Biomedical subjects

Diana Freed

Publications and source records attributed to Diana Freed.

5 recordsLinked to original sources

PubMed2006

Clinical presentation and optimal management for intramedullary cavernous malformations.

OBJECT: Intramedullary cavernous malformations (CMs) account for approximately 5% of all intraspinal lesions. The purpose of this study was to define the spectrum of presentation for spinal intramedullary CMs and the results of microsurgery for these benign but clinically progressive lesions. METHODS: Retrospective chart review was performed in 26 patients with histologically diagnosed CMs. All patients had undergone preoperative magnetic resonance (MR) imaging studies. All patients were treated with a laminectomy and microsurgical resection of the malformation. CONCLUSIONS: The MR imaging findings are diagnostic for intramedullary CMs; these lesions abut a pial surface and have a characteristic imaging pattern. Spinal intramedullary CMs present with either an acute onset of neurological compromise or a slowly progressive neurological decline. Acute neurological decline occurs secondary to hemorrhage inside the spinal cord. Chronic progressive myelopathy occurs due to microhemorrhages and resulting gliotic reaction to blood products. Surgery and total removal of the lesion tends to halt progression of symptoms.

Adolescent↗

PubMed2005

Spinal solitary fibrous tumors: a series of four patients: case report.

OBJECTIVE AND IMPORTANCE: Intraspinal solitary fibrous tumors, which are rare mesenchymal tumors, have previously been reported as case reports. We review our experience and, to our knowledge, the first small institutional series with respect to clinical presentation, diagnosis, surgical management, pathohistological analysis, progression-free survival, and long-term outcome. CLINICAL PRESENTATION: In this retrospective review, four patients (three male and one female) ranging in age from 17 to 59 years (mean, 38.5 yr) had spinal solitary fibromas located throughout the spinal canal. Three tumors were located in the thoracic region and one in the cervical spine. All patients presented with pain and paresthesia. Two patients had an associated spinal deformity. All had gross total resection as confirmed by postoperative imaging studies. INTERVENTION: All four patients underwent surgical treatment for spinal solitary fibromas. None of these patients underwent irradiation or chemotherapy after surgery at our center; therefore, outcome was attributed to surgery alone. There were no surgical deaths, and the 5-year actuarial survival rate was 100%. At the most recent follow-up examination, neurological function was stable or improved in 90% of patients. CONCLUSION: Patients with solitary fibrous tumors have a long survival. These tumors have an indolent course, and radiotherapy or chemotherapy seems to be unnecessary.

Adolescent↗

PubMed2004

Spinal cord gangliogliomas: a review of 56 patients.

There have been only case reports concerning the management of intramedullary spinal cord gangliogliomas. We review our experience of 56 patients with respect to functional status, progression-free survival and long-term outcome. In this retrospective review, 56 patients, 35 males and 21 females ranging in age from 7 months to 25 years (mean, 7.0 y), underwent surgical treatment for intramedullary gangliogliomas located throughout the spinal cord. Forty-six patients had gross total resection as confirmed by postoperative imaging studies, and 10 had radical subtotal resection. Only five patients underwent postoperative irradiation or chemotherapy after surgery at our center and therefore outcome was attributed to surgery alone. There were no operative deaths, and the 5-year actuarial survival rate was 88%. The progression-free survival rate at 5 years was 67%. Neurological function in the surviving patients at recent follow-up evaluation was stable or improved in 72%. Patients have a long survival following radical surgery. These tumors have an indolent course, and radiotherapy appears to be unnecessary.

Adolescent↗

PubMed2003

Brainstem gliomas.

INTRODUCTION: Brainstem gliomas have historically been one of the most difficult pediatric cancers to treat. Tumors arising in the brainstem were once uniformly discounted as surgically unresectable lesions. Early neurosurgeons thought this location to be inoperable and fraught with disaster. The advent of computed tomography (CT), magnetic resonance imaging (MRI), and sophisticated neurophysiological monitoring techniques have significantly advanced the surgical treatment of these precarious lesions. REVIEW: Brainstem gliomas are now recognized as a heterogenous group of tumors. They have been broadly classified into several categories depending upon the classification scheme. All these classification systems provide a framework to predict growth patterns, surgical resectability, and overall prognosis of these tumors. These systems allow the surgeon to obtain a better understanding of the distinction between low-grade tumors and diffuse inoperable tumor types. The authors review the current literature and management of brainstem tumors.

Brain Stem↗

PubMed2003

Intramedullary spinal cord tumors in children.

INTRODUCTION: Pediatric intramedullary spinal cord tumors are rare and make up only a small percentage of all central nervous system neoplasms. DISCUSSION: These neoplasms are predominantly benign histologically, regardless of size, with a large percentage being astrocytomas or gangliogliomas. Ependymomas, which are common in adults, are relatively uncommon in children. Contemporary management of these tumors has generated much controversy. These neoplasms occur primarily in the cervical region, with pain or a motor deficit as the chief complaint. Surgery on these neoplasms can safely be performed using modern surgical adjuncts such as the ultrasonic aspirator, contact laser and neurophysiological monitoring. A radical resection of these tumors results in a good long-term outcome, since the majority are histologically benign. Adjuvant radiation therapy should only be administered for high-grade or malignant tumors. CONCLUSION: The majority of spinal cord tumors are benign; however, malignant tumors have a dismal outcome and surgery in these children should be limited to a conservative debulking. An attempt should be made for radical surgery in hope of avoiding radiation and chemotherapy for the benign tumors. Spinal deformity is a concern in these patients since 35% of children may require a stabilization procedure.

Adolescent↗