Ferruh Gezen

Review of 36 Cases of Spinal Cord Meningioma

STUDY DESIGN Thirty-six consecutive patients with histologically confirmed spinal cord meningioma were presented to evaluate clinical, diagnostic, therapeutic options and to correlate treatment methods and outcome. OBJECTIVE To present the incidence, clinical presentation, localization, techniques, and long term results of surgically treated spinal meningiomas. SUMMARY OF BACKGROUND DATA Meningiomas are common tumors of spinal neoplasm. They are generally benign and slow-growing. Advanced in radiologic and surgical techniques have brought about better surgical results. The goal of surgical treatment must be total resection if possible. However, spinal meningiomas may recur, especially as a result of incomplete resection. METHODS Thirty-six consecutive patients with histologically confirmed spinal meningiomas were treated from 1980 to 1997. Neuroradiological diagnosis was made through myelogram in 20 patients, CT scan in 15 patients, and MRI in 16 patients. All patients were operated on via the posterior approach and using microsurgical technique and when necessary Cooper-Ultrasonic surgical aspirator (CUSA) and CO2 laser were also applied. The patients were followed for 2 to 15 years (mean 9 years). Radiotherapy was not undertaken except in recurrent tumors. RESULTS The most frequent site of spinal meningiomas was in the thoracic region. In 30 (83%) patients tumors were found to be completely intradural extramedullary during surgery. Total tumor resection was achieved in 35 (97%) of patients. In the follow-up period, 30 cases (83%) improved when compared to their preoperative conditions. There was one operative mortality (3%). A 66-year-old women died of pulmonary emboli. CONCLUSIONS Magnetic resonance imaging is the best imaging technique for diagnosis. Total tumor resection improved the surgical results of spinal meningiomas. If total removal of the tumor cannot be achieved, or in the case of early recurrence followed by total resection, radiotherapy should be performed in adjuvant therapy.

Causes of infections and management results in penetrating craniocerebral injuries

From February 1992 to December 1994, 148 patients with penetrating craniocerebral injuries were treated surgically with primary and secondary debridement including repair of dural defects and removal of retained intracranial bone and metal fragments. Dural defects were closed primarily or with temporalis fascia, pericranium, and cadaver graft. Cerebrospinal fluid fistulas were observed in 11(7.3 %) patients; 7 of these were infected. Central nervous system (CNS) infection was seen in 2 patients without CSF fistula. Excluding those 11 patients with CSF fistula, CNS infection was shown in 2 of the 137 cases (1.5 %). All patients underwent CT scans periodically. In 51 (34 %) of 148 patients, bone and metal fragments were determined on control CT scans. During this time, 12 patients died (8 %). Most of deaths were caused by the direct effect of brain injury and occured within the first month after injury. Fragments retained after first debridement were followed periodically by CT scan. Surgery was not performed until infection developed. Retained fragments did not increase the infection risk, but high rates of infection did occur in cases with CSF fistula.

spinal Pigmented Villonodular Synovitis : A Case Report

Study Design This case report illustrates a young male patient with thoracal spinal pigmented villonodular synovitis who presented with difficulty in walking. Objectives The treatment of this lesion with posterior approach for preventing neurological deterioration and follow‐up with magnetic resonance imaging studies. Summary of Background Data Spinal involvement of pigmented villonodular synovitis rare. It is treated by radical surgical excision. But in some cases, as in our case, surgical total excision of the lesion with a one‐stage operation is not possible. For this reason, in such cases, follow‐up studies with magnetic resonance images are sufficient. This report represents the 14th case of spinal involvement of pigmented villonodular synovitis. Methods The patient presented with difficulty walking and received surgery including posterior decompression and subtotal tumor excision. All neurologic signs and symptoms disappeared in a short period. Postoperatively, follow‐up studies with magnetic resonance imaging were performed and regrowth of residual lesion was not detected. Results The patient was discharged home without neurologic deficit. Follow‐up studies with magnetic resonance images showed no regrowth of residual lesion. Conclusions The principle of surgical management of spinal lesions causing neurologic deficit is early surgical decompression. Although pigmented villonodular synovitis requires total excision, in the presented case total excision of lesion was impossible, because vertebral body involvement needs an anterior or posterolateral approach. During the 16‐month follow up, regrowth of the lesion has not occurred. These observations indicate that surgical decompression and follow‐up of a patient with magnetic resonance imaging constitute a satisfactory treatment of pigmented villonodular synovitis.

Primary Ewing's sarcoma of the skull: follow-up with bone scanning

The authors report and discuss an extremely rare case of primary Ewings sarcoma originating in the flat bones of the skull. The case was followed up by serial bone scanning during the postoperative period. A subclinical recurrence was detected as a focus at the original site 2.5 years after the first operation. Following a second operation and adjuvant chemotherapy the patient is still asymptomatic.