Objective : Based on surgical outcomes of patients with infratentorial meningiomas surgically treated at our institution, we analyzed the predictors for surgical resection, recurrence, complication, and survival. Methods : Of surgically treated 782 patients with intracranial meningioma, 158 (20.2%) consecutive cases of infratentorial location operated on between April 1993 and May 2013 at out institute were reviewed retrospectively. The patients had a median age of 57.1 years (range, 16-77 years), a female predominance of 79.7%, and a mean follow-up duration of 48.4 months (range, 0.8-242.2 months). Results : Gross total resection (Simpson's grade I & II) was achieved in 81.6% (129/158) of patients. Non-skull base location was an independent factor for complete resection. The recurrence rate was 13.3% (21/158) and the 5-, 10-, and 15-year recurrence rates were 8.2%, 12.0%, and 13.3%, respectively. Benign pathology, postoperative KPS over than 90, low peritumoral edema, and complete resection were significantly associated with longer recurrence-free survival rate. The 5-, 10-, and 15-year survival rates were 96.2%, 94.9%, and 94.9%, respectively. Benign pathology, postoperative KPS over than 90 and complete resection were significantly associated with a longer survival rate. The permanent complication rate was 13% (21/158). Skull base location and postoperative KPS less than 90 were independent factors for the occurrence of permanent complication. Conclusion : Our experience shows that infratentorial meningiomas represent a continuing challenge for contemporary neurosurgeons. Various factors are related with resection degree, complications, recurrence and survival.
Pulmonary sequestration (PS) is a rare congenital malformation of the lower respiratory tract. The anomaly is characterized by absence of communication with the tracheobronchial tree and isolated blood supply from an anomalous systemic vessels. With the utilization of antenatal ultrasound, the diagnosis of asymptomatic neonatal PS has increased. Treatment options include observation, arterial embolization and surgical resection. The aim of the present study is to review the clinical course of PS and to share our experience with thoracoscopic resection. A total of 96 patients with PS were treated at Asan Children's Hospital between 1999 and 2010. The diagnosis of PS was established by CT in the cases managed by observation or embolization, and by tissue pathology in the surgical cases. Medical records and radiographic images were retrospectively reviewed. Thirty-nine patients were managed by embolization and 30 patients by surgery. The remaining 27 patients have been under observation without any procedures. Among 27 observation patients, 1 patient regressed completely and 10 patients were lost to follow up. Of the 39 embolizations patients, 2 had their lesion regress and sepsis was suspected after embolization. In 1 patient, the microcoil migrated to the iliac artery during the embolization procedure, and another patient developed renal abscess caused by renal artery embolization. Among 30 surgical cases, resection by thoracotomy was performed in 27 at the Department of Thoracic Surgery, and thoracoscopic resection in 3 at the Division of Pediatric Sugery. Only one wound complication ocurred. We conclud that surgical excision should be recommended for pulmonary sequestration, whether the sequestration is symptomatic or not because of the risk of infection, the low rate of natural regress, poor compliance, severe complications after embolization, and to exclude other pathology. In summary, thoracoscopic resection of the pulmonary sequestration is feasible, efficacious, safe and cosmetically superior even in neonatal period.
A retrospective analysis was performed on 53 patients with brain malignant astrocytoma and glioblastoma multiforme treated with surgical resection and postoperative radiotherapy in the period between January 1980 and June 1991. There were 13 patients with malignant astrocytoma, 40 patients with glioblastoma multiforme. Survival rates were analyzed according to histologic grade, age, performance status, extent of surgical resection, tumor location, symptom duration, total radiation dose and addition of chemotherapy after radiation therapy. 5 year actuarial survival rate for malignant astrocytoma was $29.4\%$, for glioblastoma multiforme was $2.8\%$. Histologic grade, age, performance status, total radiation dose were statistitically significant prognostic factors.
Mucoepidermoid carcinoma developed in tracheobronchial tree is one of rare lung tumor. It is histologically divided into low grade malignancy of relatively benign course versus high grade malignancy of fatal course. In low grade malignancy, it can be curative with a surgical resection. We experienced a case of mucoepidermoid carcinoma in a 28-year-old woman who complained sudden dyspnea and presented right total lung collapse on chest roentgenogram. It was diagnosed as a low grade mucoepidermoid carcinoma and removed by the surgical excision.
Papillary thyroid carcinoma is known as its relatively high cure rate after surgical treatment. But invasion of the trachea by thyroid carcinoma is poor prognostic factor and the best management is en bloc surgical resection of the tumor invading the trachea. A 55-year-old man was diagnosed as papillary thyroid cancer with tracheal invasion. We treated the patient by total thyroidectomy with window resection of invading trachea followed by immediate reconstruction with sternohyoid muscle flap and tracheostomy. At 48 days after surgery, tracheostoma was closed and the patient had no functional complication by the surgical process. Until 10 months after surgery, there was no sign of recurrence and the patient led social life without any discomfort. We present this case with a review of the related literatures.
Intrahepatic cholangiocarcinoma (ICC), one of the primary liver cancers, is frequent in the northeastern part of Thailand. Surgical resection remains the best method of treatment, but patients suffering from ICC usually present at a late stage of the disease. Studies of survival and prognostic factors after surgery remain rare. The aim here was to evaluate the survival rate and factors affecting the survival of patients with intrahepatic cholangiocarcinoma after surgery. The study used a retrospective cohort design. The subjects were 73 consecutive patients with ICC, who were admitted for surgery to Srinagarind Hospital, Khon Kaen University, during the period 2005-2009. The censoring date was 31 December, 2011, data being evaluated using uni- and multivariate analyses. Postoperative survival analysis was performed by the Kaplan-Meier method, and the Cox proportional hazard model was used to identify independent prognostic factors. The total follow-up time was 99 person-years. The total number of deaths was 59, giving a mortality rate of 59 per 100 person-years. The cumulative 1-, 3-, and 5-year survival rates were 52.1%, 21.7%, and 11.2%, respectively. The median duration of survival after resection was 12.4 months. Univariate analysis revealed stage of disease, lymph node metastasis, histological type, histological grade and macroscopic classification to be statistically significant (p-value<0.05) prognostic factors. In the multivariate analysis, only macroscopic classification was statistically significant (p-value<0.05). In conclusion, macroscopic classification was the only independent factor found to be significantly associated with survival following surgical treatment of ICC.
Recently, a major resection of the pancreas has been carried out not only to treat carcinoma of pancreas but also chronic pancreatitis. But limited and often contradictory reports have been made on the exocrine effects after partial surgical pancreatectomy in mammals. It was suggested that the growth of the residual tissue in pancreatectomized rat is very active, because pancreas has the great power of regeneration after partial pancreatectomy, while others observed that rat pancreas after partial surgical resection revealed a perplexing mixture of atrophy and regeneration of acinar tissue. On the other hand, another results showed that the amount of insulin required to control diabetes after partial resection of pancreas is much greater than that needed after total pancreatectomy. Because the anti-insulin system, such as glucagon secretion and hypophyseoadrenal function, is probably depressed after total pancreatectomy. Furthermore, minimal resection line which will not influence the normal function of pancreas is not agreeable, such 75%, 80% or 95% resection of the total pancreas in rat. So far, studies on the exocrine function other than endocrine function after partial pancreatectomy have been limited. Therefore, the main purpose of this study is to examine the changes of exocrine as well as endocrine function of pancreas at the different time interval after 60% or 80% pancreatectomy in rats. The results summerized as follow: 1) In both 60% and 80% resected groups, a slight decrease of the total body weight was observed at a day after partial pancreatectomy in rats, but the body weight was continued to increase for following 100 days. 2) The weight of residual pancreas was continuously increased during experiment in both 60% and 80% resected groups. But the content of tissue protein in residual pancreas was significantly decreased comparing with those of resected pancreas. 3) The flow rate of pancreatico-biliary juice was significantly decreased immediately after pancreatectomy in both resected groups. But it was recovered to control level after a day in 60% resected group, after 30 days in 80% resected group. 4) The output of amylase and lipase in resected groups were significantly decreased right after pancreatectomy comparing with control group. In the 60% resected group, the output of amylase was recovered during the following 100 days after pancreatectomy, while lipase output in 3 days. However, in the 80% resected group, the output of amylase and lipase were not recovered during 100 days after pancreatectomy. 5) In order to examine the endocrine function, blood sugar level were examined at all experimental periods after partial pancreatectomy. There was no difference between control and 60% resected group in the sugar level. But in the 80% resected group the level was significantly incresed immediately after pancreatectomy, and reached the highest level at 3 days. Then it was decreased to control level during the next 10 days after pancreatectomy. The above results showed that in 60% resected group little changes were observed on pancreatic function, but severe functional impairments were observed in 80% resected group. This results suggested that the endocrine function was recovered within a short period, although the exocrine function was not recovered for a long time after 80% pancreatectomy in rats.
The authors herein propose the staged excision as a novel strategy to preserve facial nerve and minimize complication during microsurgery of large vestibular schwannoma (VS). At the first stage, for reducing mass effect on the brain stem and cerebellum, subtotal tumor resection was performed via a retrosigmoid craniotomy without intervention of meatal portion of tumor. With total resection of the remaining tumor, the facial nerve was decompressed and delineated during the second stage translabyrinthine approach at a later date. A 38-year-old female who underwent the staging operation for resection of her huge VS is illustrated.
Yuh, Woon Tak;Chung, Chun Kee;Park, Sung-Hye;Kim, Ki-Jeong;Lee, Sun-Ho;Kim, Kyoung-Tae
Journal of Korean Neurosurgical Society
/
v.61
no.2
/
pp.233-242
/
2018
Objective : A spinal cord subependymoma is an uncommon, indolent, benign spinal cord tumor. It is radiologically similar to a spinal cord ependymoma, but surgical findings and outcomes differ. Gross total resection of the tumor is not always feasible. The present study was done to determine the clinical, radiological and pathological characteristics of spinal cord subependymomas. Methods : We retrospectively reviewed the medical records of ten spinal cord subependymoma patients (M : F=4 : 6; median 38 years; range, 21-77) from four institutions. Results : The most common symptoms were sensory changes and/or pain in eight patients, followed by motor weakness in six. The median duration of symptoms was 9.5 months. Preoperative radiological diagnosis was ependymoma in seven and astrocytoma in three. The tumors were located eccentrically in six and were not enhanced in six. Gross total resection of the tumor was achieved in five patients, whereas subtotal or partial resection was inevitable in the other five patients due to a poor dissection plane. Adjuvant radiotherapy was performed in two patients. Neurological deterioration occurred in two patients; transient weakness in one after subtotal resection and permanent weakness after gross total resection in the other. Recurrence or regrowth of the tumor was not observed during the median 31.5 months follow-up period (range, 8-89). Conclusion : Spinal cord subependymoma should be considered when the tumor is located eccentrically and is not dissected easily from the spinal cord. Considering the rather indolent nature of spinal cord subependymomas, subtotal removal without the risk of neurological deficit is another option.
Background: Pelvic exenteration is a procedure which includes enbloc resection of pelvic organs followed by surgical reconstruction. Aims include both cure and palliation but data for pelvic exenteration in Thailand are very limited. Objective: This study was conducted to evaluate characteristics of patients, operative procedure outcomes and complications. Materials and Methods: This retrospective review covered all of the charts of exenteration patients during January 2002 to December 2011. Baseline characteristic of the patients were collected as well as details of clinical results. Results: A total of 13 cases of pelvic exenteration were included. Most underwent total pelvic exenteration (9 cases) and the remainder posterior and anterior exenteration. Their primary cancers were ovarian, cervical and vulva. Mean operative time was 532 minutes (SD 160.2, range 270-750) and estimated blood loss was 2830 ml (1850, 1000-8000). Mean tumor size was 7.33 cm (3.75, 4-15). Mean hospital stay was 35.2 days (29.8, 13-109). The most common post operative complication was urinary tract infection. Overall disease free survival with a negative surgical margin was significantly better than in positive surgical margin patients (p=0.014). Conclusions: Surgical margin was the most significant prognostic factor for disease free survival, in line with earlier studies.
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