Abstract:
OBJECTIVE:Identification of risk factors for perioperative epilepsy remains crucial in the care of patients with meningioma. Moreover, associations of brain invasion with clinical and radiological variables have been largely unexplored. The authors hypothesized that invasion of the cortex and subsequent increased edema facilitate seizures, and they compared radiological data and perioperative seizures in patients with brain-invasive or noninvasive meningioma. METHODS:Correlations of brain invasion with tumor and edema volumes and preoperative and postoperative seizures were analyzed in univariate and multivariate analyses. RESULTS:Totals of 108 (61%) females and 68 (39%) males with a median age of 60 years and harboring totals of 92 (52%) grade I, 79 (45%) grade II, and 5 (3%) grade III tumors were included. Brain invasion was found in 38 (22%) patients and was absent in 138 (78%) patients. The tumors were located at the convexity in 72 (41%) patients, at the falx cerebri in 26 (15%), at the skull base in 69 (39%), in the posterior fossa in 7 (4%), and in the ventricle in 2 (1%); the median tumor and edema volumes were 13.73 cm3 (range 0.81-162.22 cm3) and 1.38 cm3 (range 0.00-355.80 cm3), respectively. As expected, edema volume increased with rising tumor volume (p < 0.001). Brain invasion was independent of tumor volume (p = 0.176) but strongly correlated with edema volume (p < 0.001). The mean edema volume in noninvasive tumors was 33.0 cm3, but in invasive tumors, it was 130.7 cm3 (p = 0.008). The frequency of preoperative seizures was independent of the patients' age, sex, and tumor location; however, the frequency was 32% (n = 12) in patients with invasive meningioma and 15% (n = 21) in those with noninvasive meningioma (p = 0.033). In contrast, the probability of detecting brain invasion microscopically was increased more than 2-fold in patients with a history of preoperative seizures (OR 2.57, 95% CI 1.13-5.88; p = 0.025). In univariate analyses, the rate of preoperative seizures correlated slightly with tumor volume (p = 0.049) but strongly with edema volume (p = 0.014), whereas seizure semiology was found to be independent of brain invasion (p = 0.211). In multivariate analyses adjusted for age, sex, tumor location, tumor and edema volumes, and WHO grade, rising tumor volume (OR 1.02, 95% CI 1.00-1.03; p = 0.042) and especially brain invasion (OR 5.26, 95% CI 1.52-18.15; p = 0.009) were identified as independent predictors of preoperative seizures. Nine (5%) patients developed new seizures within a median follow-up time of 15 months after surgery. Development of postoperative epilepsy was independent of all clinical variables, including Simpson grade (p = 0.133), tumor location (p = 0.936), brain invasion (p = 0.408), and preoperative edema volume (p = 0.081), but was correlated with increasing preoperative tumor volume (p = 0.004). Postoperative seizure-free rates were similar among patients with invasive and those with noninvasive meningioma (p = 0.372). CONCLUSIONS:Brain invasion was identified as a new and strong predictor for preoperative, but not postoperative, seizures. Although also associated with increased peritumoral edema, seizures in patients with invasive meningioma might be facilitated substantially by cortical invasion itself. Consideration of seizures in consultations between the neurosurgeon and neuropathologist can improve the microscopic detection of brain invasion.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Hess K,Spille DC,Adeli A,Sporns PB,Brokinkel C,Grauer O,Mawrin C,Stummer W,Paulus W,Brokinkel Bdoi
10.3171/2017.11.JNS172265subject
Has Abstractpub_date
2018-04-27 00:00:00pages
789-796issue
3eissn
0022-3085issn
1933-0693pii
2017.11.JNS172265journal_volume
130pub_type
杂志文章abstract::OBJECTIVE Many colloid cyst patients present with obstructive hydrocephalus that resolves after resection of the cyst. However, a proportion of patients with these cysts will require cerebrospinal fluid shunting after tumor resection, despite resolution of the obstruction at the foramina of Monro. The goal of this stu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.9.JNS151183
更新日期:2016-09-01 00:00:00
abstract::The effect of intrathecal fibrinolysis on cerebrospinal fluid (CSF) absorption was investigated after experimental subarachnoid hemorrhage (SAH). In 11 cats, SAH was induced by intracisternal application of 1 to 4 ml of fresh autologous blood. Thirty minutes after the experimental SAH, the CSF outflow resistance was f...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1991.74.5.0789
更新日期:1991-05-01 00:00:00
abstract::Tuberous sclerosis complex is a genetic disorder characterized by the development of hamartomas in multiple organs including the brain, skin, eye, kidney, and heart. Neurological features include seizures and mental retardation. Cortical tubers and subependymal nodules are the characteristic intracranial lesions of tu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2005.102.3.0322
更新日期:2005-04-01 00:00:00
abstract::OBJECTIVE Diffusion-weighted MRI was used to assess periprocedural lesion load after repair of unruptured intracranial aneurysms (UIA) by microsurgical clipping (MC) and endovascular coiling (EC). METHODS Patients with UIA were assigned to undergo MC or EC according to interdisciplinary consensus and underwent diffusi...
journal_title:Journal of neurosurgery
pub_type: 临床试验,杂志文章
doi:10.3171/2016.2.JNS152456
更新日期:2017-04-01 00:00:00
abstract:OBJECT:Gamma Knife surgery (GKS) is one of the methods available to treat vestibular schwannomas (VSs), in addition to microsurgical resection; however, clear information regarding balance function outcomes and the impact of treatment on patients' quality of life over time remains an important clinical need. The purpos...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/109/12/S21
更新日期:2008-12-01 00:00:00
abstract::The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.8.JNS16342.test
更新日期:2017-03-17 00:00:00
abstract::The current state of surgery for vestibular schwannomas (VSs) is the result of a century of step-by-step technical progress by groundbreaking surgeons who transformed the procedure from its hazardous infancy and high mortality rate to its current state of safety and low morbidity rate. Harvey Cushing advocated bilater...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/2008.3.17473
更新日期:2009-04-01 00:00:00
abstract::Bilateral trigeminal neuralgia occurred in 32 (11.9%) of 269 consecutive patients who were treated with radiofrequency electrocoagulation (RFE). This is a higher incidence than has been reported before and may be explained by the prospective nature of the present study, the long follow-up period, and the inclusion of ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.67.1.0044
更新日期:1987-07-01 00:00:00
abstract:OBJECT:The authors analyzed tumor control rates and complications in patients with superficially located meningiomas after gamma knife surgery (GKS). METHODS:Between 1998 and 2003, GKS was performed in 23 patients with 26 lesions in whom follow-up imaging for 1 year or more was available. The male/female ratio was 1:2...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.102.s_supplement.0255
更新日期:2005-01-01 00:00:00
abstract:OBJECT:The purpose of this study was to assess the long-term outcome achieved after repeat Gamma Knife surgery (GKS) for trigeminal neuralgia (TN) using a uniform treatment plan. METHODS:Between 1985 and 2010, 53 patients underwent repeat GKS for refractory TN. In the initial GKS, which involved targeting the root ent...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.8.GKS101075
更新日期:2010-12-01 00:00:00
abstract::OBJECTIVERebleeding remains a frequent and catastrophic event leading to poor outcome after subarachnoid hemorrhage (SAH). Reduced platelet function after the initial bleed is associated with higher risk of early rebleeding. Desmopressin (DDAVP) is a well-known hemostatic agent, and recent guidelines already suggest i...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2017.7.JNS17990
更新日期:2018-01-01 00:00:00
abstract::Lumbar cerebrospinal fluid (CSF) pressure and ventricular size were determined in six patients with impairment of cerebral venous outflow caused by either sagittal sinus thrombosis or arteriovenous shunting into the sagittal sinus. None of the patients had enlargement of the ventricular system, but all six had elevate...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0656
更新日期:1980-11-01 00:00:00
abstract::Coccidioidomycosis is an infection originating in the San Joaquim Valley of southern California, but now seen with increasing frequency throughout southern California and the southwestern United States. Central nervous system involvement is usually manifested as meningitis. The authors present the case of a young man ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.80.1.0140
更新日期:1994-01-01 00:00:00
abstract::Experiments were carried out to compare the effectiveness of oncotic and osmotic therapy in dogs with experimental cerebral edema caused by a left parietal cold lesion. Animals were divided into five groups and treated for 6 hours with either crystalloid (control group), or mannitol, albumin, furosemide, or albumin/fu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1984.60.3.0481
更新日期:1984-03-01 00:00:00
abstract:OBJECT:The combined petrosal approach is a suitable technique for the resection of medium-to-large petroclival meningiomas (PCMs). Multiple technical modifications have been reported to increase the surgical corridor, including the method of dural and tentorial opening. The authors describe their method of dural openin...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.11.JNS11985
更新日期:2012-03-01 00:00:00
abstract::A cohort of 514 hospitalized head-injury survivors was identified based on their injury and 448 (87%) of them were followed for 1 year. Comprehensive neurobehavioral testing was performed 1 month and 1 year after injury. The authors developed predictions of six neuropsychological and two psychosocial outcomes 1 year a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.82.5.0764
更新日期:1995-05-01 00:00:00
abstract:OBJECT:Insight may be gained into the physiological mechanisms of deep brain stimulation (DBS) by analyzing local and contralateral subthalamic nucleus (STN) single-unit activity during activation of previously placed DBS electrodes. Special techniques are required to perform such analysis due to the presence of a larg...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.12.JNS102176
更新日期:2012-05-01 00:00:00
abstract::The object of this study was to analyze the pathology of collateral vessels newly induced by indirect bypass surgery for moyamoya disease (MMD). An autopsy analysis was conducted on a 39-year-old woman with MMD who had died of a brainstem infarction. The patient had undergone bilateral indirect bypass surgeries 22 yea...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2015.4.JNS15155
更新日期:2016-05-01 00:00:00
abstract:OBJECT:The angles of arterial bifurcations are governed by principles of work minimization (optimality principle). This determines the relationship between the angle of a bifurcation and the radii of the vessels. Nevertheless, the model is predicated on an absence of significant communication between these branches. Th...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2004.101.1.0108
更新日期:2004-07-01 00:00:00
abstract:OBJECT:Guglielmi detachable coil (GDC) technology is a valuable therapeutic alternative to the surgical treatment of ruptured or incidental intracranial aneurysms. The authors describe their technical and clinical experience in the use of the GDC technique in patients who underwent endovascular occlusion for the treatm...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1999.90.2.0207
更新日期:1999-02-01 00:00:00
abstract::Developmental cysts lined by neuroepithelium are a distinctive form of neural tube dysgenesis. Neuropathological study of fourth ventricular cysts that caused symptomatic hydrocephalus indicated its neuroepithelial origin. The cyst arose from the ventral surface of cerebellar vermis. Evagination of the rhombencephalic...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1977.46.6.0820
更新日期:1977-06-01 00:00:00
abstract:OBJECTIVE:The present study was designed to explore the association between facility type (academic center [AC] vs non-AC), facility volume (high-volume facility [HVF] vs low-volume facility [LVF]), and outcomes of glioblastoma (GBM) treatment. METHODS:Based on the National Cancer Database (NCDB), GBM patients were ca...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2018.10.JNS182247
更新日期:2019-02-15 00:00:00
abstract::A technique of "frameless" stereotaxy that allows real-time intraoperative neurosurgical localization is described. The system is composed of four components: a hand-held probe containing two ultrasonic emitters, a microphone array that is rigidly affixed to the operating table in proximity to the surgical field, hard...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1993.78.3.0510
更新日期:1993-03-01 00:00:00
abstract::The effect of subarachnoid hemorrhage (SAH) on endothelium-dependent vasodilation of the isolated rabbit basilar artery was examined using an isometric tension recording method. The SAH was induced by injecting 5 ml of fresh arterial blood into the cisterna magna. Sixty-two rabbits were separated into four groups acco...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.66.6.0915
更新日期:1987-06-01 00:00:00
abstract::The ability of a single large intravenous dose of the sodium succinate esters of the glucocorticoids methylprednisolone, prednisolone, or hydrocortisone to enhance early neurological recovery after moderate to severe blunt head injury was examined in male CF-1 mice. Unanesthetized mice were restrained and subjected to...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.62.6.0882
更新日期:1985-06-01 00:00:00
abstract::This study was undertaken to confirm the presence of alpha-1-antitrypsin (alpha 1-AT) in human brain tumors and to attempt to elucidate its significance. Seventy-seven consecutive unselected patients with various brain tumors were entered in this study. The alpha 1-AT and alpha 2-macroglobulin contents of the tumor ex...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.67.2.0258
更新日期:1987-08-01 00:00:00
abstract::The authors describe a simple technique that reduces the incidence of retained ventricular catheters and minimizes the risk of life-threatening intraventricular hemorrhage during the removal of an obstructed, adherent ventricular catheter in patients with hydrocephalus. The technique requires no special equipment and ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.6.1101
更新日期:1995-12-01 00:00:00
abstract:OBJECT:Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler-Martin Grades III-V AVMs. METHODS:Seventy-six patients with posterior fossa AVMs tre...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/6/1152
更新日期:2008-06-01 00:00:00
abstract:OBJECT:The severity of neurological impairment following traumatic brain injury (TBI) is exacerbated by several endogenous processes, including hyperglycemia, hypotension, and the generation of glutamate. However, in addition to controlling hyperglycemia, insulin has pleiotropic effects on tissue metabolism, which incl...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2010.4.JNS10263
更新日期:2011-01-01 00:00:00
abstract::OBJECTIVEThe goal of this article is to review the history of surgery for low- and high-grade gliomas located within the insula with particular focus on microsurgical technique, anatomical considerations, survival, and postoperative morbidity.METHODSThe authors reviewed the literature for published reports focused on ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/2018.10.JNS181519
更新日期:2019-01-01 00:00:00