Resection of deep-seated gliomas using neuroimaging for stereotactic placement of guidance catheters.
ABSTRACT A simple computed tomography- (CT) or magnetic resonance (MR) imaging-guided stereotactic method for guided microsurgical resection of either deep-seated gliomas or tumors adjacent to an eloquent area is described. The technique employs the Brown-Roberts-Wells stereotactic system and twist drills, 2.7 mm in diameter, for the stereotactic placement of 2.4 mm diameter scaled guidance catheters through the calvaria. In a patient with a deep-seated small glioma, less than 2 cm diameter, one catheter was implanted into the center of the enhanced mass through the cerebral cortex. In the other 14 patients, three to six catheters were used which made the tumor border clearer. After implantation of the guidance catheters, the stereotactic frame was removed and a standard open craniotomy performed. Target localization is not affected by brain movement, which is inevitable during open surgery. The tumor involved the frontal lobe in eight patients, the parietal lobe in two, and the thalamus in five. In all cases the lesion was quickly localized and radical removal was achieved. Neurological complications occurred in only one patient who suffered transient hemiparesis after the resection of a lesion in the pyramidal tract. The results demonstrate that microsurgery combined with CT- or MR imaging-guided stereotactic placement of guidance catheters is a new option for surgery of deep-seated gliomas or tumors adjacent to an eloquent area.
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ABSTRACT: Two to five percent of pediatric brain tumors are located in the thalamus. The optimal management for these tumors remains unclear. The aim of this study was to determine whether clinical and neuroimaging features could guide treatment, and to what extent these features, together with histological diagnosis and treatment modalities, influenced survival. The records of 69 children who presented with a thalamic tumor between 1989 and 2003 were retrospectively reviewed. Three groups of tumors were analyzed separately: 1) unilateral thalamic tumors (54 lesions); 2) thalamopeduncular tumors (six); and 3) bilateral thalamic tumors (nine). In the patients in whom a unilateral thalamic tumor was diagnosed, 33 had an astrocytic tumor. Of the 54 patients, 32 had a low-grade and 22 had a high-grade tumor. The survival rate was significantly better for patients with the following characteristics: symptom duration longer than 2 months (p < 0.001), lesions with low-grade histological features (p = 0.003), and tumor excision greater than 90% at surgery (p = 0.04). The perioperative morbidity and mortality rates were 37 and 4%, respectively. Fifty-four percent of the patients in this group had a long-term and independent survival. The thalamopeduncular tumors were mostly pilocytic astrocytomas, which had a good prognosis following surgery. The bilateral thalamic tumors in this series were mainly low-grade astrocytic lesions, and more than half of the children attained long-term survival (mean follow-up duration 4.5 years). The majority of tumors arising in the thalamus are astrocytic, of which less than half are high-grade lesions. Histological evaluations should be performed in all patients in whom resection is being considered for discrete lesions. Long-term survival is possible in patients with these tumors.Journal of Neurosurgery 05/2007; 106(5 Suppl):354-62. · 3.15 Impact Factor
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ABSTRACT: INTRODUCTION: Thalamic tumors are typical deep brain tumors; their incidence is not precisely known because of the different definition criteria. However, taking only lesions arising in the thalami into consideration (and excluding those secondarily involving the thalami from adjacent structures) approximately 40% of thalamic tumors affect patients under 18 years of age and thalamic neoplasms account for 2-5% of all intracranial tumors in children. MATERIALS AND METHODS: In the present paper we have focused attention on the neuroimaging features of thalamic tumors in a pediatric population; based upon personal experience, we suggest a rational neuroradiological approach to the diagnostic evaluation, describe CT and MRI findings of the most common tumors, and attempt to define basic patterns in order to provide the most reliable "pathological" diagnosis.Child s Nervous System 09/2002; 18(8):426-39. · 1.24 Impact Factor
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ABSTRACT: Evaluate evolution and time course of stereotactic neurosurgery within surgical neuro-oncology. MEDLINE search 1966-2003 sub-stratified and analyzed for annual trends. AANS/CNS membership databases for Joint Sections. ACRC neuro-oncology program database 1998-2003. Tumor stereotaxis emerged in 1980 and became the dominant stereotactic publication topic by 1984. Frame-based tumor stereotaxis led publications through 1994, when supplanted by stereotactic radiosurgery (SR). Brachytherapy led SR 1982-1987, but then fell behind, reducing to pre-1983 levels by 1996. SR publications currently comprise 65% of stereotactic tumor articles and publication rate continues to rise at a steady rate. Frameless stereotaxis (FS) publications began to increase in 1993 and growth is larger than the corresponding fall in frame-based volumetric resection publications. Data suggest increased utilization for cases that would have otherwise utilized ultrasound or gone without image guidance. Intraoperative MR developed predominantly as complimentary technology to FS. Tumor diagnostic needle biopsy publications continue to be mostly frame-based, while FS techniques are largely resection focused. This may change as >80% of our tumors biopsied with frame-based techniques would be candidates for FS biopsy based solely on lesion size, location, and technique accuracy considerations. CNS parenchymal delivery of experimental therapies continues to be predominantly frame-based. The role of tumor stereotaxis in surgical neuro-oncology is important, but changing. SR is increasingly dominating the subspecialty. Stereotactic tumor resection has become a mainstream neurosurgical procedure due to FS, and this will likely occur with needle biopsy as well. Delivery of experimental therapies remains predominantly frame-based, but may need to transition to FS in order to gain wider mainstream acceptance and applicability once efficacy is demonstrated.Journal of Neuro-Oncology 01/2004; 69(1-3):35-54. · 3.12 Impact Factor