Ved P. Sachdev

Esthesioneuroblastoma: Surgical treatment without radiation

This study compares the treatment of two groups of patients diagnosed with esthesioneuroblastoma limited to the nasal cavity without evidence of cribriform plate erosion. Five patients were treated with radiation and extra‐cranial excision, and eight patients were treated by cranio‐facial resection only. The incidences of local recurrence were 60% and 12%, respectively. The paper also presents a new staging classification for these tumors.

Surgical treatment of spinal cord compression from epidural metastasis.

PURPOSEnA retrospective study of the results of neoplastic cord compression was undertaken to determine the effectiveness of surgical treatment and to assess quality of life in patients undergoing extensive procedures with potential morbidity.nnnPATIENTS AND METHODSnOver a 5-year period (1989 to 1993), a total of 110 patients underwent surgery. Fifty-five patients (50%) had undergone prior treatment, including 47 (43%) who had failed to respond to prior irradiation (RT). Before surgery, 48 patients (44%) were nonambulatory, with severe paresis being present in 20. Surgery included staged anterior-posterior resections in 53 patients (48%), anterior resections in 33 (30%), and posterior resection in six (5%), all of whom required spinal instrumentation for reconstruction; only 18 patients underwent resection without instrumentation.nnnRESULTSnPostoperatively, 90 patients (82%) were improved, both in terms of pain relief and ambulatory status. Fifty-three patients (48%) experienced postoperative complications, related statistically to the following three factors: age over 65 years, prior treatment, and presence of paraparesis. The overall median survival duration was 16 months, with 46% alive at 2 years. Apart from primary tumor, the presence of preoperative paraparesis had the most significant impact on survival.nnnCONCLUSIONnOur data suggest that the effective surgical treatment of neoplastic compression requires anterior-posterior resection in most patients to achieve the goal of total tumor resection, with the majority requiring instrumentation. Long-term survival is feasible in a subset of patients with this aggressive surgical approach.

Reoperation for brain metastases.

We report the results of reoperation for brain metastases in 21 patients with recurrent tumors following initial successful resection. The tumor recurrences were local (original site) in 14 patients, and occurred at other sites in the brain in the remaining seven. Time to CNS recurrence ranged from 3 to 30 months. At time of repeat craniotomy, disease was limited to the CNS in 12 (57%) of the patients. Median survival following second craniotomy was 9 months, and the actuarial 2-year survival was 25%. Neurological improvement was seen in two thirds of the patients; the median duration of neurological improvement was 6 months. There was no mortality, and only one patient developed increased deficit following surgery. We conclude that repeat resection of brain metastases is an important therapeutic option in selected patients, and should be considered in symptomatic patients with accessible mass lesions before the use of other experimental treatment.

Malignant Meningioma within the Third Ventricle: A Case Report

A case of a malignant meningioma within the 3rd ventricle is presented. Although malignant transformation of meningiomas has been described, occurrence within the ventricular system is extremely rare.

Ossified spinal meningioma en plaque

Ossified spinal meningiomas alone are uncommon lesions and spinal meningiomas en plaque are even more. A rare case is presented of ossified meningioma en plaque in the midthoracic spine, which was totally removed. Characteristics of this tumor with reference to relatively pathognomonic neuroimagings are discussed. Microsurgical outcome of this type of tumor is expected to be good.

Ependymal cyst of the quadrigeminal plate: case report.

A patient with an ependymal cyst of the quadrigeminal plate is reported. The patient presented with headache, diplopia, and evidence of increased intracranial pressure. A nonenhancing cyst with hydrocephalus was demonstrated by computed tomographic scan. The cyst was subtotally resected using a transtentorial approach. The causes, clinical presentation, and treatment of quadrigeminal plate ependymal cysts are discussed, together with a review of the literature.

INTRAFRONTAL SINUS PRIMARY MENINGIOMA

This 45-year-old w o m a n presented with (a) one month s history of severe bifrontal headaches which radiated to the vertex and occipital regions, and (b) vague right frontal fullness of u n k n o w n duration. Chi ldhood seizures had started at age six years, for which she received Dilant in 300 mg q.d. and Valium 10 mg h . s . q . d , for m a n y years. Physical examinat ion, neurological examinat ion and multiple E E G s have been normal . She has been seizurefree for the last 8 years. Plain radiographs revealed a right f rontal sinus mass with smooth remodel l ing of bone along the media l and caudal aspects of the lesion and permeat ive bone destruction along the right lateral margin of the lesion (Fig. 1 a). Non-cont ras t G E 9800 CTs revealed a h o m o g e n e o u s nearly isodense mass tha t e roded por t ions of the poster ior table of the r ight frontal sinus. The lateral margins of the bone defect were displaced poster ior ly into the cranial cavity. The intersinus sep tum showed smoo th remodel l ing and displacement a round the left lateral aspect of the lesion. The mass could not be clearly separa ted f rom the right frontal lobe (Fig. i b). 0.3 T Fona r M R scan revealed a nearly h o m o g e n e o u s right frontal sinus mass and that was hypointense to brain on T l -we igh ted sequences (Fig. 1 c) and hyper intense to brain on T2-weighted sequences (Fig. 1 d). A crescent of increased signal circumscribed most of the poster ior margin of the lesion, and was in terpreted as edema. However , at several points the poster ior margin of the mass could not be clearly separa ted f rom the frontal lobe or meninges. Biopsy obta ined through the lower anter ior frontal sinus wall was interpreted as meningioma. Frontal cran iec tomy was then pe r fo rmed for exentera t ion of the frontal sinuses. The poster ior sinus table was found to be