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  • 1
    Electronic Resource
    Electronic Resource
    Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients (1995)
    Springer
    Acta neurochirurgica 136 (1995), S. 117-126 
    Details
    ISSN: 0942-0940
    Keywords: Medulloblastoma ; recurrence ; metastases
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although primary treatment of medulloblastoma is now successful in a high percentage of patients, its secondary manifestations still bear a poor prognosis. Thorough studies of secondary manifestations are therefore pivotal to plan therapeutic approaches for the long-term management of medulloblastoma. Here we describe the incidence of secondary tumour manifestations in 66 patients of a single centre who underwent surgery for medulloblastoma between 1975 and 1990. No patient was excluded due to a poor postoperative course. Thirty-five patients showed evidence of secondary tumour growth. Of these, 17 suffered from local recurrence, and 27 developed metastastatic disease. The median latencies for secondary manifestations were 25 months for local recurrence (n = 17), 11 months for spinal metastases (n = 10), 15 months for supratentorial metastases (n = 8), 8 months for subleptomeningeal dissemination (n = 6), and 23 months for systemic metastases (n = 8). Two patients developed primary metastatic spread to the posterior fossa. Of 8 patients with supratentorial metastases, 6 developed fronto-basal lesions. In our patients, 89% of secondary lesions occurred within less than 3 years after primary diagnosis. 85% of patients with extra-axial tumour spread had been treated with a permanent shunt. Radical tumour resection and radiotherapy with 30 Gy to the neuraxis and 20 Gy boost to the posterior fossa was an important prognostic factor in this series. Patients with additional chemotherapy did not benefit significantly from this treatment. We conclude that optimal management of the primary lesions should aim at (i) total resection, (ii) avoid permanent shunting, and (iii) completion of the radiotherapy with inclusion of the medial frontobasal cisterns in the radiotherapeutic regimen. Our analysis suggests that adequate postoperative screening programmes should consist of 3-monthly scans of the neuraxis in the first three postoperative years and 6-monthly scans thereafter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01410612
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  • 2
    Electronic Resource
    Electronic Resource
    Punctate Midline Myelotomy A New Approach in the Management of Visceral Pain (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 881-883 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Visceral pain; myelotomy; pain pathway.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  Nauta et al. reported on a successful punctate midline myelotomy (PMM) for the treatment of intractable pelvic pain. The authors describe an other case history of a patient with multiple anaplastic carcinomas of the small intestine, peritoneal carcinosis and retroperitoneal lymphomas, suffering from severe visceral pain in the hypo-, meso-, and epigastrium. Nauta's PMM was successfully performed at the Th4 level. Narcotic medication was tapered from 30 mg iv. morphine per hour pre-operatively to 5 mg per hour within 5 days postoperatively. Intensity of pain decreased from 10 to 2–3 on the visual analog scale. Only minor transient side effects appeared and the patient was discharged 5 days postoperatively. The pain reduction was maintained until the patient died from the extended disease five weeks later.  We conclude that punctate midline myelotomy sufficiently controls not only pelvic visceral pain, but also visceral pain generated in the meso- and epigastrium. The findings support the concept of a midline dorsal column visceral pain pathway.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050390
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Staging, scoring and grading of medulloblastoma (1995)
    Springer
    Acta neurochirurgica 132 (1995), S. 59-65 
    Details
    ISSN: 0942-0940
    Keywords: Medulloblastoma ; PNET-PF ; grading ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Although recently survival of some medulloblastoma patients increased remarcably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed. Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method. The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p〈0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p〈0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p〈0.01) or partial resection (p〈0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p〈0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p〈0.01). According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished. The good prognosis group (n=29) showed a significantly better survival (p〈0.05) than the moderate prognosis group (n=26), whereas the moderate prognosis group had a significantly better survival (p〈0.05) than the poor prognosis group (n=11). A Kaplan-Meier survival rate of 62% was found in patients of the good prognosis group, a rate of 22% in the moderate prognosis group, and a rate of 0% in the poor prognosis group. It is concluded that this new staging, scoring and grading system is a simple and recommendable prognostic system for all patients treated surgically for medulloblastoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01404849
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  • 4
    Electronic Resource
    Electronic Resource
    Aneurysm of the posterior inferior cerebellar artery caused by a traumatic perforating artery tear-out mechanism in a child (1999)
    Springer
    Child's nervous system 15 (1999), S. 354-356 
    Details
    ISSN: 1433-0350
    Keywords: Key words Traumatic aneurysm ; Posterior inferior cerebellar artery ; PICA ; Pathomechanism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Traumatic posterior circulation aneurysms in the absence of fractures and penetrating wounds are extremely uncommon, especially in children. To our knowledge this is the first traumatic posterior inferior cerebellar artery(PICA) aneurysm reported that cannot be related to a skull fracture or a trauma caused by the edge of a rigid meningeal structure. In the present case, the initial subarachnoid hemorrhage (SAH) was caused by a perforating artery, originating from the PICA, which was torn out as the result of a deceleration trauma. Such a mechanism explains both the initial SAH and the development of the false aneurysm responsible for the second SAH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050411
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    Paper (German National Licenses)
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