After successful passing of three surgeries, the patient has no sphincter disorders and she is able to walk with the sticks and she has only small sensitivity deterioration.

CONCLUSION

All forms of teratoma are chemo- and radioresistent, so beside total extirpation we have no relevant possibilities to cure this tumour. The size of the extirpation is mostly limited by the time of appearance, the size of the tumour and by the potential damages of the normal spinal cord tissue, which could be protected by using neurophysiology (Fig. 3, Ref. 9).

[Effect of histologic classification on surgical treatment of peripheral nerve tumors]

The influence of histological classification on the options of the peripheral nerve tumors surgery Peripheral nerve sheath tumors (PNST) constitute significant part of all tumors of peripheral nerves. In 1998-2000 years we have operated 7 such patients--3 females, 4 males in our department. The definite diagnosis was made by histology. Total removal was performed in all patients. The nerve continuity was preserved in 4 cases (3x neurofibroma, 1x schwannoma) and nerve had to be disconnected in 3 cases (1x neurobibroma, 1x plexiform neurofibroma as a part of von Recklinghausen disease (VRD), 1x malignant schwannoma). Good neurological outcome was in patients with preserved nerve continuity. Out of 3 patients with the need of nerve disconnection, graft and complete reinervation was performed in case of benign neurofibroma, but in the patient with von Recklinghausen disease and in the patient with malignant schwannoma the permanent leasion of nerve remained. We can conclude that histological classification directly predetermine the options of the peripheral nerve tumors surgery.