المؤلفون: Xinru Xiao, Ye Cheng, Xuesong Bai, Ge Chen, Guolu Meng, Jian Ren, Yuhai Bao, Jiantao Liang, Jie Tang, Gang Song, Mingchu Li, Hongchuan Guo

المصدر: World Neurosurgery. 146:e1242-e1254

مصطلحات موضوعية: Adult, Male, Vagus Nerve Diseases, medicine.medical_specialty, medicine.medical_treatment, Glossopharyngeal Nerve Diseases, Neurosurgical Procedures, Foramen Magnum Meningioma, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Tracheotomy, Meningeal Neoplasms, medicine, Humans, Foramen Magnum, Cranial Nerve Injuries, Gait Disorders, Neurologic, Aged, Foramen magnum, Hoarseness, business.industry, Cranial nerves, Headache, Middle Aged, Debulking, Dysphagia, Surgery, Tumor Debulking, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Neurology (clinical), medicine.symptom, Deglutition Disorders, Meningioma, business, Organ Sparing Treatments, 030217 neurology & neurosurgery, Jugular foramen

الوصف: Background This study established novel technique nuances in surgery for ventral foramen magnum meningiomas (vFMMs) via a dorsal lateral approach. Methods From July 2012 to July 2019, 37 patients with vFMMs underwent tumor resection surgery and were operated on with a dorsal lateral approach. Two safe zones were selected as the entrance of the surgical corridor. Safe zone I was located between the dural attachment of the first dental ligament (FDL) and the branches of C1; safe zone II lay between the dural attachment of the FDL and the jugular foramen. The tumor was debulked first through safe zone I and then through safe zone II. The tumor was removed through a trajectory from the caudal to cephalad to allow tumor debulking from below and downward delivery, away from the brainstem and lower cranial nerves. Results Thirty-three patients underwent gross total resection, and 4 patients underwent subtotal resection. Four patients transiently required a nasogastric feeding tube. All patients recovered within 3 months postoperatively. Three patients (8.1%) developed permanent mild hoarseness and dysphagia as a result of postoperative damage of cranial nerves IX and X. One patient underwent tracheotomy. No patient experienced tumor recurrence during the follow-up period. Conclusions We established a minimal retraction principle, in which the selection of 2 safe zones as the entrance of the surgical corridor, tumor removal from the inferior to superior direction, and debulking followed by devascularization were the key elements to implement the minimal retraction principle in vFMM surgery.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c80c00dc421ec0ab67c482a476f77d91Test
https://doi.org/10.1016/j.wneu.2020.11.140Test

المؤلفون: Eulâmpio José da Silva Neto, Leandro Martins da Silva, Paula Rejane Beserra Diniz, Severino A. Araújo-Neto, Elayne C.O. Ribeiro, José J.C. Nascimento

المصدر: World Neurosurgery. 152:121-123

مصطلحات موضوعية: Adult, Male, Intraclass correlation, Basilar invagination, 03 medical and health sciences, 0302 clinical medicine, Platybasia, Humans, Medicine, Cutoff, Foramen Magnum, Aged, Observer Variation, Foramen magnum, Receiver operating characteristic, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Confidence interval, Sagittal plane, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Female, Surgery, Neurology (clinical), business, Nuclear medicine, 030217 neurology & neurosurgery

الوصف: OBJECTIVE To describe the foramen magnum angle (FMA) as a new parameter for basilar invagination (BI) type B. METHODS The FMA was performed on sagittal slice of magnetic resonance imaging (MRI) as a line from the hard palate to the opisthion (angle vertex), and another line from the opisthion to the basion. The MRIs from 31 participants with BI type B and 96 controls were used. Intraclass correlation coefficient, descriptive data, and receiver operating characteristic (ROC) curve were used for statistical analysis at the 95% confidence interval. RESULTS The interobserver agreement of the FMA was 0.952. Patients with BI type B had a FMA significantly greater (25.9° ± 9.3°) than control participants (11.6° ± 4.9°) (P < 0.001). The area under the ROC curve showed a diagnostic value of 0.947. The FMA showed sensitivity 0.900 and specificity 0.854 for the cutoff criterion 17° (P < 0.001). CONCLUSIONS The FMA had an optimal diagnostic value that provided complementary evidence to investigate BI type B.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cd8eefe9ad9a5f928e9b0d777a677bceTest
https://doi.org/10.1016/j.wneu.2021.06.028Test

المؤلفون: Hao Wu, Qingyu Yao, Fengzeng Jian, Can Zhang, Wanru Duan, Zan Chen, Jian Guan, Longbing Ma, Chenghua Yuan, Zhenlei Liu, Xingwen Wang, Kai Wang, Lei Cheng

المصدر: World Neurosurgery. 144:e178-e188

مصطلحات موضوعية: Adult, Male, Pathology, medicine.medical_specialty, Adolescent, Dura mater, Cisterna magna, Neurosurgical Procedures, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Cerebrospinal fluid, medicine.artery, medicine, Foramen, Humans, Foramen Magnum, Aged, Retrospective Studies, Foramen magnum, business.industry, Cerebral Arteries, Middle Aged, Decompression, Surgical, medicine.disease, Magnetic Resonance Imaging, Subdural Effusion, Syringomyelia, Treatment Outcome, Posterior inferior cerebellar artery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Tonsil, Female, Surgery, Neurology (clinical), Arachnoid, business, 030217 neurology & neurosurgery, Follow-Up Studies

الوصف: Objective This article discusses the procedure of foramina magnum and Magendie dredging, summarizing the pathologic changes in the intradural region of the craniocervical junction in patients with syringomyelia and the pathophysiologic mechanism of cerebrospinal fluid (CSF) circulation obstruction. Methods Clinical data from 50 adult patients with syringomyelia treated at Xuanwu Hospital from July 2018 to January 2019 were collected and retrospectively analyzed. All operations were performed with foramina magnum and Magendie dredging, and all intradural factors that may have induced the obstruction of CSF circulation were recorded. Results Intradural pathology was found in all patients. The pathologic changes that may have caused obstruction of the CSF circulation include tonsil occupying the foramen magnum and overlying foramen of Magendie in 88% (44/50), intertonsillar arachnoid adhesions in 36% (18/50), tonsil to medulla arachnoid adhesions in 18% (9/50), medialized tonsils in 70% (35/50), vermian branch of posterior inferior cerebellar artery in 22% (11/50), arachnoid veil in 16% (8/50), cisterna magna cyst in 4% (2/50), and tonsil to dura mater arachnoid adhesions in 8% (4/50). Mean duration of follow-up was 13.3 months. The long-term effective rate was 96.0%. Postoperative magnetic resonance imaging revealed that the size of the syringomyelia was reduced or completely resolved in 88% of patients. The mean preoperative Japanese Orthopaedic Association score was 12.9 ± 3.1, which improved to 14.7 ± 3.2 (P Conclusions Intradural pathology that causes CSF circulation obstruction exists in many forms. Relieving the obstruction of the foramen magnum and foramen of Magendie is key to surgical treatment.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f3b7332fcd415cd9c4e88e49ea1a7c0cTest
https://doi.org/10.1016/j.wneu.2020.08.068Test

المؤلفون: Toshihiro Ishibashi, Yuichi Murayama, Shota Kakizaki, Naoki Kato, Kengo Nishimura, Issei Kan

المصدر: World Neurosurgery. 144:43-49

مصطلحات موضوعية: Male, Microsurgery, medicine.medical_specialty, Vertebral artery, medicine.medical_treatment, Fistula, Arteriovenous fistula, Posterior meningeal artery, 03 medical and health sciences, 0302 clinical medicine, medicine.artery, medicine, Basilar artery, Humans, Dimethyl Sulfoxide, Foramen Magnum, Treatment Failure, Embolization, Aged, Central Nervous System Vascular Malformations, Foramen magnum, business.industry, Ascending pharyngeal artery, medicine.disease, Surgery, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Polyvinyls, Neurology (clinical), business, 030217 neurology & neurosurgery

الوصف: Background Foramen magnum dural arteriovenous fistula (DAVF) is a rare disease, with some reported cases of successful treatment. We achieved complete obliteration of the foramen magnum DAVF through microsurgery after complications of endovascular embolization. We reviewed the treatment modalities and outcomes, focusing on pathologic and anatomic features from the literature. Case Description A 65-year-old man was admitted to our hospital with sudden diplopia. Magnetic resonance imaging revealed a subarachnoid hemorrhage around the right side of the prepontine cistern, and a foramen magnum DAVF was diagnosed by angiography. Subsequent angiography revealed that the fistula was supplied by the right neuromeningeal trunk of the ascending pharyngeal artery and the right posterior meningeal artery of the vertebral artery (VA), and the veins of the pouch via the fistula were retrogradely draining into the intracranial veins. We aimed to treat complete occlusion endovascularly with balloon-augmented transarterial Onyx injection via the posterior meningeal artery, but Onyx was refluxed to the VA through the anastomosis between the VA and posterior meningeal artery. Onyx subsequently migrated to the top of the basilar artery, causing occlusion, so we urgently removed the Onyx with a stent retriever (Trevo). Several weeks later, we performed complete obliteration of the foramen magnum DAVF via a lateral suboccipital approach with a C1 laminectomy. Conclusions Most foramen magnum DAVFs were obliterated completely with only endovascular treatment. Microsurgery is an effective and reliable treatment for incomplete occlusion and complications.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::70a7fcafcf25cb624376f9ce5bdd24dbTest
https://doi.org/10.1016/j.wneu.2020.08.077Test

المؤلفون: Meltem Yilmaz, Goktug Akyoldas, Yavuz Samanci, Selçuk Peker, Meric Sengoz

المصدر: Neurosurgical Review. 44:2667-2673

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Gamma knife radiosurgery, Radiosurgery, Foramen Magnum Meningioma, 030218 nuclear medicine & medical imaging, Meningioma, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Meningeal Neoplasms, Humans, Medicine, Foramen Magnum, Aged, Retrospective Studies, Foramen magnum, business.industry, General Medicine, Long term results, Middle Aged, medicine.disease, Treatment Outcome, medicine.anatomical_structure, Radiological weapon, Cohort, Female, Surgery, Neurology (clinical), Neurosurgery, Radiology, business, 030217 neurology & neurosurgery, Follow-Up Studies

الوصف: Outcomes of 37 patients of foramen magnum meningioma (FMM) were evaluated, and the related literature was reviewed to determine the efficacy of Gamma Knife radiosurgery (GKRS) for treating patients with FMM. We present the largest series reported from a single institution with the longest follow-up to date. The database of patients who underwent GKRS for FMM between 2007 and 2019 was evaluated retrospectively. A total of 37 patients with radiological and pathological features consistent with FMM were included in this series. Thirty-three patients were female, and 4 were male. The median age was 58 years (range, 23–74 years). The most common symptom at diagnosis was headache (64.9%). Twelve patients had a history of microsurgical resection. The median duration from the initial onset of symptoms to GKRS was 12 months (range 1–140 months). Among the 37 tumors, eight (21.6%) were located ventrally, 24 (64.9%) laterally, and five (13.5%) dorsally. The median target volume was 3.30 cm3 (range, 0.6–17.6 cm3). Thirty-five patients (95%) were treated with single fraction GKRS, and two patients (5%) were treated with hypofractionated GKRS. The median clinical follow-up was 80 months (range, 18–151 months), while the median radiological follow-up was 84 months (range, 18–144 months). At the last clinical follow-up after GKRS, 27 patients (73%) had improved symptoms, and none had worsened pre-GKRS symptoms. At the last radiological follow-up after GKRS, 23 tumors (62.2%) remained stable, 13 (35.1%) decreased in size, and 1 (2.7%) increased in size. Tumor control, including stable and regressed tumors, was achieved in 97.3% of patients. Our cohort demonstrates that GKRS is an effective and safe treatment for patients with either primary or recurrent/residual FMM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::120afd377d25b233105ea3ac8a09d152Test
https://doi.org/10.1007/s10143-020-01446-5Test

المؤلفون: Hirotaka Ito, Shigeki Yamada, Marie Oshima, M. Ishikawa, K. Yamamoto, M. Yamaguchi, Kazuhiko Nozaki

المصدر: AJNR Am J Neuroradiol

مصطلحات موضوعية: Male, 030218 nuclear medicine & medical imaging, Stress (mechanics), Motion, 03 medical and health sciences, 0302 clinical medicine, Cerebrospinal fluid, Alzheimer Disease, medicine, Foramen, Shear stress, Humans, Radiology, Nuclear Medicine and imaging, Aged, Cerebrospinal Fluid, Foramen magnum, business.industry, Adult Brain, Cerebral Aqueduct, Anatomy, Stroke volume, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Hydrocephalus, Normal Pressure, Hydrocephalus, medicine.anatomical_structure, Cerebral aqueduct, Female, Stress, Mechanical, Neurology (clinical), business, 030217 neurology & neurosurgery

الوصف: Background and purpose:Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus.
Materials and methods:By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. These shear stress parameters at the cerebral aqueduct were compared with apertures and stroke volumes at the foramen of Magendie and cerebral aqueduct.
Results:Two wall shear stress magnitude peaks during a heartbeat were changed to periodic oscillation by converting oscillatory shear stress. The mean oscillatory shear stress amplitude and time-averaged wall shear stress values at the dorsal and ventral regions of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus groups were significantly higher than those in controls. Furthermore, those at the ventral region of the cerebral aqueduct in the idiopathic normal pressure hydrocephalus group were also significantly higher than those in the co-occurrence of idiopathic normal pressure hydrocephalus with Alzheimer-type dementia group. The oscillatory shear stress amplitude at the dorsal region of the cerebral aqueduct was significantly associated with foramen of Magendie diameters, whereas it was strongly associated with the stroke volume at the upper end of the cerebral aqueduct rather than that at the foramen of Magendie.
Conclusions:Oscillatory shear stress, which reflects wall shear stress vector changes better than the conventional wall shear stress magnitude and the oscillatory shear index, can be directly measured on 4D flow MR imaging. Oscillatory shear stress at the cerebral aqueduct was considerably higher in patients with idiopathic normal pressure hydrocephalus.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a1a358958f41deb29e1c6f0dc78673a8Test
https://doi.org/10.3174/ajnr.a6941Test

المؤلفون: Khaled Aljarrah, Vasanthakumar Packirisamy, Nawaf Al Anazi, Satheesha B Nayak

المصدر: Morphologie : bulletin de l'Association des anatomistes. 106(355)

مصطلحات موضوعية: Male, Adult, Adolescent, Population, Saudi Arabia, Biology, Condyle, Young Adult, Discriminant function analysis, medicine, Humans, Foramen Magnum, education, Aged, Foramen magnum, education.field_of_study, Forensic anthropology, Reproducibility of Results, Anatomy, Middle Aged, Occipital condyle, Sexual dimorphism, Skull, medicine.anatomical_structure, Occipital Bone, Female, Tomography, X-Ray Computed

الوصف: Summary Objective of the study The objective of this study was to evaluate FM and occipital condyles measurements morphometrically for sex determination by using discriminant function analysis and to note visually the variation in the shape of the foramen magnum in a Saudi Arabian population by using CT scan images. Material and methods This study included 472 CT scans (236 males and 236 females; age range, 18–72 years). The foramen magnum shapes were classified into 8 types: oval, egg, round, hexagonal, pentagonal, tetragonal, irregular (A) and irregular (B). The intraobserver and interobserver test was done to calculate the reliability of the measurement. Eight dimensions of the FM and occipital condyle were evaluated to determine the sexual dimorphism using an independent t-test. Sex determination was estimated using discriminate function analysis. Results The commonest shape of FM was hexagonal and the tetragonal shape was the least common type. Coefficient of reliability (R) was high, ranging between 0.89 and 0.99, which indicates the measurements are reliable and sufficiently precise. All the eight measurements, the FM length and width, FM index, FM area, the width and length of right and left occipital condyles were significantly greater in males than the female. Univariate discriminant function showed an accuracy rate varying from 61% to 66.6% based on FM or occipital condyles measurements. The multivariate analysis of FM and occipital condyle measurements increased the overall accuracy rate of sex determination to 71.6%. Conclusion The univariate analysis of FM and occipital condyle measurements indicates, that the FM area (66.1%), FML (62.5%), FMW (62.5%) and ROCL (62.1%) could be reliable individual variables in sex determination. The multivariate analysis including all the eight variables of FM and occipital condyle increased the accuracy rate of sex determination to 71.6% in determining the sex as male (73.3%) or female (69.9%). The shape of the FM is not useful in sex estimation. The results obtained showed a low degree of sexual dimorphism in the basicranium, the use of this method in forensic anthropology could be helpful for assessment on highly fragmented skull bases.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6621577bed040baec5be5276117273c4Test
https://pubmed.ncbi.nlm.nih.gov/34391659Test

المؤلفون: Mitsunori Yamada, Kazuhiro Hongo, Kiyoshi Ito, Tetsuyoshi Horiuchi

المصدر: Neurosurgical Review. 43:575-580

مصطلحات موضوعية: Adult, Male, Reoperation, musculoskeletal diseases, medicine.medical_specialty, Adolescent, Decompression, Dura mater, Neurosurgical Procedures, 030218 nuclear medicine & medical imaging, Young Adult, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, stomatognathic system, Humans, Medicine, Syrinx (medicine), Foramen Magnum, Child, Aged, Retrospective Studies, Foramen magnum, business.industry, General Medicine, Middle Aged, Surgical procedures, Decompression, Surgical, medicine.disease, Magnetic Resonance Imaging, Arnold-Chiari Malformation, nervous system diseases, Surgery, Treatment Outcome, medicine.anatomical_structure, Radiological weapon, Cerebellar tonsil, Female, Dura Mater, Neurology (clinical), Neurosurgery, Tomography, X-Ray Computed, business, 030217 neurology & neurosurgery

الوصف: Several surgical procedures can be applied for syrinx associated with Chiari type 1 malformation; however, it remains controversial as to which approach is the most effective. Here, we evaluated the indications and limitations of foramen magnum decompression (FMD) with or without dural plasty. Forty patients with Chiari type 1 malformation were surgically treated and followed up for > 12 months. Thirty-two patients (80.0%) underwent FMD with removal of only the outer dura mater layer, while eight patients underwent FMD with dural plasty. We evaluated surgery-related complications and preoperative radiological findings affecting syrinx shrinkage rates. Post-surgery, the mean syrinx shrinkage rates were 0.32 ± 0.44 in the outer layer-removal group and 0.72 ± 0.27 in the dural plasty group (P = 0.012). Surgery-related complications were less frequent, but reoperation was more frequent, in the outer layer-removal group. The extent of tonsillar descent significantly affected syrinx shrinkage in FMD with outer layer removal (P = 0.042). The outcomes of both approaches in patients with tonsillar descent

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::04e7a9a620da93bae25028bd308fb806Test
https://doi.org/10.1007/s10143-019-01079-3Test

المؤلفون: Serra Ozbal Gunes, Hasan Ali Durmaz, Rafet Özay, Sahin Hanalioglu, Zeki Sekerci, Ebru Doruk, Mehmet Sorar

المساهمون: Tıp Fakültesi

المصدر: Clinical Neurology and Neurosurgery. 174:123-128

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Adolescent, Medullary cavity, Cervico-Medullary Compression Ratio, Herniated Cerebellar Tonsil, Severity of Illness Index, Young Adult, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Chiari Malformation, Foramen Magnum, Aged, Retrospective Studies, Chiari malformation, Medulla Oblongata, Foramen magnum, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Spinal cord, Magnetic Resonance Imaging, Syringomyelia, Arnold-Chiari Malformation, Hydrocephalus, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Cervical Vertebrae, Cerebellar tonsil, Female, Surgery, Neurology (clinical), Radiology, Tomography, X-Ray Computed, business, 030217 neurology & neurosurgery

الوصف: WOS: 000450134600021 PubMed ID: 30236638 Objectives: Chiari malformation type 1 (CM-1) is associated with cough headache, intracranial hypertension, cerebellar and spinal cord symptoms/signs. Herniated cerebellar tonsil length (HCTL) is widely used radiological parameter to determine the severity of CM-1, but with limited utility due to its weak correlation with some clinico-radiological findings. In this study, we aimed to evaluate a novel, practical parameter (cervico-medullary compression ratio; "CMCR") for its relationship with clinico-radiological findings in CM-1. Patients and methods: Thirty-five adult patients (17 F, 18 M) with CM-1 were included in this retrospective study. Head CT and craniospinal MR images were assessed. CMCR was calculated as the ratio of herniated cerebellar tonsil surface area to foramen magnum surface area, and HCTL was measured. These two parameters were correlated with clinical and radiological findings. Results: The mean CMCR was 0.60 +/- 0.15 and mean HCTL was 8.91 +/- 3.4 mm with no significant difference between gender and age groups for both parameters. For cough headache (0.64 +/- 0.14 vs 0.52 +/- 0.15, p = 0.043) and syringomyelia (0.67 +/- 0.11 vs 0.56 +/- 0.16, p = 0.039), only CMCR; for intracranial hypertension (CMCR: 0.64 +/- 0.14 vs 0.55 +/- 0.16, p = 0.049; HCTL: 9.66 +/- 3.59 mm vs 7.79 +/- 3.03 mm; p = 0.045) and cerebellar symptoms (CMCR: 0.65 +/- 0.14 vs 0.54 +/- 0.16, p = 0.048; HCTL: 10.4 +/- 3.5 mm vs 7.4 +/- 2.8 mm, p = 0.041), both CMCR and HTCL were significantly different between patients with and without respective findings. However, neither CMCR nor HTCL was different between patients with and without spinal cord symptoms and hydrocephalus. Conclusion: CMCR is a superior numerical parameter than HCTL for the assessment of clinical severity in CM-1 cases and needs further validation with larger studies.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1ac8b76de779994faf0f4a77831b8594Test
https://doi.org/10.1016/j.clineuro.2018.09.016Test

المؤلفون: Douglas Kondziolka, Jason P. Sheehan, Mohana Rao Patibandla, Gautam U. Mehta, Kevin Blas, Georgios A. Zenonos, Brendan J McShane, David Mathieu, Amparo Wolf, Cheng-Chia Lee, L. Dade Lunsford, Chung Jung Lin, John Y K Lee, Inga S. Grills

المصدر: Journal of Neurosurgery. 129:383-389

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Internationality, Ataxia, medicine.medical_treatment, Skull Neoplasms, Gamma knife radiosurgery, Radiosurgery, Meningioma, 03 medical and health sciences, 0302 clinical medicine, Multicenter trial, medicine, Humans, Foramen Magnum, Aged, Retrospective Studies, Aged, 80 and over, Foramen magnum, business.industry, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Surgery, Treatment Outcome, medicine.anatomical_structure, 030220 oncology & carcinogenesis, Radiological weapon, Female, medicine.symptom, business, 030217 neurology & neurosurgery

الوصف: OBJECTIVEMeningiomas are the most common benign extramedullary lesions of the foramen magnum; however, their optimal management remains undefined. Given their location, foramen magnum meningiomas (FMMs) can cause significant morbidity, and complete microsurgical removal can be challenging. Anterior and anterolateral FMMs carry greater risks with surgery, but they comprise the majority of these lesions. As an alternative to resection, stereotactic radiosurgery (SRS) has been used to treat FMMs in small case series. To more clearly define the outcomes of SRS and to delineate a rational management paradigm for these lesions, the authors analyzed the safety and efficacy of SRS for FMM in an international multicenter trial.METHODSSeven medical centers participating in the International Gamma Knife Research Foundation (IGKRF) provided data for this retrospective cohort study. Patients who were treated with Gamma Knife radiosurgery and whose clinical and radiological follow-up was longer than 6 months were eligible for study inclusion. Data from pre- and post-SRS radiological and clinical evaluations were analyzed. Stereotactic radiosurgery treatment variables were recorded.RESULTSFifty-seven patients (39 females and 18 males, with a median age of 64 years) met the study inclusion criteria. Thirty-two percent had undergone prior microsurgical resection. Patients most frequently presented with cranial neuropathy (39%), headache (35%), numbness (32%), and ataxia (30%). Median pre-SRS tumor volume was 2.9 cm3. Median SRS margin dose was 12.5 Gy (range 10–16 Gy). At the last follow-up after SRS, 49% of tumors were stable, 44% had regressed, and 7% had progressed. Progression-free survival rates at 5 and 10 years were each 92%. A greater margin dose was associated with a significantly increased likelihood of tumor regression, with 53% of tumors treated with > 12 Gy regressing. Fifty-two percent of symptomatic patients noted some clinical improvement. Adverse radiation effects were limited to hearing loss and numbness in 1 patient (2%).CONCLUSIONSStereotactic radiosurgery for FMM frequently results in tumor control or tumor regression, as well as symptom improvement. Margin doses > 12 Gy were associated with increased rates of tumor regression. Stereotactic radiosurgery was generally safe and well tolerated. Given its risk-benefit profile, SRS may be particularly useful in the management of small- to moderate-volume anterior and anterolateral FMMs.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0fc9e19008575abb80440ab8fb5376ceTest
https://doi.org/10.3171/2017.3.jns163008Test