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Saad H, Bray DP, McMahon JT, Philbrick BD, Dawoud RA, Douglas JM, Adeagbo S, Yarmoska SK, Agam M, Chow J, Pradilla G, Olson JJ, Alawieh A, Hoang K. Permanent Cerebrospinal Fluid Diversion in Adults With Posterior Fossa Tumors: Incidence and Predictors. Neurosurgery 2021; 89:987-996. [PMID: 34561703 DOI: 10.1093/neuros/nyab341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Posterior fossa tumors (PFTs) can cause hydrocephalus. Hydrocephalus can persist despite resection of PFTs in a subset of patients requiring permanent cerebrospinal fluid (CSF) diversion. Characteristics of this patient subset are not well defined. OBJECTIVE To define preoperative and postoperative variables that predict the need for postoperative CSF diversion in adult patients with PFTs. METHODS We surveyed the CNS (Central Nervous System) Tumor Outcomes Registry at Emory (CTORE) for patients who underwent PFT resection at 3 tertiary-care centers between 2006 and 2019. Demographic, radiographic, perioperative, and dispositional data were analyzed using univariate and multivariate models. RESULTS We included 617 patients undergoing PFT resection for intra-axial (57%) or extra-axial (43%) lesions. Gross total resection was achieved in 62% of resections. Approximately 13% of patients required permanent CSF diversion/shunting. Only 31.5% of patients who required pre- or intraop external ventricular drain (EVD) placement needed permanent CSF diversion. On logistic regression, size, transependymal flow, use of perioperative EVD, postoperative intraventricular hemorrhage (IVH), and surgical complications were predictors of permanent CSF diversion. Preoperative tumor size was only independent predictor of postoperative shunting in patients with subtotal resection. In patients with intra-axial tumors, transependymal flow (P = .014), postoperative IVH (P = .001), surgical complications (P = .013), and extent of resection (P = .03) predicted need for shunting. In extra-axial tumors, surgical complications were the major predictor (P = .022). CONCLUSION Our study demonstrates that presence of preoperative hydrocephalus in patients with PFT does not necessarily entail the need for permanent CSF diversion. We report the major predictive factors for needing permanent CSF diversion.
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Affiliation(s)
- Hassan Saad
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - David P Bray
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | | | - Reem A Dawoud
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Segun Adeagbo
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | | | - Matthew Agam
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jocelyn Chow
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ali Alawieh
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Kimberly Hoang
- Department of Neurosurgery, School of Medicine, Emory University, Atlanta, Georgia, USA
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Park HH, Roh TH, Choi S, Yoo J, Kim WH, Jung IH, Yun IS, Hong CK. Endoscopic Transorbital Approach to Mesial Temporal Lobe for Intra-Axial Lesions: Cadaveric Study and Case Series (SevEN-008). Oper Neurosurg (Hagerstown) 2021; 21:E506-E515. [PMID: 34528091 DOI: 10.1093/ons/opab319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/18/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Endoscopic transorbital approach (ETOA) has been proposed as a minimally invasive technique for the treatment of skull base lesions located around mesial temporal lobe (MTL), mostly extra-axial pathology. OBJECTIVE To explore the feasibility of ETOA in accessing intraparenchymal MTL with cadaveric specimens and describe our initial clinical experience of ETOA for intra-axial lesions in MTL. METHODS Anatomic dissections were performed in 4 adult cadaveric heads using a 0° endoscope. First, a stepwise anatomical investigation of ETOA to intraparenchymal MTL was explored. Then, ETOA was applied clinically for 7 patients with intra-axial lesions in MTL, predominantly high-grade gliomas (HGGs) and low-grade gliomas (LGGs). RESULTS The extradural stage of ETOA entailed a superior eyelid incision followed by orbital retraction, drilling of orbital roof, greater and lesser wing of sphenoid bone, and cutting of the meningo-orbital band. For the intradural stage, the brain tissue medial to the occipito-temporal gyrus was aspirated until the temporal horn was opened. The structures of MTL could be aspirated selectively in a subpial manner without injury to the neurovascular structures of the ambient and sylvian cisterns, and the lateral neocortex. After cadaveric validation, ETOA was successfully performed for 4 patients with HGGs and 3 patients with LGGs. Gross total resection was achieved in 6 patients (85.7%) without significant surgical morbidities including visual field deficits. CONCLUSION ETOA provides a logical line of access for intra-axial lesions in MTL. The safe and natural surgical trajectory of ETOA can spare brain retraction, neurovascular injury, and disruption of the lateral neocortex.
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Affiliation(s)
- Hun Ho Park
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Tae Hoon Roh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seonah Choi
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jihwan Yoo
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Woo Hyun Kim
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Ho Jung
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - In-Sik Yun
- Department of Plastic surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery , Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.,Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Shtaya A, Dabbous B, Fanou E, Bridges L, Hettige S. Unusual Intraparenchymal Pontomedullary Epidermoid Cyst in a 2-Year-Old Child: A Case Report and Review of the Literature. World Neurosurg 2017; 104:1046.e15-1046.e20. [PMID: 28529053 DOI: 10.1016/j.wneu.2017.04.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intrinsic brainstem epidermoid cysts are rare, benign, slow-growing lesions. Their eloquence precludes complete excision; however, subtotal resection often will result in prolonged or sometimes permanent relief of presenting symptoms and signs. We describe an unusual case and review the literature of this pathology in the pediatric population. CASE DESCRIPTION We report an intra-axial pontine epidermoid cyst in a 2-year-old girl who presented with developmental delay, multiple cranial nerve palsies, and pneumonia. Magnetic resonance imaging demonstrated an intrinsic pontine lesion with partial restricted diffusion and an enhancing plaque, the latter not typically seen in congenital lesions like epidermoid. However, gross surgical inspection and histopathology confirmed an epidermoid. CONCLUSIONS Our case, supported by the literature, shows that brain stem epidermoid cysts may have atypical radiologic characteristics and that near-total resection remains safe and can improve outcome.
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Affiliation(s)
- Anan Shtaya
- Academic Neurosurgery Unit, St George's, University of London, London; Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom.
| | - Bassam Dabbous
- Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom
| | - Evgenia Fanou
- Department of Neuroradiology, St George's University Hospital, London, United Kingdom
| | - Leslie Bridges
- Department of Cellular Pathology, St George's University Hospital, London, United Kingdom
| | - Samantha Hettige
- Department of Neurosurgery, Atkinson Morley Wing, St George's University Hospital, London, United Kingdom
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